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Ａ　ＣＯＭＢＩＮＥＤ　ＴＲＥＡＴＭＥＮＴ　ＦＯＲ　ＳＥＣＯＮＤＡＲＹ　ＨＥＰＡＴＩＣ　ＣＡＲＣＩＮＯＭA

Ｄｕｒｉｎｇ　ｔｈｅ　ｐａｓｔ　５４　ｍｏｎｔｈｓ　ａ　ｔｏｔａｌ　ｏｆ　２４　ｐａｔｉｅｎｔｓ　ｗｉｔｈ　ｓｅｃｏｎｄａｒｙ　ｈｅｐａｔｉｃ　ｃａｒｃｉｎｏｍａ　ｈａｖｅ　ｂｅｅｎ　ｔｒｅａｔｅｄ　ｂｙ　　ｒｅｓｅｃｔｉｏｎ　ｏｆ　ｈｅｐａｔｉｃ　ｍｅｔａｓｔａｓｉｓ　ａｎｄ　ｐｏｓｔｏｐｅｒａｔｉｏｎ　ｐｅｒｃｕｔａｎｅｏｕｓ　ｉｎｔｒａｈｅｐａｔｏｐｏｒｔａｌ　ｃｈｅｍｏｔｈｅｒａｐｙ（ＰＨＰＣ）　ｕｎｄｅｒ　ｕｌｔｒａｓｏｕｎｄ　ｇｕｉｄａｎｃｅ Ａ　ｆｏｌｌｏｗｕｐ　ｆｒｏｍ　ｆｉｖｅ　ｍｏｎｔｈｓ　ｔｏ　ｆｏｕｒ　ｙｅａｒｓ　ｓｈｏｗｓ　ｔｈａｔ　２１　ｐａｔｉｅｎｔｓ　ｈａｖｅ　ｓｕｒｖｉｖｄｅ　ｆｏｒ　５　ｔｏ　４８　ｍｏｎｔｈｓ　ｅｘｃｅｐｔ　３　ｅｘｔｒｅｍｅｌｙ　ａｄｖａｎｃｅｄ　ｃａｓｅｓ．　Ｔｈｅ　ａｕｔｈｏｒｓ　ｓｕｇｇｅｓｔ　ｔｈａｔ　ａ　ｃｏｍｂｉｎｅｄ　ｔｈｅｒａｐｅｕｔｉｃ　ｍｅｔｈｏｄ　ｆｏｒ　ｔｒｅａｔｉｎｇ　ｓｅｃｏｎｄａｒｙ　ｈｅｐａｔｉｃ　ｃａｒｃｉｎｏｍａ　ｉｓ　ｍｏｒｅ　ｅｆｆｅｃｔｉｖｅ　ｔｈａｎ　ｅｉｔｈｅｒ　ｓｉｍｐｌｅ　ｈｅｐａｔｅｃｔｏｍｙ　ｏｒ　ｃｈｅｍｏｔｈｅｒａｐｙ．

Value of Ultrasound-Guided Trans-Hepatic Bile Tract Exploration in Treatment of Hepatolithiasis

目的 探討與評價術中B超定位下經肝膽管取石在肝內膽管結石治療中的手術指征及優劣性。方法 總結2002～2006 年29例肝內膽管結石行肝葉切除+經肝膽管取石患者的臨床資料,對其手術效果及并發癥進行分析。結果 無膽管損傷及手術死亡病例, 并發癥發生率為37.93%，殘石率為10.34%。結論 術中B超定位下經肝膽管取石結合肝葉切除對肝內膽管結石是一種較好的治療方式，主要適用于Ⅱb型肝內膽管結石患者。

Effect of B Ultrasound-Guided Percutaneous Catheter Drainage Combined with Veno-Venous Hemofiltration at Different Time Points and Multi-Site in Treatment of Hyperlipidemic Severe Acute Pancreatitis

ObjectiveTo investigate the therapeutic effect of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site in treatment of hyperlipidemic severe acute pancreatitis (HL-SAP). MethodsThe clinical data of 34 patients with HL-SAP initially underwent B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site from January 2010 to June 2014 were retrospectively analyzed. According to the different of the onset to treatment time, 34 cases were divided into the≤24 h group and > 24 h group. The serum platelet activating factor (PAF) and triglyceride (TG) at the time of admission and after admission 1, 3, 5, 7, and 10 days were detected, and the hospitalization time, mortality, and the rate of conversion to open surgery were observed. ResultsThe levels of PAF and TG in the both groups tended to gradually decrease with different degrees, were significantly lower than that the before treatment (P < 0.05), and the decline of PAF and TG in≤24 h group were more significant than > 24 h group. The hospitalization time, mortality, and the rate of conversion to open surgery in the≤24 h group were significantly lower than those of the > 24 h group (P < 0.05). ConclusionThe early using of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site would have a beneficial impact on the management of HL-SAP and complications.

Lesion Extraction from B-type Ultrasound Image Using Subordinate Degree Region Level Set Method

B-type ultrasound images have important applications in medical diagnosis. However, the widely spread intensity inhomogeneity, low-scale contrast, constructed defect, noise and blurred edges all make it difficult to implement automatic segmentation of lesion in the images. Based on region level set method, a subordinate degree region level set model was proposed, in which subordinate degree probability of each pixel was defined to reflect the pixel subjection grade to target and background respectively. Pixels were classified to either target or background by calculation of their subordinate degree probabilities, and edge contour was obtained by region level set iterations. In this paper, lesion segmentation is regarded as local segmentation of specific area, and the calculation is restrained to the local sphere abide by the contour, which greatly reduce the calculation complexity. Experiments on B-type ultrasound images showed improved results of the proposed method compared to those of some popular level set methods.

滲出型老年性黃斑變性玻璃體積血的追蹤觀察

ULTRASOUND GUIDED CORE-NEEDLE BIOPSY OF NONPALPABLE BREAST LESIONS

目的 評價B超引導下核心針活檢術（CNB）對不可觸及的乳腺病變（NPBL）的診斷價值。方法 采用18G Tru-cut針結合活檢槍對88例患者的96個NPBL行B超引導下CNB，并與切除活檢病理結果比較。結果 NPBL大小4～23mm（平均13.1mm）。在CNB中，86個為良性，2個為可疑惡性，6個為惡性，2個取材不良。在切除活檢中9個為惡性，87個為良性。CNB可疑惡變的2個NPBL均為惡性，1個惡性NPBL誤診為乳腺腺病，取材不良的2個NPBL均為良性。本組NPBL中惡性病變占9.38%（9/96），B超引導下CNB對NPBL的良惡性診斷正確率為98.94%（93/94），診斷乳腺癌的敏感性為88.89%（8/9），特異性為100%（8/8），良性病變的病理診斷符合率為97.70%（85/87），取材不良為2.08%（2/96）。結論 B超引導下CNB對NPBL的診斷具有較高的敏感性和特異性，結果準確可靠。

Experience in PTCD Under Improved BMode Ultrasound Guidance

目的 總結分析普通B超監測引導PTCD方法改進后的優點及經驗。方法 用普通B型超聲診斷儀，腹部扇掃探頭和國產配套的專用PTCD套針及引流管，改進監測引導PTCD的方法，總結分析其方法的優越性。結果 95例梗阻性黃疸患者PTCD成功率為100%，引流效果良好，并發癥發生率為零。結論 用改進普通B超監測引導的方法進行PTCD，能克服在X線下進行PTCD的盲目性，對碘過敏者無禁忌，避免了長時間X線對人體的傷害。同時具有定位準確、費時少、成功率高、并發癥少、價格便宜、適宜在基層醫院推廣應用等優點。

Diagnosis and Treatment of Pancreatic Duct Stone in Chronic Pancreatitis

目的　探討胰管結石慢性胰腺炎的診斷和治療。方法　收集我院1993年3月至2003年9月經手術治療的胰管結石慢性胰腺炎患者34例的臨床資料并進行回顧性分析。結果　全組病例均經B超和CT檢查確診，均經手術治療。手術方式： 胰十二指腸切除術5例； 胰管切開取石、胰空腸Roux-Y吻合術27例，其中同時行膽囊切除術6例，Oddi擴約肌切開、T管引流術4例，膽腸Roux-Y吻合術2例； 胃空腸、膽腸吻合加活檢術2例。治愈31例，緩解2例，死亡1例。結論　影像學檢查是診斷本病的重要手段，準確率高。根據合并癥和胰管擴張程度選擇合適的手術方式，可取得良好治療效果。

B超引導靜脈留置針持續引流在處理乳腺癌術后局部皮下積液中的應用

目的　探討B超引導靜脈留置針持續引流在乳腺癌術后局部皮下積液治療中的應用及優勢。方法　回顧性分析筆者所在科室2001～2011年期間113例乳腺癌改良根治術后出現局部皮下積液患者的臨床資料，根據處理方法不同分成穿刺抽液組和靜脈留置針持續引流組，觀察2組的治療結果。結果　對乳腺癌術后局部皮下積液行B超引導靜脈留置針持續引流可縮短治療時間，減少出血、感染等并發癥。結論　對乳腺癌術后出現的局部皮下積液，B超引導靜脈留置針持續引流方法簡單易行，治療效果確切，患者痛苦小、易于接受，具有一定的應用價值。

B超立體定位可提高頸內靜脈穿刺置管成功率

【摘要】 目的 總結B超引導下對深靜脈穿刺置管的方法，減少并發癥提高一次性穿刺置管成功率。 方法 2009年8月-2010年1月對99例患者，用超聲探頭探測頸內靜脈，測得直徑及皮下距離后，沿靜脈縱軸從穿刺點向近心端兩點或三點定位，并沿定位標記穿刺進針。 結果 B超定位下一定穿刺成功98例，無氣、血胸、頸部血腫及神經損傷等并發癥發生。 結論 B超定位能有效提高低年資醫師頸內靜脈一次性置管成功率，并能相對降低頸內靜脈置管并發癥。