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.
【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.
目的:探讨带膜支架腔内隔绝术治疗B型主动脉夹层的技术方法及疗效。方法:对近年我院收治的40例主动脉夹层进行分析。40例患者均行股动脉穿刺插管至升主动脉造影，了解主动脉真假腔、夹层裂口及其与重要血管分支位置关系。切开右或左侧股动脉置入覆膜血管内支架，封堵原发破口，置入支架后重复造影检查。观察真假腔血流变化、主动脉分支供血的情况。结果:40例患者支架置入定位准确，术后即刻造影显示真腔血流恢复正常。手术成功率100%，无术中转开胸手术，无截瘫及瘤体破裂等严重并发症，无围手术期死亡。所有患者术后3～6个月复查增强CT，假腔不再显影，支架通畅，无扭曲、移位。结论:带膜支架腔内隔绝术治疗B型主动脉夹层具有创伤小，术后恢复快，手术死亡率低，手术成功率高的优点，但远期效果有待进一步观察。
目的探讨介入治疗在肝外伤术后胆道出血和胆瘘并发症中的作用。方法6例肝外伤术后胆道并发症（胆道出血1例，胆瘘3例，胆道出血合并胆瘘2例）采用介入治疗。胆道出血行肝动脉出血分支血管栓塞，胆瘘采用B超引导下穿刺置管引流。结果3 例胆道出血（肝动脉出血）血管成功栓塞，随访3~6个月未再发生出血。5例胆瘘行B超引导下穿刺置管引流，3例引流3~4周痊愈，1例因引流效果差改手术置管引流6周痊愈，1例伴脓肿者手术置管引流2个半月痊愈。结论介入治疗是处理胆道出血和胆瘘并发症的有效措施。
目的分析比较肝血管瘤不同栓塞剂的栓塞治疗结果，寻找更为理想、合理的方法。方法对12例肝血管瘤16例次经皮穿刺超选择性肝动脉插管行栓塞治疗，其中单纯碘化油栓塞2例次，碘化油+明胶海绵颗粒栓塞6例次，碘化油+聚乙烯醇（PVA）微球栓塞5 例次，碘化油+平阳霉素栓塞3例次。随访10~32个月。结果全部病例均取得较肯定的疗效，无并发症发生。碘化油+平阳霉素和碘化油+PVA微球两种方法疗效稳定，复发率低，优于前两种方法。结论肝动脉栓塞治疗肝血管瘤疗效肯定，几种栓塞剂中，碘化油+平阳霉素及碘化油+PVA微球最佳。
T lymphocyte acid α-naphthl acetate esterase (Tc-ANAE) activity was measured in 23 pathologically proved gastric cancer patients before and after surgical intervention. The result showed that interventional treatment obviously decreased the Tc-ANAE activity in patients with gastric cancer (Ｐ＜0.01), especially decreased the immune function in late stage cases (stage Ⅳ) (Ｐ＜0.01), the more advanced the cancer was, the more impaired the immune function was. Interventional treatment had no influence on immune function in earlier stages (Ｐ＞0.05).