原发性肝细胞癌射频消融后快速广泛复发的因素

目的: 探讨原发性肝细胞癌患者射频消融后肝内肿瘤快速广泛复发的发生机制及影响因素.方法:1999-12/2006-03我院接受经皮射频消融的原发性肝细胞癌患者926例,术后30-45 d内CT、MRI及AFP复查,并进行随访,分析10个可能影响肿瘤射频后快速复发的变量,包括肝功能Chuk-Pugh分级、肿瘤数目、大小、部位、生长方式、AFP值、肿瘤分化程度、有无门脉癌栓、射频治疗系统类型(或电极针类型)以及术前有无实施肝动脉化学栓塞(TACE).结果:874例患者获得有效随访记录.54例患者初始治疗后获得局部完全坏死,但术后30-45 d首次复查即发生肝内肿瘤快速广泛复发.射频消融后肿瘤广泛快速复发的危险因素分别为肿瘤类型(OR=2.647, P<0.001)、门脉癌栓(OR=1.341,P<0.001)、肿瘤部位(OR=0.197,P=0.006)和射频前有无进行TACE(OR=1.512,P=0.042).结论:位于主要门脉分支处、浸润性生长及术前存在血管侵袭是射频消融后肿瘤快速广泛复发的影响因素,这些类型的肝细胞癌患者射频消融前更应实施TACE治疗.     

腹腔镜超声在肝癌射频消融治疗中的临床应用

目的: 探讨腹腔镜超声技术在肝癌射频消融(radiofrequency ablation, RFA)治疗中的临床应用.方法: 2007-09/2008-04我院对15例肝癌患者的20个肝内肿瘤实施了腹腔镜超声引导下RFA治疗, 肿瘤直径2.5-7.3(平均4.5) cm. HBV(+)10例, HCV(+)1例, 合并有不同程度肝硬化11例,胆囊结石9例. 其中1个癌灶12例, 2个癌灶1例,3个癌灶2例. 术后采用超声检查及螺旋CT增强扫描评价RFA疗效.结果: 12例顺利完成腹腔镜下射频消融治疗,其中8例同时行胆囊切除术, 单个肿瘤平均射频治疗时间40.2±12.3 min, 平均总手术时间98.7±28.5 min, 平均总出血量145.3±82.8mL. 患者术中、后均未出现严重并发症. 术后随访4-12 mo, 4例射频治疗部位复发, 1例发现肝内新病灶, 均采用经皮射频消融进行治疗.其中有2例患者第3次定期复查时, CT诊断原发性肝癌复发, 外科医生建议行肝移植术, 其余13例随访至今均存活.结论: 在RFA治疗肝癌过程中, 腹腔镜超声引导技术已成为协助外科医生顺利完成手术必不可少的手段之一.     

腹腔镜超声和经皮超声在肝癌射频消融治疗中的联合应用

目的:探讨腹腔镜超声和经皮超声在肝癌射频消融治疗中的联合应用.方法:2007-09/2008-11我院对25例肝癌患者的43个肝内肿瘤在腹腔镜超声和经皮超声引导下行射频消融治疗.肿瘤直径2.7-7.5(平均3.8)cm.本组中,HBV(+)14例,HCV(+)2例,合并有不同程度肝硬化16例,胆囊结石13例.其中1个癌灶14例,2个癌灶3例,3个癌灶4例,4例多发.术后采用超声检查及螺旋CT增强扫描评价RFA疗效.结果:25例患者顺利完成腹腔镜超声引导下射频消融治疗,有4例射频治疗部位复发和3例肝内新发病灶又采取经皮超声引导下射频消融治疗.全部病例中,11例同时行胆囊切除术,在腹腔镜超声引导下,单个肿瘤平均射频治疗时间为39.3±12.1 min,平均总手术时间95.5±25.8 min,平均总出血量148.5±84.3 mL.在经皮超声引导下,单个肿瘤平均射频治疗时间28.3±10.3 min,平均总手术时间50.2±11.5min,治疗后超声检查肝周、腹腔未见明确积液.患者术中、后均未出现严重并发症.术后随访,有3例CT提示原发性肝癌复发,外科医生建议行肝移植,其余22例随访至2008-11均存活.结论:腹腔镜超声和经皮超声在肝癌射频消融治疗中的联合应用,使患者的远期疗效比较满意.     

超声引导射频消融联合缓释化疗粒子植入治疗肝转移癌

目的探讨超声引导射频消融联合缓释化疗粒子植入对肝转移癌的治疗效果及临床应用价值。方法58例肝转移癌患者（89个病灶）行超声引导下射频治疗,同时植入缓释化疗粒子。结果随访3～18个月,52例存活（89．7％）。肿瘤直径≤5cm的43个癌灶中,超声检查完全缓解、部分缓解、稳定分别为27、13、3个;肿瘤直径〉5cm的15个癌灶,完全缓解、部分缓解、稳定、恶化分别为3、6、4、2个。1个月后CT增强扫描显示87个病灶完全失去活性。结论超声引导射频消融联合缓释化疗粒子植入术是治疗肝转移癌安全、有效的新手段。     

髋臼加强环联合全髋关节置换术治疗髋臼周围肿瘤的临床回顾

目的回顾分析13例髋臼周围肿瘤行手术切除,应用髋臼加强环联合全髋关节置换术重建髋关节的临床疗效。方法13例髋臼周围肿瘤患者,其中骨肉瘤1例,软骨肉瘤3例,腺泡状软组织肉瘤1例,骨巨细胞瘤3例,恶性纤维组织细胞瘤2例,转移性肿瘤3例。手术切除髋臼肿瘤,使用髋臼加强环联合全髋关节置换重建髋关节,均使用生物性股骨假体。其中8例行S-P入路,5例行髋关节前外侧入路。术后对患者进行随访。按Enneking（MSTS）术后功能评分标准进行功能评估。结果随访5～26个月,平均18．3个月,2例于术后3个月和6个月局部复发,1例术后4个月出现肺转移,其余患者髋关节功能恢复良好,均无瘤生存,且无全身及局部并发症。术后下肢功能优良率84％。结论髋臼加强环作为髋臼周围肿瘤切除术后重建的一种方式,术前严格判断使用指征,手术创伤相对较小、失血少,短期随访可获得良好的髋关节功能。     

冷冻消融与射频消融对心肌损伤的对比研究

目的观察冷冻消融和射频消融环肺静脉电隔离后对阵发性心房颤动(PAF)患者心肌肌钙蛋白I(cTnI)和C反应蛋白(CRP)的影响。方法选取PAF患者102例,冷冻组有42例,射频组有60例,所有患者均于术前、术后3～4h测定血清cTnI和CRP并对其进行比较。术后随访3个月,比较早期复发与未复发患者的cTnI和CRP水平。结果所有患者术前cTnI和CRP均在正常范围。两组患者术后cTnI和CRP均升高,与术前相比差异有显著性(P0.001)。与射频组相比,冷冻组术后cTnI和CRP水平升高幅度更大(P0.05)。术后3个月随访,共复发31例(30.4%),其中冷冻组15例(35.7%),射频组16例(26.7%),两者复发率无明显差异(P0.05)。射频组术后复发的患者CRP水平明显高于未复发的患者(P0.05)。结论冷冻消融较射频消融对心肌损伤程度更大;射频消融术后CRP较高可能与早期复发相关。     

经内镜射频消融和置入内支架联合治疗不能切除的胆胰肿瘤

目的探讨经内镜射频消融和置入内支架的联合治疗在延长不能切除的胆胰肿瘤患者胆道通畅期中的作用。方法共58例患者采用联合治疗：6例十二指肠乳头癌先作内镜下乳头局部切除，而后对残留病灶作射频消融；52例经ERCP测出肿瘤狭窄段的范围，对狭窄段作射频消融，然后置入相匹配的金属内支架。收集同期52例单放金属内支架者作为对照组。结果在联合治疗组中，3例治疗后2个月内因胆道严重感染、全身衰竭死亡，余55例胆道平均通畅期为9．2个月，平均存活期为16个月。其中48例再次梗阻后再次内镜下治疗，28例单作射频消融和20例射频消融加再置入内支架，通畅期又平均延长5．1个月。而单放内支架组胆道通畅期为6．1个月，平均存活期为13个月。结论射频消融能阻止肿瘤的局部增长，从而延长内支架的通畅期和患者的存活期。     

射频消融治疗植入型心律转复除颤器术后电风暴疗效分析

目的:探讨射频消融治疗植入型心律转复除颤器(ICD)患者术后电风暴的有效性。方法:回顾性纳入2010年1月1日—2019年12月31日就诊于大连医科大学附属第一医院行ICD或心脏再同步化治疗-除颤器(CRT-D)术后电风暴行射频消融治疗的患者。收集研究对象的年龄、性别、基础心脏病、心脏超声指标和B型利钠肽(BNP)等临床资料。出院后定期随访,随访一级终点为电风暴复发,二级终点为心脏性猝死和全因死亡。K-M曲线评估射频消融术后电风暴复发情况;Cox回归计算射频消融术后电风暴复发相关危险因素。结果:本研究共纳入13例患者(男11例,女2例),年龄(60.53±10.63)岁。13例患者共进行19次标测与消融,单纯行心内膜标测患者11例,心内膜结合心外膜标测患者2例。术中消融所有室性心动过速者共11例,消融临床室性心动过速但能诱发非持续性室性心动过速者2例,术后仍能诱发临床室性心动过速1例,消融即刻完全成功率为84.62%,部分成功率为15.38%,失败率为7.69%。13例患者消融后平均随访(30.29±19.07)个月,末次导管消融后远期完全成功率、部分成功率及失败率分别为38.46%(5/13)、15.38%(2/13)及46.15%(6/13)。随访至2020年7月31日,有2例患者因心室颤动电风暴死亡,基础病因分别为缺血性心肌病和扩张型心肌病。亚组比较扩张型心肌病组和非扩张型心肌病组,两组在消融成功率上无显著差异(P=0.959)。Cox回归发现年龄、BNP、左室射血分数、左室舒张末期内径、右室舒张末期内径、心功能分级均与射频消融术后电风暴复发无关。结论:射频消融能够显著减少ICD术后电风暴发生。     

原发性肝癌射频消融术后针道转移再消融治疗效果分析

目的研究原发性肝癌射频消融术后针道转移危险因素及消融术治疗效果。方法回顾性分析2017年1月-2018年10月4例原发性肝癌射频消融术后发生针道转移在首都医科大学附属北京佑安医院肝病与肿瘤介入治疗中心行消融术再治疗的患者临床资料,评价危险因素、消融治疗效果及术后并发症发生情况。结果 4例患者肝内肿瘤病灶均临近肝包膜,低分化肝细胞癌2例,中分化肝细胞癌1例,高分化肝细胞癌1例。消融术后发生针道转移时间间隔为3. 6～14. 3个月,针道转移病灶数目均为单发,3例位于前腹壁,1例位于右侧侧腹壁。后行氩氦刀冷冻消融术治疗3例,射频消融术治疗1例。术后2例患者出现发热及暂时性疼痛加重,给予对症治疗后症状缓解,无严重并发症发生。术后1个月复查增强CT显示3例患者转移灶完全消融,随访2～19个月无复发。1例患者局部病灶残余,但疼痛症状较前明显缓解,随访3个月残余灶无明显增大。所有患者术后1个月血清AFP及异常凝血酶原值均明显下降。结论消融治疗尤其是氩氦刀消融术治疗腹壁针道转移灶具有疗效确切、并发症少、耐受性好的优势,对于无法耐受外科手术或不愿意行外科手术的患者是一种较好的治疗选择。     

术中超声引导下射频消融治疗晚期胰体尾癌的临床研究

目的探讨术中超声引导下射频消融治疗晚期胰体尾癌的临床意义。方法对14例手术不能切除的晚期胰体尾癌行术中超声引导下射频消融治疗,观察术中、术后并发症、近期疗效及生存情况。结果所有病例术中均在超声引导下避开大血管进行消融治疗,在超声图中见到胰腺组织明显气化,肉眼观察到胰腺组织明显碳化,病理活检为凝固性坏死。所有病例均无出血、感染、胰瘘等并发症发生,术后癌性腹痛均立即明显缓解,生存期内癌性腹痛完全消失7例,尚能忍受5例,不能忍受2例。平均随访18个月,5例死亡,9例带瘤生存。结论术中超声引导下射频消融治疗晚期胰体尾癌是一种安全有效的姑息性疗法。     

Treatment of colorectal cancer with synchronous bilobar liver metastases with simultaneous bowel and liver resection plus radiofrequency ablation

Patients with synchronous bilobar colorectal liver metastases usually have an extent or distribution of the metastases that precludes curative resection. Recently radiofrequency ablation has been proved to safely control liver metastases but a combination of radiofrequency ablation with more than liver resection is rarely performed. We report two patients with colorectal primary and synchronous classically unresectable bilobar liver metastases treated with a combination of bowel and liver resection plus radiofrequency ablation. In the first patient we performed left colectomy, left hepatic lobectomy and radiofrequency ablation of lesions in segments I and VII. In the second patient we performed low anterior resection, wedge resections for three superficially placed lesions in segments V and VIII, and radiofrequency ablation of five more deeply located lesions in segments III, IV, VI and VII. Both patients recovered uneventfully. At the eighth month, the first patient developed three new liver metastases that were treated with subsequent radiofrequency ablation and at the tenth and seventh months of follow-up respectively, both patients are disease free. In conclusion, combination of bowel and liver resection plus radiofrequency ablation expands the possibilities to treat more patients with colorectal cancer having synchronous bilobar unresectable liver metastases.     

阵发性房颤经导管射频消融与药物治疗的对比评价

目的比较阵发性房颤经导管射频消融与抗心律失常药物治疗的长期疗效。方法连续入选阵发性房颤患者26例,给予CARTO指导下的射频消融环肺静脉电隔离术,配对入选26例房颤患者,给予药物治疗。临床随访观察房颤、房速的发生情况。结果平均随访28.7个月。消融组患者73.1%消融成功,药物治疗对照组11.5%无房颤发作,差异有统计学意义(P0.001)。结论研究结果提示,阵发性房颤患者射频消融治疗的长期效果明显优于药物治疗。     

Comparison of late results of surgical or radiofrequency catheter modification of the atrioventricular node for atrioventricular nodal reentrant tachycardia.

AIMS: Although arrhythmia surgery and radiofrequency catheter ablation to cure atrioventricular nodal reentrant tachycardia differ in technical concept, the late results of both methods, in terms of elimination of the arrhythmogenic substrate and procedure-related new and different arrhythmias, have never been compared. This constituted the purpose of this prospective follow-up study. METHODS AND RESULTS: Between 1988 and 1992, 26 patients were surgically treated using perinodal dissection or 'skeletonization', and from 1991 up to 1995, 120 patients underwent radiofrequency modification of the atrioventricular node for atrioventricular nodal reentrant tachycardia. The acute success rates of surgery and radiofrequency catheter ablation were 96% and 92%, respectively. Late recurrence, rate in the surgical and radiofrequency catheter ablation groups was 12% and 17%, respectively. Mean follow-up was 53 months in the surgical group and 28 months in the radiofrequency catheter ablation group. The final success rate after repeat intervention was 100% in the surgical group and 98% in the radiofrequency catheter ablation group. Comparison of the initial and recent series of radiofrequency catheter ablated patients showed an increased initial success rate with fewer applications. In the radiofrequency catheter ablation group, a second- or third-degree block developed in three patients (2%), requiring permanent pacing, whereas in the surgical group no complete atrioventricular block was observed. Inappropriate sinus tachycardia needing drug treatment was observed in 13 patients (11%), mostly after fast pathway ablation, but was never observed after surgery. New and different supraventricular tachyarrhythmias arose in 27% of the patients in the surgical group and in 11% of the radiofrequency catheter ablation group, but did not clearly differ. CONCLUSION: This one-institutional follow-up study demonstrated comparable initial and late success rates as well as incidence of new and different supraventricular arrhythmias following arrhythmia surgery and radiofrequency catheter ablation for atrioventricular nodal reentrant tachycardia. Today radiofrequency catheter ablation has replaced arrhythmia surgery for various reasons, but the late arrhythmic side-effects warrant refinement of technique.     

Impact of intra-operative ultrasonography in liver surgery.

BACKGROUND/OBJECTIVE: Intra-operative ultra-sonography (IOUS) during surgery for primary and metastatic hepatic tumors identifies additional lesions and helps in determining the most optimal surgical strategy. We assessed the impact of IOUS in liver surgery at our hospital, a tertiary-care cancer center. METHODS: Patients with potentially resectable hepatic tumors underwent surgical exploration. The relationship of the tumor with regard to the intrahepatic vasculature was determined by IOUS. A search was also made for additional lesions not detected by pre-operative imaging modalities. In appropriate cases, IOUS was also used to assist resection and radiofrequency ablation/ethanol injection. RESULTS: Between January 2003 and January 2005, 52 patients underwent surgery for primary or secondary hepatic tumors. IOUS was performed in 48 of these patients. It detected additional hepatic lesions in 14 patients (29.2%). IOUS contributed to changing the operative plan in 21 patients (43.8%). It was directly responsible for avoiding resection or ablation in 7 patients (14.6%), 5 of whom had multiple bilobar lesions, 1 had IOUS-guided biopsy that revealed caseating granuloma on frozen section, and 1 patient had no lesion on IOUS. Three patients had extent of resection changed based on IOUS findings. IOUS also guided radiofrequency ablation in 8 patients and ethanol injection in one patient. CONCLUSION: IOUS is an essential tool in surgery for hepatic tumors. In addition to accurate staging, it also aids in safe resection and radiofrequency ablation in appropriate cases.     

对比经皮射频消融术和经腹腔镜下肝切除术治疗Ⅰa期原发性肝癌的临床效果

目的对比经皮射频消融术(PRFA)和经腹腔镜下肝切除术治疗Ⅰa期原发性肝癌的临床效果。方法选取罗田县人民医院2015年1月至2017年1月间收治的Ⅰa期原发性肝癌患者114例,采用随机数字法将其分为PRFA组和腔镜组,每组各57例。比较两组患者并发症发生率,治疗前后肝功能水平、生存时间和无瘤生存时间。结果治疗后,PRFA组患者并发症总发生率为7.02%(4/57),腔镜组患者并发症总发生率为24.56%(14/57),差异有统计学意义(χ2=7.00,P<0.05)。治疗前,两组患者血清ALT、AST水平比较,差异均无统计学意义(P>0.05);治疗1个月后,两组患者肝功能水平均显著优于治疗前,且PRFA组患者肝功能水平显著优于腔镜组,差异均有统计学意义(P<0.05);治疗后,PRFA组患者生存时间和无瘤生存时间分别为(34.29±2.88)个月和(27.14±4.16)个月,腔镜组患者生存时间和无瘤生存时间分别为(28.30±4.11)个月和(22.67±3.99)个月,PRFA组患者生存时间和无瘤生存时间均显著优于腔镜组,差异均有统计学意义(P<0.05)。结论针对治疗Ia期原发性肝癌,PRFA与经腹腔镜下肝切除术比较,能够更有利于肝功能恢复,从而更加有效延长患者的生存时间和无瘤生存时间,同时降低并发症发生率,值得在临床推广。     

Short- and-long term results of intraoperative radiofrequency ablation of liver metastases

BACKGROUND: Surgical resection is the only therapeutic option with curative effect on malignant liver tumours, but in over 70% of cases, this is not a feasible option. A prospective study was performed to assess the short- and long-term effects of intraoperative radiofrequency ablation on unresectable liver metastases. PATIENTS: Between 1997 and 2001, 57 patients (mean age 61.9 years; range 31-83 years) with 297 unresectable liver metastases (colorectal adenocarcinoma, n=38; carcinoid tumour, n=4; malignant melanoma, n=3; other metastases, n=12) underwent intraoperative radiofrequency ablation. RESULTS: No mortality was observed in patients managed solely with radiofrequency ablation. Eight postoperative complications occurred in eight patients (14%). Three occurred when radiofrequency ablation was combined with resection. Of the 33 patients completely ablated, 30 patients are still alive and 21 are disease-free after a median follow-up of 18.1 months (range 2-43). Ten patients underwent more than one intraoperative radiofrequency ablation episode. Overall survival was 72.5% at 1 year and 52.5% at 3 years. Complete ablation and the number of lesions were significant independent prognostic factors for survival, with p<0.001 and p<0.0001, respectively. CONCLUSION: Radiofrequency ablation is a safe and effective option for patients with inoperable liver metastases without extra hepatic disease. Prospective controlled trials comparing the results of different treatments are required to assess which patients will benefit best from this emerging new treatment.     

Seeding after radiofrequency ablation of hepatocellular carcinoma in patients with cirrhosis: A prospective study

BACKGROUND: Neoplastic seeding of hepatocellular carcinoma may arise after radiofrequency ablation. AIMS: In order to clarify the real risk of seeding, we observed a prospective cohort of patients undergoing radiofrequency ablation. METHODS: Ninety-three (22.9%) out of 406 consecutive patients with hepatocellular carcinoma superimposed to cirrhosis diagnosed at our Liver Unit (2000-2005) were selected for radiofrequency ablation according to the Barcelona 2000 EASL guidelines. Seventy-one patients were treated by a percutaneous approach and 22 at laparotomy. After radiofrequency ablation ultrasound scan was repeated every 3 months and spiral-computed tomography every 6 months. RESULTS: Overall 145 sessions were performed in 93 patients: 113 (77.9%) by a percutaneous approach and 32 (22.1%) at laparotomy. The median follow-up was 23 months (range 1-60). Only 1 of the 71 patients (1.4%; 95% C.I. 0.25-7.56) treated percutaneously and none of the 22 (0%; 95% C.I. 0-14.8) treated at laparotomy showed neoplastic seeding. CONCLUSION: In our experience the risk of seeding of hepatocellular carcinoma after radiofrequency ablation was small (1.1% per patient, 95% C.I. 0.19-5.84; 0.7% per procedure, 95% C.I. 0.12-3.80). A stringent selection of patients for radiofrequency ablation and retraction of the needle with a hot tip may have been instrumental in obtaining this low frequency.     

Transpulmonary radiofrequency ablation for hepatocellular carcinoma under real-time computed tomography-fluoroscopic guidance

BACKGROUND/AIMS: Radiofrequency ablation has been accepted as a safe treatment for unresectable malignant hepatic tumors. Tumors beneath the diaphragmatic dome may be difficult to visualize with ultrasonography. The aim of this study was to assess the use of transpulmonary radiofrequency ablation under real-time computed tomography-fluoroscopic guidance for hepatocellular carcinoma. METHODOLOGY: Twenty-four radiofrequency ablation treatments by means of a transpulmonary approach were performed in 22 patients under computed tomography-fluoroscopic guidance between December 2002 and April 2006. Every patient had a hepatocellular carcinoma less than 3cm in size beneath the diaphragmatic dome. RESULTS: Transpulmonary radiofrequency ablation under real-time computed tomography-fluoroscopic guidance was successfully performed in every procedure. There was no local tumor recurrence in 22 cases (92%) on follow-up dynamic computed tomography performed an average of 8 months after radiofrequency ablation. The major complication was pneumothorax after 9 procedures (38%): pneumothorax in 6 patients had completely resolved on follow-up chest radiographs, and was treated with manual aspiration immediately after radiofrequency ablation in 3 patients, and no patients required chest-tube placement. CONCLUSION: Transpulmonary radiofrequency ablation under computed tomography-fluoroscopic guidance is a useful method for the accurate and safe ablation of hepatocellular carcinoma that is not detectable with ultrasonography.     

心腔内超声在心律失常射频消融术中的应用

目的探讨应用心腔内超声（ICE）在心律失常射频消融术中的疗效及安全性。 方法研究入选2020年5月至2021年2月在苏州大学附属第一医院心内科接受射频消融术治疗心律失常患者200例，年龄（60.40±12.14）岁，其中男126例。根据其术中是否应用ICE分为ICE组与对照组。比较两组间术中X线曝光时间、并发症及手术成功率。 结果①ICE组共100例患者，其中阵发性心房颤动（房颤）37例，持续性房颤35例，室性早搏28例；对照组100例患者中，阵发性房颤45例，持续性房颤39例，室性早搏16例；②ICE组X线曝光时间明显短于对照组［（2.65±1.98）min对（6.33±1.89）min，P<0.001］；③ICE组无1例于房间隔穿刺时出现心脏压塞，对照组3例于穿刺时出现心脏压塞；ICE组食管周围迷走神经损伤发生低于对照组（9例对21例，P=0.017）；两组股静脉穿刺相关并发症差异无统计学意义（P>0.05）；④ICE组和对照组阵发性房颤、持续性房颤和室性早搏手术成功率差异无统计学意义（90%对80%，74%对77%，89%对79%，P>0.05）。 结论ICE运用于心律失常射频消融术中可以显著提高手术安全性。     

程控刺激不能诱发的房室结折返性心动过速慢径消融的临床疗效评估

目的　评价程控刺激不能诱发的房室结折返性心动过速 (AVNRT)射频消融慢径的临床疗效。方法　 6 1例有心动过速病史且心电图疑诊为AVNRT的病人 ,电生理检查有房室结双径(DAVNP)但不能诱发AVNRT ,随机分为两组。A组 30例不消融而进行临床随访 ,当心动过速复发且经心电图证实为窄QRS心动过速者接受射频消融阻断慢径。B组 31例接受射频消融以阻断慢径 ,术后临床随访。结果　A、B两组分别有 2 4例和 2 7例病人完成随访。A组 2 4例随访中分别在 1年内发作心动过速 ,再次接受消融阻断慢径后随访 (12 .1± 12 .2 )个月 ,仅 1例复发心动过速 (4.2 % ) ,与消融前比较差异有显著性 (P <0 .0 0 0 1)。B组 2 7例平均随访 (2 4 .2± 17.6 )个月 ,1例复发心动过速 (3.7% ) ,与A组病人消融前相比差异有显著性 (P <0 .0 0 0 1) ,而与其消融后比较差异无显著性 (P >0 .0 5 )。结论　有阵发性心动过速病史且心电图疑诊为AVNRT的病人 ,电生理检查有DAVNP而不能诱发心动过速者 ,射频消融阻断慢径具有良好的临床疗效。