Introduction and detailed information of interventional radiology

It is summarized that interventional radiology is developed on the basis of new technologies such as image diagnosis, selective or superselective angiography, fine needle aspiration and cytopathology. It includes two basic contents: ① Non-surgical treatment of some diseases under image monitoring based on image diagnosis and using catheter and other technologies. ② Under the image monitoring, the histological, bacteriological, physiological and biochemical data were obtained by percutaneous puncture, catheter and other techniques to clarify the nature of the lesion.

It can be understood that interventional radiology, under the guidance of imaging medicine, provides a new drug delivery method and surgical method for modern medical diagnosis and treatment. Compared with the traditional administration route and surgical method, it is more direct, effective, simple and minimally invasive.

Interventional radiology was introduced into China in the early 1980s and developed rapidly. It is a new frontier discipline integrating medical imaging and clinical treatment, involving the diagnosis and treatment of digestive, respiratory, orthopedic, urinary, neurological and cardiovascular diseases. Especially for diseases that were previously considered incurable or difficult to cure (various cancers and cardiovascular diseases), interventional therapy has opened up a new treatment approach, which has the advantages of simplicity, safety, minimally invasive, few complications and quick response. Under the guidance of imaging methods, it uses percutaneous puncture and intubation to diagnose and treat various diseases through "non-surgical" methods such as drug perfusion, vascular embolization or dilation. Because it has something in the diagnosis and treatment of diseases that traditional internal medicine and surgery do not have (minimally invasive; Strong repeatability; Accurate positioning; High curative effect and quick response; The incidence of complications is low; The unique characteristics such as simple application of various technologies quickly established its important position in the field of modern medical diagnosis and treatment. 1996 1 1 month, the State Science and Technology Commission, the Ministry of Health and the State Administration of Medicine jointly held the "China Interventional Medicine Strategy Seminar", which officially listed interventional therapy as the third largest therapeutic discipline alongside internal medicine and surgical therapeutics, and called it interventional medicine. It can be predicted that with the continuous development of interventional medicine, this discipline will be subdivided into neurointerventional department, cardiac interventional department and digestive interventional department, just like clinical disciplines such as internal medicine and surgery.

With the development and popularization of interventional radiology, patients have more rehabilitation opportunities and become the first choice for selective treatment, which attracts patients' attention and welcome.

The development history of foreign countries began in 1960s, mostly based on seldinger's puncture and intubation technology. At present, it is not only used for the treatment of vascular diseases and bleeding, but also widely used for the diagnosis and treatment of many diseases in other systems.

Theory and Practice of Interventional Radiology (1) first reported that Lussenhop and Spence applied catheter embolization to an AVM under X-ray guidance.

(2) In1964, Dotter and Judkin introduced the percutaneous catheter system, which was used to dilate peripheral blood vessels until the blood vessels reopened, but it could not be popularized because there were more chances of bleeding and embolism.

(3) 1973, Gruntzing invented the double-lumen balloon dilation catheter, which achieved the purpose of dilating the narrow blood vessels, and thus developed percutaneous transluminal angioplasty (PTA).

(4) In cardiac interventional therapy, Rashkind initiated the opening of atrial diaphragm in 1966, and Postmann applied PDA closure in 1967. In the past 20 years, it has been developed to treat atrial septal defect and VSD closure, pulmonary valve stenosis and dilatation, pulmonary arteriovenous fistula embolism and so on.

(5) For tumor treatment, Rosch embolized liver and kidney malignant tumors in 1972, and Maddison and Spigos partially embolized spleen in 1970s to treat hypersplenism.

(6) 1969 Kaude percutaneous transhepatic biliary drainage, 1978 Hoevels internal and external biliary drainage and stent treatment for biliary stricture.

(7) 1970 Christoffersen and 1972 Oscarson performed fine needle biopsy and abscess drainage of solid organs under the guidance of X-ray, CT and ultrasound.

Domestic (1) 1973 Zhongshan Hospital of Shanghai First Medical College reported the selective coronary angiography test by percutaneous intubation for the first time in China.

(2) 1978 Zhao and Chen of Shanghai Huashan Hospital reported that domestic puncture needles and catheters were used in renal arteriography.

(3) 1982, Shanghai Huashan Hospital reported for the first time a case of PVA treating femoral artery stenosis.

(4) 1983, xuanwu hospital reported 10 cases of renal artery stenosis were treated with PTA.

(5) During1986, the Affiliated Hospital of Tianjin Medical College, Fuwai Hospital and Wuhan Third Hospital of China Medical University reported the application of double-lumen balloon in the treatment of renal artery stenosis.

(6) 1980- 1985, Shanghai Huashan Hospital reported renal artery embolization for renal cell carcinoma; Gui Lin of Zhongshan Hospital used different embolic agents to embolize liver and renal artery; Feng Gansheng of Wuhan Medical College used Bletilla striata as embolic agent. Their research has created a new way to combine interventional radiology with traditional Chinese medicine. Gui Lin, Sun Da and Peng Bo reported that hepatic artery embolization was used to treat liver cancer, arterial embolization was used to treat hypersplenism, and superselective external carotid artery embolization was used.

(7) At 198 1, Shanghai Zhongshan Hospital and the Third People's Hospital reported percutaneous cholangiography and external drainage (PTCD). 1985 reported the treatment of abdominal abscess, liver abscess, renal pelvis drainage and T-shaped pipe network basket lithotomy by percutaneous catheter drainage.

(8) 1984- 1986 reported the percutaneous biopsy guided by X-ray, B-ultrasound and CT, which provided the pathological basis for the lesions that were difficult to be diagnosed by simple imaging.

(9) Bethune International Peace Hospital 1978 started selective celiac arteriography, and bronchial artery embolization was performed in the same year to treat massive hemoptysis, which was one of the earliest units in China.

Interventional radiology has been very popular abroad since 1970s, forming a new field of radiology. In recent years, it is also on the rise in China, and plays an active role in tumor treatment, becoming an indispensable new treatment method. Commonly used methods are as follows:

(1) Intra-arterial infusion of anticancer drugs has a much higher concentration of anticancer drugs than general peripheral intravenous administration, which significantly improves the curative effect and reduces systemic adverse reactions. It is suitable for treating liver cancer, lung cancer, head and neck tumor, gastric cancer, bile duct tumor, pancreatic cancer, pelvic tumor and malignant tumor of limbs.

(2) Arterial embolization: Inserting the catheter into the blood supply artery of the tumor, selecting the appropriate embolic agent, blocking the blood supply artery, cutting off the blood supply of the tumor, and making the tumor infarct. It is suitable for the treatment of liver, kidney and pelvic tumors, and also for the first aid of bleeding caused by tumors.

(3) Transcatheter decompression is mainly used to relieve the obstruction symptoms caused by tumor compression of bile duct or urethra. Because this method is less traumatic than surgery, it is especially suitable for elderly and weak patients, so it is widely used.

Classification Introduction Interventional radiology can be divided into interventional diagnosis and interventional therapy according to the purpose; According to the technology, it can be divided into: vascular interventional radiology (drug perfusion; Embolization technique; Forming bracket; Filtering technology, etc. ) and non-vascular radiology (puncture biopsy; Drainage technology; Foreign body removal; Cavity stent, etc. ); According to the clinical application scope, it can be divided into tumor interventional radiology, non-tumor interventional radiology, neurointerventional radiology and so on. Although CT, MR and B-ultrasound are valuable in the diagnosis of some vascular diseases, angiography is still the gold standard for diagnosis, especially for the differentiation of vascular arteries, small vascular lesions and dynamic observation of blood flow. Interventional therapy has become the first choice for some vascular diseases and tumors, such as renal artery stenosis and liver cancer. Especially, it has obvious curative effect on the opening of some vascular stenosis diseases, such as esophageal, bile duct, trachea, urinary tract stenosis and even nasolacrimal duct stenosis.

Interventional radiology salon case discussion Technical classification of interventional radiology I. Vascular interventional radiology

Interventional angiography, also known as interventional angiography, refers to the injection of drugs or certain substances from the catheter into the vascular cavity or the implementation of certain measures at the same time as diagnostic angiography to achieve the purpose of treatment. There are three commonly used vascular interventional techniques.

1, intravascular infusion drug therapy

(1) vasoconstrictive therapy: vasopressin is injected into the relevant arteries through the catheter to control gastrointestinal bleeding, such as esophageal and gastric variceal bleeding, diffuse gastric mucosal bleeding, colonic diverticulum bleeding, etc.

(2) Put the tumor chemotherapy catheter in the tumor blood supply artery, drip chemotherapy drugs, and increase the local drug concentration to avoid or reduce the systemic reaction caused by chemotherapy.

2. Transcatheter embolization.

The embolus is delivered to the target blood vessel through the original angiographic catheter or special catheter. One is to treat internal bleeding such as traumatic organ bleeding, ulcer disease, tumor or unexplained organ bleeding. On the other hand, embolization is used to treat tumors, because tumor circulation is partially or completely blocked by embolic substances, thus controlling tumor growth or as a treatment means of surgical resection; It can also be used for non-surgical organ resection, such as injecting embolic substances into splenic artery branches, that is, partial splenic embolization, to treat hypersplenism without affecting spleen immune function.

Commonly used emboli such as autologous blood clot, gelatin sponge, anhydrous alcohol, polyvinyl alcohol, liquid silica gel, stainless steel ring, metal or plastic beads, traditional Chinese medicine bletilla striata, etc.

3. Percutaneous transluminal angioplasty

In the 1960s, it was applied to arteries to dilate narrow blood vessels. After the successful development of double-lumen balloon catheter in 1970s, it was widely used, mostly in iliac artery, femoral artery, popliteal artery and renal artery. Renal artery PTA (or PTPA) is mostly used for nephrogenic hypertension, which dilates the narrow renal artery and lowers blood pressure. PTA can also be used in coronary artery, which is called percutaneous transluminal coronary angioplasty (PTCA), to dilate the hardened coronary artery and achieve the purpose of treating coronary heart disease. The catheter used in PTA is a double-lumen catheter with capsule. Place the capsule segment at the narrow blood vessel, inject the liquid containing contrast agent into the capsule, and pressurize it to 3~6 atmospheric pressure, each time for 10- 15o. Pressurization can be repeated 3~4 times, and most of them can dilate narrow blood vessels.

PTA is often used for atherosclerotic stenosis of blood vessels, and its mechanism is that atherosclerotic plaque is compressed, intima and medial layer are torn and stretched, which widens the lumen. Other causes of vascular stenosis, such as Takayasu's arteritis and congenital vascular stenosis, can sometimes be treated with PTA.

Non-vascular interventional radiology

1, percutaneous biopsy, PNB)

Puncture the diseased parts of various parts of the body directly with a fine needle (No.22 ~ No.23, external diameter 0.6~0.7mm). Because of the special device on the needle, it is convenient to take out the biopsy specimen of the lesion. Fine needle can also be used to directly aspirate diseased tissue fragments and then do biopsy.

Chest PNB is used to diagnose lung, mediastinum and chest wall lesions, which is of great significance to the qualitative diagnosis of pulmonary spherical lesions and mediastinal masses, with an accuracy rate of 85%. The common complications are pneumothorax and hemorrhage, but fine needle complications are rare, and PNB is widely used in abdomen, and masses in liver, gallbladder, pancreas, spleen, kidney and abdominal posterior wall can be used, so the diagnosis preparation is also high. Bone marrow puncture needs a thicker bone needle to diagnose bone tumor. In addition, it is also used to puncture thyroid masses and orbital masses.

In order to ensure that acupuncture can safely reach the focus to be investigated, TV screen, CT, B-ultrasound and related contrast examination should be used to guide the puncture direction.

2, percutaneous puncture drainage

(1) Percutaneous transhepatic biliary drainage (PTCD or PTD) causes extrahepatic biliary obstruction due to malignant (such as cholangiocarcinoma and pancreatic head cancer) or benign (such as choledocholithiasis) lesions, and jaundice appears in clinic. PTCD is feasible for internal and external drainage of biliary tract, which can relieve obstruction and jaundice and provide favorable conditions for radical surgery. Percutaneous cholangiography should be performed before PTCD to determine the location, degree, scope and nature of bile duct obstruction. PTCD can be divided into internal drainage and external drainage. The guide wire is introduced through the puncture needle of PTC, then pulled out from the puncture site, and then fed into the catheter with multiple side holes at the end along the guide wire. The catheter is in the bile duct above the obstruction section, and its internal port is also there. Bile is continuously drained through the external orifice of the catheter, which is external drainage. If the catheter passes through the obstruction area and stays in the bile duct at the distal end of the obstruction or enters the duodenum, bile will flow into the bile duct or duodenum below the obstruction along the side hole of the catheter, which is called internal drainage.

(2) Percutaneous nephropyelotomy is mainly used for drainage of urinary tract obstruction, and can also be used to push down stones in renal pelvis or ureter and send them to bladder for discharge. The method of ostomy is the same as above. Puncture the kidney with a fine needle and enter the renal pelvis. Percutaneous anterograde pyelography was used to observe the shape, stenosis or obstruction of urinary tract and its degree, and then guide wire was fed along the puncture needle, and then catheter was inserted to stay in the renal pelvis.

According to the clinical application classification 1, vascular diseases:

(1)PTA+ stent in the treatment of vascular stenosis.

(2) Thrombolysis +PTA and/or stent therapy for vascular stenosis.

(3) Using embolic material, steel ring and internal stent to treat aneurysm, AVM, arteriovenous fistula and vascular bleeding.

(4) Treatment of portal hypertension and Budd-Chiari syndrome with puncture +PTA+ stent.

(5) Treatment of gastrointestinal vascular bleeding with embolization or vasopressin.

(6) The inferior vena cava filter can prevent thrombosis in lower limbs, abdomen and pelvis.

2, heart disease:

(1) ASD and VSD were treated with closed umbrella.

(2) Treating PDA with steel ring or plugging agent.

(3) Balloon dilation for pulmonary and mitral stenosis.

(4) PTA+ stent was used to treat coronary artery stenosis.

(5) Radiofrequency ablation for tachycardia.

(6) Pacemakers are used to treat all kinds of bradycardia.

3. Tumors:

(1) Selective arterial infusion chemotherapy and embolization for malignant tumor.

(2) Percutaneous injection of absolute alcohol and boiling water to treat malignant tumor.

(3) Embolization for cavernous hemangioma, tendinous hemangioma, hysteromyoma, osteosarcoma, nasopharyngeal fibroangioma, etc.

(4) Thermal ablation of liver cancer and lung cancer.

4. Non-vascular diseases:

(1)PTA+ stent or PTA alone in the treatment of digestive tract, urinary tract, biliary tract, airway and nasolacrimal duct stenosis.

(2) Treatment of ectopic pregnancy by tubal embolization or injection of sclerosing agent.

(3) Ureteral stricture was treated by dilation.

5, puncture biopsy:

Use a special puncture needle to aspirate or extract tissue for pathological examination.

According to the application equipment classification 1. Under the guidance of x-ray fluoroscopy.

2. Under the guidance of CT.

3. Under the guidance of B-ultrasound.

4. Under the guidance of nuclear magnetic resonance.

Scope of diagnosis and treatment Interventional radiology scope: 1. Angiography of various parts of the body; Treatment of various tumors: such as liver cancer, lung cancer, esophageal cancer, renal cancer, pancreatic cancer, various metastatic tumors, gynecological tumors, bone tumors, etc. ; Third, embolization of hepatic hemangioma and aspiration hardening of hepatic and renal cysts and abscesses; 4. Embolization of various aneurysms and vascular malformations and PTA or stent implantation for vascular occlusive diseases; Non-vascular stenosis: benign and malignant esophageal stenosis, gastrointestinal anastomotic stenosis, biliary obstruction stent implantation; Six, uterine fibroids, ectopic pregnancy, tubal obstruction caused by infertility; 7. Percutaneous fine needle biopsy of various system lesions; Eight, others: femoral head necrosis, hypersplenism, gastrointestinal bleeding, acute bleeding in obstetrics and gynecology, bronchiectasis hemoptysis, vena cava filter implantation (prevention or treatment of lung infarction).

Equipment and materials used: various special catheters, guide wires, puncture needles, vascular sheaths, balloons and biopsy needles.

Material internal stent, embolic material (water agent, viscose, gelatin sponge, silk thread segment, various special particles such as PVA, detachable balloon, steel ring, etc.). ), filter and drainage catheter.

1 and the standardization of interventional therapy technology have problems.

2. Domestic interventional instruments and instruments can not meet the needs of clinical work and development, and mainly rely on imports.

3. The academic and professional level of interventional therapy varies from place to place.

4. Facing the challenge of minimally invasive surgery.

Looking forward to the development of interventional radiology in China, it can be said that it started late but developed rapidly. It is estimated that almost all provinces, municipalities and autonomous regions in China have carried out interventional therapy to varying degrees. From the number of interventional treatments and professional teams, abdominal and thoracic interventional treatments are the most (about 2/3), followed by cardiovascular and nervous systems, and less work is done in other systems and parts.

At the same time, vascular interventional therapy is far more than non-vascular work. At present, interventional therapy technology has been widely used in many diseases and lesions of various systems in the whole body, so it can be summarized as interventional medicine, which will become the three major diagnosis and treatment technologies alongside internal medicine and surgery, with broad development prospects.

Book information book name: interventional radiology

Guo Qiyong Interventional Radiology

Publishing House: People's Health Publishing House

Release date: 2065438+August 1 00

Format: 16

Pricing: 32.00 yuan

With the development of medicine, medical education and the cultivation of medical talents are becoming more and more important, which is also the cornerstone of medical sustainable development. The compilation of medical textbooks is an important means to improve the level of medical education and strengthen the training of medical talents. With the medical discipline becoming more and more refined and specialized, medical branches in various fields need corresponding teaching materials to ensure and promote their own progress. It is in this spirit that the textbook Interventional Radiology (1 version) was compiled in 2000, and 10 has been strongly supported by readers for many years, achieving the goal of enabling students to master basic theories, basic knowledge and basic skills, and promoting the development of interventional radiology education itself.

Interventional radiology is one of the fastest developing disciplines in the field of image diagnosis and medicine. In the past 10 years, interventional radiology has made great progress, and related technologies and concepts have been continuously improved and developed. This book summarizes the successful experience of the textbook 1, and on the basis of introducing the relevant equipment and drugs of interventional radiology in detail, especially the brand-new equipment and drugs widely used in recent years, it continues to elaborate the three basic treatment technologies of interventional radiology, including puncture and drainage, vascular embolization and perfusion, and lumen plasty, and focuses on the concepts, specific operation methods, indications, complications and clinical applications of various interventional methods. Even if students master the operation essentials, they also introduce some worthwhile ones. It embodies the guiding ideology of dialectical unity of "ideological, scientific, advanced, inspiring and applicable" in medical textbooks.

The first chapter of the book catalogue is an overview

The first part is a brief history of interventional radiology.

A brief history of the development of interventional radiology in the world

Second, a brief history of interventional radiology in China.

Section 2 Interventional Radiology Equipment

I. Image Monitoring Equipment

Second, the use of equipment

Section 3 Drug use in interventional radiology

A, vasoconstrictor and dilator drugs

Second, hemostatic, anticoagulant and thrombolytic drugs

Third, anti-tumor drugs.

Section 4 embolic substance

I. Biological substances

Second, sponges.

Third, the coil class

Fourth, detachable balloons.

Five, tissue necrosis agent

Six, particles, microspheres, microcapsules

Seven, iodized oil

Eight, Chinese medicine

Nine, physical factors

Stickies

Section 5 Classification and Category of Interventional Radiology

First, according to the classification of interventional radiology methods

Second, according to the field of treatment classification

Third, the category of interventional radiology

Section VI Current Situation and Future of Interventional Radiology

First, its position in the field of radiology.

Second, its position in the medical field.

Chapter II Percutaneous Puncture Drainage

Section 1 Equipment and Operation Technology

I. Equipment

Second, the operation method

Section 2 Indications and Contraindications

I. signs

Second, contraindications

Section 3 Adverse Reactions and Complications

Section IV Clinical Application

First, biliary obstruction

Second, urinary tract obstruction

Third, renal cystic lesions.

Fourth, liver abscess.

Five, abdominal and pelvic abscess

Chapter III Transcatheter Vascular Embolization and Perfusion

Section 1 Transcatheter Vascular Embolization

First, the treatment mechanism of embolism

Second, embolic equipment and embolic substances

Third, the operation technology

Four. Indications and contraindications

Five, embolism reaction and complications

Six, clinical application

Section II Transcatheter Drug Perfusion

I. Basic principles

Ii. equipment and methods

Iii. Chemotherapeutic drugs commonly used by IAI

Fourth, clinical application

Chapter IV Percutaneous transluminal angioplasty

The first section processing mechanism

First, the mechanism of balloon angioplasty

Second, the mechanism of stent angioplasty

Section 2 Equipment and Operation Technology

First, balloon angioplasty equipment and operation technology

Second, stent angioplasty equipment and operation technology

Section III Indications and Contraindications

Indications and contraindications of balloon angioplasty

Indications and contraindications of stenting

Section 4 Adverse Reactions and Complications

First, adverse reactions and complications of balloon angioplasty

Second, adverse reactions and complications of stent angioplasty

Section 5 Restenosis and Prevention

Restenosis after balloon angioplasty

Second, restenosis after stenting.

Prevention and treatment of restenosis after angioplasty

Section 6 Clinical Application

Section 7 Introduction to Other Angioplasty

1. Percutaneous laser angioplasty

2. Percutaneous mechanical endarterectomy

Chapter V Non-vascular Vertebroplasty

The first section processing mechanism

A, airway plasty

Second, digestive tract plasty

Three. Bile duct plasty

Four, urethroplasty

Verb (abbreviation of verb) tubal repair

Section 2 Equipment and Operation Technology

First of all, the equipment needed for non-vascular angioplasty

Second, the operation technology

Section III Indications and Contraindications

Indications and contraindications of airway plasty

Indications and contraindications of digestive tract plasty

Indications and contraindications of biliary tract plasty

Indications and contraindications of urethroplasty

Indications and contraindications of fallopian tube recanalization

Section 4 Adverse Reactions and Complications

First, the complications of airway plasty

Second, the complications of digestive tract plasty

Three. Complications of cholangioplasty

Four, urethral stent complications

Five, fallopian tube recanalization complications

Section 5 Clinical Application

First, esophageal stenosis

Second, tracheobronchial stenosis

Three, the stomach and duodenum stent

Four. Colon and rectum stenting

Five, bile duct stenosis

Six, tubal obstruction

Prostate and urethra stent.

Chapter VI Other Interventional Therapy Techniques

Percutaneous foreign body removal at section 1

1. Percutaneous removal of foreign bodies in cardiovascular cavity

Second, percutaneous soft tissue foreign body removal

The inferior vena cava filter was placed in the second part.

I. Overview

Second, common filters.

Third, the choice of vena cava filter

Fourth, the operation method and matters needing attention

Clinical application of verb (abbreviation of verb)

Section III Interventional Treatment of Benign and Malignant Spinal Diseases

First, interventional therapy of lumbar disc herniation

Second, percutaneous vertebroplasty

Three, percutaneous kyphoplasty

Chapter VII Tumor Intervention and Comprehensive Treatment

Section 1 Primary liver cancer

I. Overview

Second, the etiology and pathology

Third, the clinical manifestations and diagnosis

Four. Interventional therapy of liver cancer

Five, interventional therapy of liver cancer complications

Six, other comprehensive management

Second cholangiocarcinoma

I. Overview

Second, the etiology and pathology

Third, the clinical manifestations and diagnosis

Four. Interventional treatment of cholangiocarcinoma

Section III Hepatic Hemangioma

I. Overview

Second, the etiology and pathology

Third, the clinical manifestations and diagnosis

Four. Interventional treatment of hepatic hemangioma

The fourth section of uterine fibroids

I. Overview

Second, the etiology and pathology

Third, the clinical manifestations and diagnosis

Four. Interventional treatment of hysteromyoma

Section 5 Radioactive Particle Implantation

I. Overview

Second, the equipment

Third, the scope of application

Fourth, common clinical applications

Chapter VIII Comprehensive Interventional Therapy for Peripheral Vascular Diseases

Section 1 Interventional Treatment of Aortic Diseases

First, aortic valve stenosis and dilatation

Endovascular repair of aortic aneurysm

Section II Interventional Treatment of Renal Artery Diseases

I. Clinical Introduction

Second, indications and contraindications

Third, interventional therapy technology

Fourth, the curative effect

Complications of verb (abbreviation of verb) and its prevention and treatment

Section III Interventional Treatment of Arterial Occlusion Diseases of Lower Extremities

……

Chapter IX Comprehensive Interventional Therapy for Nervous System Diseases

Chapter 10 Comprehensive Interventional Therapy for Liver Cirrhosis

Chapter III XI Interventional Diagnostics

Noun index