超声引导经皮注射乙醇治疗中晚期肝癌

 超声引导经皮注射乙醇 (Percuta neousAlcoholInjection ,PAI)治疗中晚期肝癌具有疗效确切、侵袭性小、操作简便、患者易接受等优点。我们于 1996年6月～ 2 0 0 0年 9月应用PAI治疗中晚期肝癌 6 6例 ,取得满意效果 ,现报告如下。     

超声引导下经皮无水酒精注射在良性甲状腺囊性结节治疗中的研究进展

随着超声技术等检查方法的发展和普及,甲状腺结节的检出率逐渐增高。手术是治疗甲状腺结节的传统治疗方法。但因手术创伤、并发症和治疗后生活质量等因素,微创治疗逐渐被推荐应用。国外大量研究认为,对于单纯囊性和囊实性甲状腺良性病变较常用的微创治疗方法为超声引导下经皮无水酒精注射。现回顾近年来国外有关经皮无水酒精对囊性甲状腺良性结节治疗的研究,并作一综述。     

超声引导下射频消融治疗乳腺良性肿瘤

近年来,射频消融（radiofrequency ablation）技术成功地用于治疗肝癌、肺癌、胰腺癌、乳腺癌、肾上腺癌、肾腺癌、腹膜后肿瘤以及骨肿瘤（骨转移癌）等实体肿瘤,并取得了良好的效果[1],但国内外用射频消融治疗乳腺良性肿瘤的报道较少,本文总结了本院应用射频消融术的经验,探讨超声引导下射频消融治疗乳腺良性肿瘤的可行性.     

超声引导下经皮肝穿注射无水酒精治疗中晚期肝癌的临床研究

1994年 2月以来 ,我院采用超声引导下经皮肝穿刺瘤体内注射无水酒精疗法 (ＰＥＩＴ)治疗中晚期肝癌 138例 ,取得了较好的临床疗效 ,报告如下。1　临床资料1.1　一般资料本组 138例 ,男 79例 ,女 5 9例 ;年龄 2 8～ 70岁。 40岁以下 11例 ,40～ 5 0岁 38例 ,5 0～ 6 0岁 6 8例 ,6 0～ 70岁 2 1例。其中原发性肝癌 131例 ,7例为转移性肝癌。 138例病人均经Ｂ超、ＡＦＰ、ＣＴ等检查定诊 ,大部分病人治疗前经肝活检病理检查发现癌细胞确诊。本组病人均有不同程度的消瘦 ,其中发热 14人 ,腹部胀痛 10 1人 ,纳差乏力 88人 ,少量腹水 2 6人 ,黄疸 …     

肝切除术与经皮乙醇注射治疗小肝癌的疗效比较

据意大利学者报道，对于小肝细胞肝癌(HCC)患者，肝切除术或经皮乙醇注射(PEI)治疗的存活率是相同的。意大利那不勒斯Nazionale Tumori研究所的Bruno Daniele博士指出，小HCC患者经常采用肝切除术或PEI治疗，为此，研究人员通过意大利肝癌计划(CLIP08)中配对病例．对照研究比较了肝切除术与PEI对存活率的影响。研究人员选择进行肝切除术(病例)或PEI(对照)治疗的单结节HCC(≤5cm)患者进行研究，配对标准为诊断时间、     

超声引导下热消融治疗甲状腺结节的研究进展

摘 要：超声引导下热消融治疗是一种新的微创治疗技术。随着甲状腺疾病检出率的逐年增高,热消融以其安全性高、疗效好和可重复治疗等优点成为部分甲状腺结节的可选治疗方法。热消融法主要包括射频消融、微波消融和激光消融等,文章就超声引导下热消融技术对甲状腺结节治疗的应用作一综述。     

经皮引导下甲状腺良性结节微波消融的疗效分析

【摘要】目的 探讨经皮超声引导下甲状腺良性结节消融治疗的临床疗效及安全性。方法 对2015年5月至2019年4月江苏省肿瘤医院、淮安市洪泽区人民医院、南京市江宁医院、句容市人民医院及南通第一人民医院甲状腺治疗中心甲状腺良性结节980例,共1 480枚病灶,超声实时监测及引导下将水冷式微波天线植入结节内,采用单点或多点一次性完全消融。消融后即时超声造影评价疗效。结果 经过1个月、3个月、6个月、12个月随访,甲状腺结节体积及最大径持续缩小(P<005),12个月以后缩小不明显(P>005),共有124枚病灶消失。手术前后患者甲状腺功能无明显变化,无并发症发生。结论 超声引导下甲状腺良性结节微波消融治疗安全有效、副作用小,值得临床推广。     

超声引导下微波消融治疗甲状腺腺瘤的临床分析

目的 探讨超声引导下微波消融治疗甲状腺腺瘤的临床疗效和安全性。方法 回顾性分析2014年7月至2016年7月74例行超声引导下微波消融治疗甲状腺腺瘤患者的临床资料,分析消融术后腺瘤体积缩小情况、术后甲状腺功能指标（三碘甲状腺原氨酸、甲状腺素、游离三碘甲状腺原氨酸、游离甲状腺素及促甲状腺激素）变化情况及术后并发症发生情况。结果 74例患者共微波消融结节104枚。所有患者术后恢复良好,仅1例术后出现轻微局部血肿,无其他并发症发生。术后随访无1例复发,术后1、3、6、12、24个月腺瘤体积缩小率分别为（11.73±37.21）％、（28.71±26.72）％、（53.33±38.24）％、（78.56±15.31）％和（94.28±4.54）％,术前与术后1个月甲状腺功能指标水平无显著性差异（P＞0.05）。结论 超声引导下微波消融治疗甲状腺腺瘤的安全性高、创伤小、术后恢复快,疗效确切而且美观,值得临床推广。     

经皮穿刺注射乙醇治疗肝细胞癌

肝细胞癌是世界上最常见的恶性肿瘤之一,尤其好发于亚、非洲国家。新近,各种影像技术,特别是超声检查和血清甲胎蛋白(AFP)测定,已成功用于肝肿瘤的检测。对高危病人,如乙型肝炎表面抗原携带者和慢性肝脏疾病患者的筛选检查,使越来越多的早期病例得以诊断。其中2/3属于单个病变,且直径小于3cm。肝原发性肿瘤外科根治性平术虽被认为是一种最有可能完全缓解并延长病人生命的治疗方法,但肝细胞癌的可切除率仍然是相当低     

Percutaneous ethanol injection under interventional radiographic computed tomography-fluoroscopic guidance for the treatment of small hepatocellular carcinomas

Background Some small hepatocellular carcinoma (HCC) lesions show as tumor stains by dynamic CT, but cannot be detected by ultrasonography. Percutaneous ethanol injection (PEI) is effective for treating small HCC lesions, but lack of adequate visualization of some lesions can limit its use. In this study, interventional radiographic, CT-fluoroscopically-guided PEI was performed as a new method for treating small HCC lesions that were diffucult to detect by ultrasonography. Methods Interventional radiographic, CT-fluoroscopically-guided PEI was performed on 11 patients (12 lesions) with HCC lesions measuring 2 cm or less in diameter. A thin needle was introduced into each tumor under CT-fluoroscopic guidance, with injection of contrast medium into the dominant hepatic artery. While lesions were observed using CT-fluoroscopy with the arteriogram, absolute ethanol was injected into the tumors. The ethanol injection rate and volume were monitored by observation of loss of tumor staining during real-time CT angiography. Results Needle introduction was successful in all 12 lesions, and disappearance of tumor staining was immediately observed on CT images after ethanol injection. Complications noted after treatment were local abdominal pain in all 11 patients, a slight fever in 9 patients, pneumothorax, right pleural effusion, and ascites, each in 1 patient. No other serious complications were observed. Conclusions Interventional radiographic, CT-fluoroscopically-guided PEI is effective in the treatment of small HCC lesions, which are difficult to show by ultrasonography and treat by conventional PEI.     

甲状腺不典型良性结节超声声像图特征的回顾性分析

目的 探讨甲状腺不典型良性结节的超声声像图特点,以提高鉴别甲状腺良恶性结节的准确性.方法 回顾性分析405例行甲状腺超声检查并行手术切除患者的临床资料,对患者的405个甲状腺结节进行超声检查,并与术后病理结果进行对照研究.结果 经术后病理证实,405个甲状腺结节中,362个为恶性结节,43个为良性结节,超声诊断准确率为89.4％.良性结节中以结节性甲状腺肿为主,结节形态不规则、边界不清晰及结节内点状强回声为其最主要的表现.结论 常规超声辅助其他超声技术有助于提高对甲状腺结节良恶性诊断的准确性.     

常规超声联合超声造影鉴别甲状腺结节良恶性的价值

目的 探讨常规超声联合超声造影技术鉴别甲状腺良恶性结节的价值.方法 对62例患者的75个甲状腺低回声结节进行常规超声及超声造影检查,测量结节大小,观察结节形态、边界、位置、有无微小钙化、血流情况及超声造影检查结果.结果 甲状腺结节内部具有多发微小钙化低回声结节13个,形态不规则低回声结节69个,边界不清晰低回声结节69个,结节邻近包膜浸润11个.造影后37个低回声结节呈无增强,38个低回声结节呈低增强,28个低回声结节体积变小.经常规超声检查诊断甲状腺恶性结节65个,经超声造影检查诊断甲状腺恶性结节64个,术后病理证实甲状腺乳头状癌62个,结节性甲状腺肿13个.常规超声联合超声造影诊断甲状腺恶性结节64个,灵敏度为100％,特异度为84.6％,Kappa=0.901.结论 常规超声联合超声造影有助于提高对甲状腺恶性结节的诊断能力.     

超声诊断甲状腺结节钙化的临床意义

目的：探讨超声诊断甲状腺钙化结节在临床诊治中的意义。方法：回顾分析2009年本院进行手术的227例甲状腺结节患者的临床,彩色多谱勒超声和病理资料。结果：227例甲状腺结节中,43例有钙化,占18．94％（43／227）。甲状腺钙化结节存在于各种病理类型,但恶性甲状腺结节钙化率41．38％（12／29）,明显高于良性甲状腺结节钙化率15．66％（31／198）,差异有显著性（P〈0．005）。在43例存在钙化的甲状腺结节中,微钙化17例,粗钙化26例,微钙化常发生在恶性肿瘤,粗钙化多发生在甲状腺良性病变。结论：彩色多谱勒超声发现甲状腺钙化结节需引起注意,若为微钙化提示甲状腺恶性肿瘤可能性大,应尽早手术治疗,粗钙化提示甲状腺良陆疾病可能性大,需密切随诊观察。     

肝动脉栓塞化疗结合无水酒精注射治疗中晚期原发性肝癌疗效分析

Objective:To evaluate the clinical efficacy of the combined treatment with transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) on hepatocellular carcinoma (HCC). Methods:312 patients with moderate or advanced HCCs were divided into two groups: 170 cases underwent TACE treatment alone, 142 cases were treated with TACE and PEI under B-ultrasotmd guidance. Results:The rates of reduction in tumor diameter and the decline in serum AFP level were 41.2% and 40.4% in the TACE group and 75.4% and 74.1% in the TACE PEI group respectively. The 6, 12 and 24 months survival rates in the TACE group were 77.1%,34.1% and 18.8%,respectively and in the TACE PEI group 87.3%, 62.0% and 38.0%, respectively. Overall, there was a significant difference between the two treatment groups (P＜0.05). Conclusion：Treatment on HCCs with TACE PEI is convenient, safe and results in better survival rates than TACE alone.     

超声诊断甲状腺结节钙化的临床意义

目的:探讨超声诊断甲状腺钙化结节在临床诊治中的意义。方法:回顾分析2009年本院进行手术的227例甲状腺结节患者的临床,彩色多谱勒超声和病理资料。结果:227例甲状腺结节中,43例有钙化,占18.94%(43/227)。甲状腺钙化结节存在于各种病理类型,但恶性甲状腺结节钙化率41.38%(12/29),明显高于良性甲状腺结节钙化率15.66%(31/198),差异有显著性(P<0.005)。在43例存在钙化的甲状腺结节中,微钙化17例,粗钙化26例,微钙化常发生在恶性肿瘤,粗钙化多发生在甲状腺良性病变。结论:彩色多谱勒超声发现甲状腺钙化结节需引起注意,若为微钙化提示甲状腺恶性肿瘤可能性大,应尽早手术治疗,粗钙化提示甲状腺良性疾病可能性大,需密切随诊观察。     

Percutaneous microwave ablation of thyroid nodules: effects on thyroid function and antibodies

Abstract

Purpose: Microwave ablation (MWA) is a new minimally invasive method for thermal ablation of benign thyroid nodules with promising results. The aim of this study was to investigate whether MWA has an impact on thyroid function. Materials and methods: Thirty patients with a total of 34 benign thyroid nodules underwent MWA between January 2013 and July 2014. Serum levels of triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyroglobuline (Tg) and additionally antibodies against Tg (anti-Tg), thyrotropin receptors (TRAb) and thyroid peroxidase (anti-TPO) were measured at enrolment, 24?h after MWA, as well as at the 3-month and 6-month follow-up. Moreover, the nodule volume was evaluated to determine effectiveness. Results: Serum TSH, T4, T3 and Tg levels did not change significantly at the 3-month or 6-month follow-up (p?>?0.05); thyroid function was not affected by MWA. Antibody levels did not change significantly either; however, two patients developed antibodies after treatment. A volume reduction of 51.4% or 7.85?mL could be demonstrated after 3 months and a reduction of 55.8% or 14.0?mL after 6 months. Slight complications such as mild pain during the ablation or superficial haematomas emerged. The development of Graves’ disease and mild Horner’s syndrome were observed as more severe side effects. Conclusions: The data suggest MWA as an alternative for the treatment of benign thyroid nodules. While first results for preservation of thyroid function are positive, further measurements of laboratory data and especially antibodies are necessary.     

Anaplastic thyroid carcinoma: Current diagnosis and treatment

Background:Anaplastic thyroid carcinoma (ATC), accounting for5% to 15% of primary malignant thyroid neoplasms, is one of themost aggressive solid tumors in humans. Generally, it is rapidly fatal, witha mean survival of six months after diagnosis. Multimodality treatment withsurgery and/or external beam radiotherapy and chemotherapy are of fundamentalimportance for local control of disease and to enhance survival. Design:We evaluated consecutive patients with ATC observed at theMayo Clinic from 1971 to 1993 and reviewed relevant articles published inmajor English-language medical journals. We used the MEDLINE database,selected bibliographies, and articles available in our personal files. Results:ATC usually does not concentrate radioiodine or expressthyroglobulin. It is essential to verify the diagnosis histologically becauseinsular thyroid cancer, lymphomas, and medullary thyroid cancer areoccasionally confused with undifferentiated neoplasms. Immunohistochemicalstudy is helpful in establishing the diagnosis. Multimodal therapy and thedevelopment of effective systemic chemotherapeutic agents should result inimprovements in survival, although no single agent has yet been identified. Conclusions:Aggressive multimodality treatment regimens showpromise in improving local control in patients with ATC. However, survivalrates remain low. Despite intense application of such therapy, no standardizedsuccessful treatment protocol has been established.     

改良法注射无水乙醇治疗肝癌的疗效

目的：介绍及推广改良式无水乙醇注射法治疗肝癌。方法：将上述的改良法与传统方法的近期疗效,副作用等进行比较。结果：同既往常规注射法对比,改良式无水乙醇注射法明显提高注射量和弥散比。疗效较前者为优,P〈0.01,对直径大于3cm之癌灶疗效尤佳。同时术后减压减少乙醇外溢,减少疼痛,患者乐于接受。结论：新方法在疗效,副作用方面较常规法有明显优势,值得临床大力推广。