Objective To formulate an individualized evidence-based treatment for a first-diagnosed patient with coronary artery-pulmonary artery fistula. Methods Aiming at the issue of whether interventional operation was necessary for first-diagnosed coronary artery-pulmonary artery fistula or not, the computer retrieval was conducted in the US National Guideline Clearinghouse, The Cochrane Library, PubMed and MEDLINE from 1990 to 2011, to collect and assess the best evidence of relevant systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines, in order to be applied in clinical treatment. Results There were 1 clinical guideline for treating coronary artery fistula and 3 different high-quality evidence studies were retrieved. The results showed percutaneous coronary intervention was the best treatment currently. According to the obtained evidence and patient’s willingness, the relevant examinations were taken, and the preoperative preparation for percutaneous coronary intervention was done actively after the patient was admitted. Three days after hospitalization, the selective coronary angiography showed right coronary artery-pulmonary artery fistula and left coronary circumflexus artery-left atrial multiple fistulae, then the percutaneous coronary intervention spring coil embolization was successfully conducted for right coronary artery-pulmonary artery fistula. After operation, bayasprin enteric-coated tablets 0.1 g/d was taken for anti-platelet aggregation and preventing thrombotic diseases. The observation during operation and postoperative 5-day hospitalization showed no relevant complications. Conclusion Percutaneous coronary intervention is safe and effective for the symptomatic patients with coronary artery-pulmonary artery fistula.
Objective To evaluate the trends, dominant diseases and clinical outcomes of the global interventional therapy for tumors based on evidence, so as to provide references for standard access of interventional technology. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI and VIP were electronically and comprehensively searched for relevant clinical or fundamental studies about interventional therapy for tumors from inception to September, 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria and extracted data. Then, descriptive analysis was performed using SPSS 13.0 and Microsoft Excel 2003 software. Results Totally, 4 544 studies were included, consisting of 4 136 (91.0%) clinical studies and 408 (9.0%) fundamental studies. These clinical studies including 155 systematic reviews (SRs), 338 randomized controlled trials (RCTs), 1 191 clinical controlled trials (CCTs), and 2 451 case series or case reports (CSs/CRs). Transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) were the most clinically frequenly-used interventional technologies for tumors, accounting for 32.6% and 17.1% of the total, respectively. Hepatocellular carcinoma (HCC) was the dominant tumor, which was mentioned in 99 SRs (57.6%), 198 RCTs (58.6%), 824 CCTs (69.1%) and 1 191 CSs/CRs (48.6%), following by colorectal liver metastases (CLM). Radiofrequency ablation (RFA) treating HCC resulted in a higher rate of 3-year survival (12 SRs/Meta-analyses) and lower recurrence (10 SRs/Meta-analyses) compared with percutaneous ethanol injection (PEI). Compared with hepatic resection (HR), RFA treating HCC resulted in lower rates of 3-year (11 SRs/Meta-analyses) and 5-year survival (9 SRs/Meta-analyses), and no significant difference was found in 1-year survival between the two groups (17 SRs/Meta-analyses). Preoperative TACE before HR or liver transplantation could not improve the survival for patients with advanced HCC (6 SRs/Meta-analyses), but postoperative TACE might prolong the 1-and 3-year survival (3 SRs/Meta-analyses). TACE combined with other interventional therapy (i.e., RFA, PEI) could also prolong the survival of HCC patients. For the treatment of uterine leiomyoma, uterine artery embolization (UAE) resulted in less hospital duration or operative time, and it caused a higher re-intervention rate, compared with surgery, but it lacked long-term outcomes. Conclusion Interventional therapy is an optional and promising technology for patients with tumors. We should well-consider currently available best clinical evidence as well as local medical facilities or skill level when applying them to clinical practice, so as to perform relevant interventional techniques with scientific, rational and standardized methods.
Objective To systematically review the effectiveness and safety of intracoronary glycoprotein IIb/IIIa inhibitors (GPIs) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) compared with intravenous administration. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 9, 2012), Ovid, CBM, CNKI and VIP were electronically searched for randomized controlled trials (RCTs) about intracoronary GPIs administration versus intravenous administration undergoing PCI for ACS from inception to September 30th, 2012. Meanwhile, domestic relevant papers published in recent 1 year were also retrieved manually. References of the included studies were retrieved, too. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed the methodologically quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results 10 RCTs involving 3 553 ACS patients were finally included. The results of meta-analysis showed that: compared with intravenous administration, intracoronary GPIs administration decreased the major adverse cardiovascular event (MACE) (OR=0.54, 95%CI 0.34 to 0.85, P=0.008). The incidences of re-infarction (MI), revascularization (TVR) and heart failure were (OR=0.62, 95%CI 0.39 to 0.97, P=0.04), (OR=0.59, 95%CI 0.36 to 0.97, P=0.04), (OR=0.52, 95%CI 0.32 to 0.84, P=0.008), respectively. But for the mortality, there were no significant differences between the two groups (OR=0.81, 95%CI 0.58 to 1.14, P=0.23). Intravenous administration and intracoronary administration were alike in the incidences of mild/serious bleeding (mild: OR=0.94, 95%CI 0.75 to 1.19, P=0.63; serious: OR=1.18, 95%CI 0.76, 1.84, P=0.47). Conclusion Compared with routine GPIs regimen of intravenous bolus, intracoronary administration with initial dosage showed significant benefits in clinical outcomes in ACS patients undergoing PCI, which could not increase the incidence of bleeding.
目的 评价选择性介入治疗在原发性肝癌（HCC）门脉高压症中的应用价值。 方法 2008年11月－2011年3月，收治65例临床明确诊断的HCC伴门脉高压症患者，选择性使用肝动脉化学疗法（化疗）栓塞术、脾栓塞术、门静脉化疗栓塞术、门静脉支架、胃冠状静脉栓塞术等介入术式，术后通过观察临床指标、定期复查影像检查等了解病变转归，随访生存期并评价疗效。 结果 65例HCC患者均合并不同程度门静脉高压，其中门静脉癌栓46例中有37例显示肝动脉-门静脉分流，通过肝动脉及门静脉化疗栓塞术进行主瘤体及癌栓治疗。11例行门静脉支架置入术，支架置入后门静脉压较术前明显下降（P＜0.01），支架中位通畅时间为5.8个月。39例行胃冠状静脉和（或）胃短静脉栓塞术，术后有4例再次发生门脉高压性出血，再出血率10.26%。18例行脾动脉栓塞术，术后3个月血小板较术前显著升高（P＜0.01）。随访术后3、6、12及24个月的生存率分别为90.77%、69.23%、35.38%及13.85%。 结论 选择性联合使用各种介入术式是治疗HCC及其相关性门脉高压症的一种有效方法，可有效预防高危风险，延长患者生存期。
【摘要】 目的 探讨2型糖尿病合并下肢血管病变血管内介入治疗的临床意义。 方法 2009年1-5月对4例2型糖尿病合并下肢血管病变患者，根据血管狭窄情况选择不同介入治疗方式，行下肢动脉造影及动脉球囊扩张或支架成形术。 结果 4例患者均有表现静息痛及间歇性跛行，下肢血管超声显示糖尿病下肢动脉有不同程度的斑块、狭窄与血栓形成，病变累及下肢股动脉、髂动脉及胫前、足背动脉。介入治疗后患者下肢血管灌注得到明显改善，静息痛及间歇性跛行明显改善，皮温改善，需要截肢患者截肢平面显著降低。 结论 通过下肢血管DSA造影检查，准确了解糖尿病患者下肢血管的阻塞部位及程度，在保守治疗基础上选择不同方式的介入治疗，有助于下肢血管病变的明显改善。【Abstract】 Objective To investigate the clinical significance of intervention therapy for patients with type 2 diabetes combined with vascular lesions of lower extremities. Methods From January to May, 2009, four diabetic patients with vascular lesions of lower extremities were examined by Doppler ultrasonography and digital subtration angiography (DSA). All patients were treated by percutaneous transluminal angioplasty (PTA) or stenting therapy. Results Stenoses and obstruction of lower extremity blood vessels were observed in all patients. After intervention therapy, vascular perfusion of lower extremities was improved and signs of rest pain and intermittent claudication were relieved; the skin temperature was improved, and the amputation level was apparently decreased. Conclusion It suggests that DSA is effective in judging extend and location of blood vessel stenosis,and the interventional treatment could lead to a satisfying prognosis.