CO2激光治疗睑缘疣和睑缘痣86例的疗效及护理体会

睑缘疣和睑缘痣是皮肤科门诊的常见病、多发病,病变影响美容,严重影响视野,给患者日常生活带来不便。我科自2008年1月至2010年10月共收治睑缘疣50例,睑缘痣36例,CO2激光治疗效果满意,无瘢痕、睑缘外翻等并发症。     

射频消融治疗眼周汗管瘤的疗效观察

目的评估射频消融治疗眼周汗管瘤的临床疗效。方法 64例眼周汗管瘤患者接受刺入式射频消融治疗,手术在头式放大镜下进行,针状消融电极与射频发射器相连,刺入皮损并将射频能量传输至位于真皮层的病灶底部。治疗前后分别对患处拍照,以数码照片评分及患者满意度调查结果为观察指标。结果每例患者最多进行3次治疗,每次术后评估临床疗效,评分≥3级的患者比率依次为71.9%,83.3%和100%。医师评估与患者评价结果的一致性(第1次治疗后kappa=0.78;第2次治疗后kappa=0.82)。结论刺入式射频消融可以有效、精准、安全地治疗眼周汗管瘤。     

CT导向下射频消融治疗不能手术切除肺癌患者的临床分析

目的:探讨CT导向下射频消融对不能手术切除肺癌治疗的有效性及安全性。方法:回顾性分析23例经CT导向下射频消融治疗的肺癌患者,其中原发性肺癌患者17例,肺癌术后转移6例,评价其治疗局部有效率和1年无进展生存期。结果:本组共23例患者共行33次射频消融治疗,手术均顺利完成。平均随访时间18.3月(13～30个月),局部控制率在3月、6月及1年分别是96.8%、93.5%及86.7%,1年无进展生存率73.9%。余发生与手术相关的严重并发症。结论:CT导向下射频消融在肺癌治疗中是一种安全有效的局部治疗方法。     

激光祛除睑缘文刺术后角膜擦伤——附2例报告

正激光祛除睑缘文刺存在着皮肤肿胀、淤血、过敏、感染、角膜损伤和睫毛毛囊损伤等不良反应。其中,激光术后角膜擦伤的发生率很低,但应及时发现和治疗,以免继续加重。为此,笔者回顾分析了2013~2015年,采用激光祛除睑缘文刺患者132例的临床资料,其中2例发生角膜擦伤,现报告如下。资料与方法1.临床资料病例1,女性;年龄43岁。双侧下眼线文饰近20年,蓝黑色,影响美观,要求祛除。     

CT引导下肺癌64例射频消融治疗的扫描方法

CT引导下肺癌的射频消融治疗,比开胸手术或胸腔镜下射频消融治疗有着无法比拟的优势,目前已广泛应用于临床。本研究就CT引导下肺癌射频消融治疗中扫描参数的选择、三维重建的方法以及控制扫描剂量等问题进行探时。     

三维标测系统指导下射频消融治疗房颤的护理观察

目的：探讨三维标测系统指导下射频消融治疗房颤的护理。方法对172例房颤患者行三维标测系统指导下射频消融治疗的观察和护理。结果手术顺利完成,手术并发症发生率低。结论三维标测系统指导下射频消融治疗房颤安全有效,有针对性的观察及有预见性的护理配合是治疗成功的重要保障。     

手术切除与射频消融治疗符合米兰标准的原发性肝癌的疗效对比分析

目的 分析手术切除与射频消融治疗符合米兰标准的原发性肝癌的有效性和安全性.方法 回顾性分析2010年12月-2012年7月在解放军302医院行手术切除或射频消融治疗的105例符合米兰标准的原发性肝癌患者临床资料,比较两组术后生存率、无瘤生存率、并发症及住院天数.结果 105例患者分为单发单纯组73例,多发联合组32例.分析结果表明,单发单纯组与多发联合组手术切除术后3年总生存率及总无瘤生存率均优于射频消融治疗(P＜0.05),射频消融治疗后主要并发症发生率明显低于手术治疗(P＜0.05),且射频消融术后具有住院时间短、恢复快等优势.结论 符合米兰标准的原发性肝癌可从外科手术中获益,且远期疗效优于射频消融治疗.     

超声辅助下射频消融治疗异常子宫出血临床观察

目的：观察超声辅助下子宫内膜射频消融治疗异常子宫出血的临床效果.方法：异常子宫出血80例,随机分成对照组40例,行宫腔镜下子宫内膜电切术治疗;观察组40例,行超声辅助下子宫内膜射频消融治疗.比较两组手术时间、术中出血量、术后发病率等.结果：两组在手术时间、术中出血量、术后病率等方面比较,差异显著（P＜0.05）;两组总有效率比较,无显著差异（P＞0.05）.结论：超声辅助下子宫内膜射频消融是治疗异常子宫出血简单、快速、安全、经济、有效的微创手术方法.     

复发性小肝癌再次手术与射频消融的临床分析

目的:总结复发性小肝癌的外科治疗方法。方法回顾性分析2005年1月至2008年6月第1次手术后复发的小肝癌35例患者的临床资料,分为再次手术组和射频消融组,比较两组术后3年生存及复发情况。结果再次手术组18例,均行肿瘤局部切除术,射频消融组17例,均行局部射频消融治疗。再次手术组3年无瘤存活率(66.1%,11/18)高于射频消融者(47.1%,8/17)(P<0.05),手术切除肿瘤局部复发率(22.2%,4/18)低于射频消融(35.6%,5/17)(P<0.05),直径<3cm的肿瘤,采用手术或射频消融治疗3年生存率和复发率差异无统计学意义(P>0.05),3～5cm肿瘤采用手术治疗者3年生存率高于射频消融治疗,复发率低于射频消融治疗(均P>0.05)。结论对复发性小肝癌瘤体小于3mm者应根据患者情况并充分考虑患者意愿进行治疗,对肿瘤为者则以手术为宜。     

探讨CT引导下射频消融治疗无法手术治疗的老年非小细胞肺癌患者的疗效及预后

目的：探讨计算机体层成像（computed tomography,CT）引导下射频消融治疗无法手术治疗的老年非小细胞肺癌（non-small cell lung cancer,NSCLC）患者的疗效及预后。方法：选取2010年1月—2014年1月南宁市红十字会医院收治的191例无法手术治疗的老年NSCLC患者作为研究对象。观察射频消融治疗老年NSCLC的疗效、安全性及预后情况。结果：191例老年NSCLC患者CT引导下射频消融治疗手术均取得成功,术后总有效率为47.12%。191例患者治疗期间并发症发生率为49.74%,无死亡患者。191例NSCLC患者1、3、5年总生存率为94.76%、70.68%、37.70%;1、3、5年无瘤生存率为84.82%、62.83%、28.27%。Cox单因素及多因素分析显示肿瘤直径、TNM分期、淋巴结转移、分子靶向治疗及淋巴管血管侵犯与老年NSCLC患者总生存期密切相关,肿瘤直径、淋巴结转移及淋巴管血管侵犯与老年NSCLC患者无瘤生存期密切相关。结论：CT引导下射频消融对无法手术治疗的老年NSCLC患者有一定疗效,安全性尚可。肿瘤直径、TNM分期、淋...     

Image-Guided Radiofrequency Ablation (RFA) of Unresectable Hepatic Tumors Using a Triple-Spiral-Shaped Electrode Needle: Initial Experience in 34 Patients

We evaluated the safety and efficacy of image-guided radiofrequency ablation (RFA) using a triple-spiral-shaped electrode needle for unresectable primary or metastatic hepatic tumors. Thirty-four patients with 46 index tumors were treated. Ablation zone, morbidity, and complications were assessed. The lesions were completely ablated with an ablative margin of about 1 cm. Five patients (14.7%) with a lesion larger than 4.5 cm had local tumor progression after 1 month and were retreated. Hemothorax, as a major complication, occurred in 1 of 34 patients (3.0%) or 1 of 46 lesions ablated (2.2%). RFA using this new electrode needle can be effective in the treatment of large unresectable hepatic tumors.     

经皮射频消融治疗膈下肝癌

目的评价CT引导下冷循环射频消融治疗膈下肝癌的可行性和疗效。方法20例肝癌患者共25个膈下病灶在CT引导下行冷循环射频消融治疗,术后复查增强CT或增强MR,观察病灶坏死情况。结果18个病灶完全坏死,病灶完全坏死率72%,其余7个病灶大部分坏死,无严重并发症。结论CT引导下冷循环射频消融术治疗膈下肝癌安全、有效。     

Do surgical clips interfere with radiofrequency thermal ablation?

OBJECTIVE: This study sought to evaluate whether surgical clips affect tissue conductivity and thereby alter the induction of radiofrequency ablation lesions and to determine whether therapy is safe after previous placement of clips in the liver. MATERIALS AND METHODS: An ex vivo porcine hepatic model was used. Three clips were placed around a radiofrequency electrode at 10, 20, and 30 mm from the point of insertion. Clips were arranged in a plane either perpendicular or parallel to the electrode track. After placement of the liver specimen on a grounding pad, radiofrequency energy was applied in a standardized manner for 5 min. Lesion growth and morphology were documented for each minute. RESULTS: Radiofrequency lesions appeared circular and homogeneous after 5 min. Lesion diameter perpendicular to the radiofrequency electrode averaged 30 mm. However, lesion formation was irregular during the early phase of the radiofrequency ablation. The lesion extended irregularly toward the 1-cm clip after 60 sec of ablation. During the second minute, a distinct lesion was observed around the clip 1 cm from the electrode; the primary lesion had not yet reached the clip. During the final 3 min, the primary lesion reached the 1-cm clip and ultimately incorporated the satellite lesion. No lesions were detected surrounding the more distant clips. CONCLUSION: Our data suggest that with the parameters applied in our study, radiofrequency ablation can be safely performed in patients with implanted clips. No aberrant conduction is observed around surgical clips that are located 20 mm and further from the radiofrequency electrode.     

Short communication. Development of a fine thermocouple-needle system for real-time feedback of thermal tumour ablation margin

Thermal tumour ablation techniques such as radiofrequency (RF) ablation are applied for radical removal of local tumours as an easier, less invasive alternative to surgical resection. A serious drawback of thermal ablation, however, is that the ablation area cannot be accurately assessed during the procedure. To achieve real-time feedback and exact and safe ablation, a superfine thermocouple-needle system (TNS) comprising a 0.25-mm diameter thermocouple embedded in a 22-G, 15-cm-long needle was devised and efficacy was tested in vitro using porcine livers (n = 15) and in vivo using rabbit back muscles (n = 2) and livers (n = 3). A 17-gauge RF electrode with a 2 cm active tip was used for ablation. The TNS was inserted 1 cm from the active tip of the RF electrode and liver temperature around the electrode was measured concurrently. The RF current was cut off when the temperature reached 60°C or after 5 min at ≥50°C. Porcine livers and rabbit back muscles were then cut along a plane passing through the axes of the electrode and the TNS. In rabbit livers, contrast-enhanced CT was performed to evaluate ablation areas. Ablation areas in cut surfaces of porcine livers exhibited well-defined discoloured regions and the TNS tip precisely pinpointed the margin of the ablation area. Contrast-enhanced CT of rabbit livers showed the TNS tip accurately located at the margin of areas without contrast enhancement. These results indicate that the TNS can accurately show ablation margins and that placing the TNS tip at the intended ablation margin permits exact thermal ablation.     

Small (< or = 2-cm) breast cancer treated with US-guided radiofrequency ablation: feasibility study

PURPOSE: To determine the feasibility and safety of ultrasonographically (US) guided percutaneous radiofrequency (RF) ablation in the local treatment of invasive breast carcinomas 2 cm or less in greatest diameter. MATERIALS AND METHODS: RF ablation of 21 malignant lesions was performed in 20 patients immediately before their scheduled lumpectomy or mastectomy. A 15-gauge needle electrode was placed in the lesions, and the prongs of the needle electrode were deployed with real-time US guidance. A temperature of approximately 95 degrees C was maintained for 15 minutes at the tips of the prongs. Histopathologic examination of the resected specimens included use of nicotinamide adenine dinucleotide in its reduced form-diaphorase stain, which is specifically used to confirm thermal cell injury and lack of viability. The desired outcome of the procedure was ablation of the tumor and of an adequate margin around it, as confirmed by the absence of viable tissue in the surgical specimen. RESULTS: In all 21 cases, complete ablation of the target lesion was visualized at US. In one patient, who had undergone preoperative chemotherapy for a mass that was initially judged to be a T2 tumor but who was found to have a small residual tumor at mammography and US performed at the time of ablation, the target lesion was ablated but residual in situ mammographically and US occult invasive carcinoma was found at histopathologic examination. There were no adverse effects. CONCLUSION: US-guided percutaneous ablation of small invasive breast carcinomas is feasible and safe.     

CT-guided radiofrequency liver tumour ablation: use of a two-step coaxial system with a fine guide needle wire unit for high-risk cases

Accurate radiofrequency (RF) needle targeting to liver lesions under CT guidance is technically difficult and generally requires multiple needle manipulations, which carries potential risk. This approach is hardly applicable for precariously located lesions or for patients who have difficulty holding their breath. The aim of this study was to develop a novel two-step coaxial system to facilitate CT-guided RF ablation in difficult cases. The study group comprised 11 patients with 12 hepatic lesions. The coaxial system consisted of two parts: a 21-gauge pencil-tip guide needle wire (GNW) unit comprising a 150-mm-long needle segment and a 250-mm-long wire segment; and a 140-mm-long outer cannula with its stylet, which accepts a 17-gauge RF electrode needle. The GNW was inserted until the route of the GNW was confirmed to be positioned correctly. The cannula with the stylet was then advanced along the GNW. Lesions were successfully accessed using the GNW, even in patients who could not hold their breath, and manipulation was feasible within the limited space of the CT gantry. The light GNW also facilitated step-by-step CT-guided angular manipulations, unlike heavy RF electrodes, which are unstable during hands-free use unless deeply inserted. Therefore, this system enabled sequential ablations of large tumours by ensuring three different routes in advance by using the GNW. Insertion of the cannula along the GNW was simple. In conclusion, the two-step coaxial system enabled CT-guided RF tumour ablation to be performed in cases conventionally contraindicated owing to high risk of serious complications.     

CT-guided radiofrequency ablation of renal cell carcinoma in a patient with solitary kidney after contralateral nephrectomy: a case report

A 62-year-old man with renal cell carcinoma in the solitary kidney after right nephrectomy underwent CT-guided radiofrequency ablation. The tumor, which was located in the dorsal part of the lower aspect of the kidney, was exophytic and measured 2 cm in diameter. A 17-gauge, internally cooled radiofrequency needle electrode was placed percutaneously into the center of the lesion. Dynamic CT 6 days after the first ablation showed band-like residual lesion along the intact renal parenchyma. A second ablation was performed for the residual lesion. CT both 1 and 3 months after the second procedure demonstrated complete ablation with the normal renal parenchyma maintained.     

离体猪椎体多极射频消融范围及热场分布

目的 通过对离体猪椎体进行射频消融(RFA),观察其骨质凝固范围及热场分布,探讨RFA时电极针在椎体中的位置与脊髓的安全性关系,以及椎体周围有无软组织损伤.方法 取30节新鲜成年猪椎体,随机分成两组.电极针深度分别为10、20 mm.消融达稳态后按预先设计测温点测温.消融20 min后,沿电极针及垂直于电极针平面切开观察骨质凝同范围.结果 各测温点在3.5 min达稳态.靠电极越近温度上升越快.两组椎体周围软组织无损伤,当电极针深10、20 mm时均无脊髓损伤.结论 对椎体后壁保持完整的椎体转移性肿瘤RFA治疗安全、可靠.     

肝肿瘤射频消融电极针研究进展

射频消融(RFA)是目前广泛应用于肝肿瘤治疗的微创、有效方法,适用于不愿或不宜外科手术治疗患者.近20余年来RFA技术取得了长足的发展与进步.作为主要治疗工具,射频电极针对RFA疗效具有很大影响.该文就目前临床常用或处于研发阶段的射频电极针,如多针尖可扩展电极针、灌注电极针、内冷却电极针及双电极针等的特点进行总结,比较它们的优势与不足,展望进一步研究方向,以提高RFA治疗肝肿瘤效果.