Objective To investigate the clinical characteristics and treatment for Type II pulmonary vascular anomaly ( pulmonary arteriovenous malformations) of hepatopulmonary syndrome ( HPS)presenting with hemothorax. Methods A case of Type II pulmonary vascular anomaly of HPS presenting with recurrent hemothorax was described. The clinical data was analyzed and the related literature was reviewed. Results A 72-year-old male patient with Type II pulmonary vascular dilatations of HPS was described to present with recurrent dyspnea and encapsulated pleural effusions. After 4 procedures of thoracentesis, a total of 2510 mL of bloody pleural effusions was drained. The routine analysis of pleural fluid showed the count of red cells exceeded 100 ×109 / L, whereas cytologic examination and tumor biomarkers were negative. Then CTPA and pulmonary angiogramrevealed a Type II pulmonary vascular anomaly of HPS combined with hemothorax. The PaO2 of arterial blood in upright and supine position was 58. 3 mm Hg and 66. 3 mm Hg, respectively. Hypoxemia was alleviated and hemothorax was controlled after embolization of malformed blood vessels. Fromliterature review, similar cases of hemothorax resulted fromrupture of Type II pulmonary vascular anomaly of HPS were not reported. The primary clinical manifestations of HPS were dyspnea and cyanosis. Orthodeoxia and platypnea were most consistent with HPS. The best screening tool for hypoxemia in patients with HPS was P( A-a) O2. The characteristic findings of HPS on chest CT was a lesion or reticulonodular opacities occurring predominantly in the bases of the lungs, which could be enhanced by contrast medium. Pulmonary angiogram was necessary to identify the types of pulmonary vascular dilatations. Hepoxemia of patients with Type II HPS often responded poorly to oxygen therapy, whereas embolization of the pulmonary arteriovenous fistulas was helpful to improve anoxia. Conclusions Rupture ofType II pulmonary vascular malformations in HPS was a rare cause of hemothorax. Thrombosis of pulmonary arteriovenous malformations may result in significant improvement in oxygen saturations as well as control of hemothorax. In the setting of liver disease, intrapulmonary vascular dilatations and hypoxemia often suggestthe existence of HPS.
摘要:目的: 评估手术、栓塞及γ刀综合治疗脑动静脉畸形的疗效。 方法 :回顾性分析了我科自2002年3月至2009年7月期间综合治疗的43例脑AVM患者,分析评估这43例脑AVM的临床特点及治疗效果,随访患者并对其进行GOS评分。 结果 :本组病例采取栓塞＋手术治疗3例、栓塞＋γ刀治疗26例、手术＋γ刀治疗11例、栓塞+手术＋γ刀治疗3例。术后随访28例,随访时间4月至7年6月,GOS评分5分者25例,患者均能重新回到工作或学校;GOS评分4分者2例,患者生活能够自理;GOS评分1分者1例,患者死亡。 结论 :对大型、功能区、有深部静脉引流的脑AVM综合治疗有一定的优越性,它不仅使脑AVM治愈率明显提高,而且与治疗相关的各种并发症和病死率也明显降低。Abstract: Objective: To evaluate the efficacy of multimodality treatment of cerebral arteriovenous malformations(AVMs) with surgery, embolization and γknife radiation. Methods : A retrospective analysis of 43 cases of cerebral AVMs applied with multimodality treatment in our department From March 2002 to July 2009 has been made, meanwhile we have analyzed and assessed the clinical characteristics and treatment outcome of these 43 patients with cerebral AVMs. Results : Patients received multimodality treatment with embolization followed by surgery(n=3), embolization followed by γknife radiation(n=26), surgery followed by γknife radiation(n=11), or embolization, surgery, and γknife radiation(n=3). Postoperative followup of 28 cases, the followup time is 4 months to 7 years and 6 months. GOS score 5 in 25 cases, who can be able to return to work or school. GOS score 4 in 2 cases, who can be able to live independently. GOS score 1 in 1 case, who is dead. Conclusion : In the cerebral AVMs which are large, or located within or immediately adjacent to eloquent regions of the brain, or have deep venous drainage, multimodality treatment has some superiority. It can not only improve the cure rate of cerebral AVMs significantly, but also reduce the treatmentrelated complications and mortality.
【摘要】 目的 探讨颅内动静脉畸形切除术中彩色多普勒超声检查的应用价值与预后的关系。 方法 在显微外科手术的基础上，将65例动脑静脉畸形患者随机分为A、B两组， A组34例动静脉畸形患者在术中接受术中超声检查，确定其畸形血管团的数目、位置、深度、大小、范围及其与周边组织结构的关系，探查供血动脉及引流静脉的数目及走行，以确定动、静脉畸形的位置、手术切除范围及切除术后是否有畸形血管残留；B组31例行常规手术，比较两组之间的差异。 结果 术中彩色多普勒超声能清晰的显示动静脉畸形的情况，两组经手术完整切除动静脉畸形率、再出血率、术后7 d Glasgow昏迷评分及预后差异均有统计学意义（Plt;0.05）。 结论 术中实时彩色多普勒超声能对脑动静脉畸形准确定位，并可判定脑动静脉畸形的血供模式及残余情况，减少脑组织损伤及降低手术并发症的发生，提高了手术安全性及治疗效果。【Abstract】 Objective To explore the application of the colored Doppler ultrasonography in the excision of intracranial arteriovenous malformation (AVM) to determine the location of the lesion and the completeness of the resection, and to evaluate the clinical value of intraoperative ultrasonography in the diagnosis, treatment and the relation to the prognosis of patients. Methods A total of 65 patients with brain AVM were randomly divided into group A and B. The microsurgery was perfromed on the patients. Intraoperative ultrasound was performed on the 34 patients in group A to the numbers, location, depth,size of different malformation vascular clumps relationship of the arteriovenous malformation with surrounding tissues. While the pateints in group B underwent the routine surgery. The difference between the two groups were compared. Results The condition of the AVM were clearly revealed by intraoperative ultrasonography. All of the intracranial AVM in group A were completely removed. The difference in rehaemorrhagia and postoperative Glasgow coma scale score of seven day between the two groups were statistically significant (Plt;0.05). Conclusions Intraoperative color Doppler ultrasounography in the resection of intracranial AVM could accurate localize the lesions, identify vascular anatomy of the AVM vascular balls and the completeness of resection. The parameters including resistance index of the vessels may identify the abnormal vessels and reduce the operative complications and brain tissue damage, which improve the safety and efficacy of the therapeutic effect.
Both Dyna CT, a rotational faultage reconstructed technique, and digital subtraction angiography (DSA) play important roles in the diagnosis and treatment of arteriovenous malformations (AVM). Three-dimensional Dyna CT can provide the spatial information of AVM nidus, while two-dimensional DSA can provide the time information for distinguishing arteries and veins. To illustrate the location relationship of the nidus, arteries and veins at the same time, these two imaging modalities need to be fused. In this paper, a two-dimensional to three-dimensional back projection and growing method is proposed, which realizes the image fusion of two-dimensional DSA and three-dimensional Dyna CT and achieves the differentiation of arteries and veins in Dyna CT. The experimental results showed that the fusion image could present both the position information of AVM nidus and the dynamic information of the blood vessels. Therefore, the proposed method can help surgeons locate the AVM abnormality and make operation plan more accurately.
摘要:目的: 探讨脊髓动静脉畸形患者科学的围手术期护理方法。 方法 :对31例脊髓动静脉畸形围术期患者进行了科学的护理,即心理,术前、术后以及特殊症状护理,并分析护理效果。 结果 :31例患者中治愈27例,好转4例。 结论 :脊髓动静脉畸形手术难度大,危险性高,科学的围手术期护理是促进治疗效果的重要保证。Abstract: Objective: To discuss the effectiveness of scientific perioperative nursing for the patients with spinal arteriovenous malformations. Methods : 31 patients with spinal arteriovenous malformations had got nursing, such as psychology nursing and special perioperative symptoms. The nursing effective is analysed. Results : 27 cases are cured and the other 4 cases improved. Conclusion : Spinal arteriovenous malformations is difficult and dangerous for operation.The scientific perioperative nursing is important guarantee for advancing the cure effective.
Objective To investigate the imaging features of idiopathic hepatic arteriovenous malformation（IHAVM） on multi-detector row spiral CT (MDCT) and magnetic resonance imaging (MRI). Methods Nineteen patients with IHAVM between January 2009 and June 2010 were included for retrospective analysis of the imaging findings on MDCT (n=9) and MRI (n=10), especially the imaging features of IHAVM on contrast-enhanced dynamic scans. Results All IHAVM lesions in 9 patients were isodense in plain scan of MDCT, and showed marked small nodular or linear enhancement with similar intensity to vascular enhancement in arterial phase, and the enhancement continued to persist to portal phase but with reduced enhancement degree. Early visualization of venous tributaries in arterial phase was present in 4 cases, and wedge-shaped or lamellar transient hepatic parenchyma enhancement in arterial phase in the edge of the lesion was observed in 6 cases. In 10 patients with MRI scan, the enhancement patterns of IHAVM were quite similar to the findings on MDCT, with early visualization of venous tributaries in arterial phase in 5 cases and wedge-shaped transient hepatic parenchyma enhancement in arterial phase in the edge of the IHAVM lesion in 7 cases. Conclusion Contrast-enhanced multi-phase MDCT and MRI scans can depict the morphologic and hemodynamic characteristics of IHAVM, thus they are very valuable for the diagnosis of IHAVM.