超声引导下行甲状腺囊实性结节热消融术的方法及疗效

目的 研究经超声引导下行甲状腺囊实性结节热消融术的疗效.方法 选取2017年4月至2018年6月在浙江省肿瘤医院就诊甲状腺结节患者65例,对共70枚囊性部分占40％～80％的甲状腺囊实混合性结节行超声引导下微波消融(MWA)或射频消融(RFA)术治疗.术后统计患者结节大小变化,计算手术前后结节体积,得出结节的体积缩小率...     

超声引导下热消融治疗甲状腺良性大结节的临床应用价值

目的 探讨超声引导下经皮热消融治疗甲状腺良性大结节(结节最大径≥4 cm)的临床应用价值.方法 选取2017年11月至2019年1月收治的诊断为良性甲状腺结节并经过治疗的患者作为研究对象.根据手术方式分为热消融组和腔镜手术组.对比两组患者手术并发症、治疗相关指标、术后生活质量评分等.结果 热消融组手术时间和术中出血量较...     

超声引导下射频消融甲状腺结节的并发症与预防方法探讨

目的通过对超声引导下射频消融治疗甲状腺结节并发症分析,探讨预防各种并发症的方法。方法观察111例甲状腺结节患者在射频消融治疗中、治疗后出现的各种并发症,并就其原因及预防方法进行探讨。结果本组病例均出现颈部疼痛,不能忍受者20例（18．02％）。术后放射性牙痛5例（4．50％）、放射性耳根痛7例（6．31％）,无任何处理,疼痛自行缓解。出血3例（2．70％）,经及时按压后出血停止。术后发生声音减低、饮水呛咳1例（0．90％）,无任何处置,观察2h声音自行恢复;喉返神经损伤2例（1．800．4）,经药物治疗1～L5个月后患者声音均恢复正常。结论超声引导下射频消融治疗甲状腺结节可能会发生喉返神经损伤、颈部出血、疼痛等并发症,但细心操作并随经验累积可将并发症降至最低;且喉返神经损伤多可在术后1～6个月恢复。采用“液体隔离带”辅助法是预防颈部重要结构受热损伤的一种有效手段。     

超声引导下射频消融甲状腺实性结节的临床应用价值

目的探讨超声引导下射频消融(RFA)甲状腺实性结节的方法、疗效及安全性。方法超声引导下对43例甲状腺结节患者58枚实性结节行射频消融治疗,术后采用常规超声及超声造影随访观察结节的大小、血供及并发症的发生情况。结果术后超声随访结节的体积较治疗前不同程度缩小(P<0.05),血流信号减少或消失,术后即刻超声造影显示53枚结节无增强,完全消融率为91.38%。术中难忍受的疼痛11例,放射性头痛3例,停止消融疼痛即可缓解。喉返神经损伤2例,经治疗声音恢复正常;1例术后即刻声音减低,未处理持续2h声音自行恢复。结论超声引导下射频消融治疗甲状腺实性结节效果显著,并发症少、安全性高、无手术疤痕,值得临床进一步推广应用。     

超声引导下射频消融与无水乙醇消融治疗甲状腺囊实性结节的Meta分析

目的 对比超声引导下射频消融（RFA）与无水乙醇消融（PEI）治疗甲状腺囊实性结节的临床疗效及安全性。方法 计算机和人工检索PubMed、Cochrane、万方数据及CNKI等数据库收录的RFA与PEI治疗甲状腺囊实性结节临床疗效及安全性的临床对照研究。研究者从中提取相关资料,根据Cochrane手册标准对纳入文献的质量予以评价。结果 最终10篇文献纳入研究,患者为900例。结果显示,RFA治疗甲状腺囊实性结节的体积缩小率高于PEI,差异有统计学意义（P<0.05);两组在并发症发生率方面差异无统计学意义（P>0.05）。结论 RFA治疗甲状腺囊实性结节临床疗效优于PEI,两组的并发症发生率无明显差异。     

超声引导下射频消融术治疗甲状腺良性结节所致并发症的多中心研究

目的评价射频消融术治疗良性甲状腺结节所致并发症的临床表现和影像学特点。材料与方法本回顾性研究获机构审查委员会批准,免除病人知情同意。从2002年6月—2009年9月,13个属于韩国甲状腺放射协会的甲状腺     

经皮微波消融治疗甲状腺良性结节吸收率影响因素分析

目的 探讨甲状腺良性结节微波消融（MWA）后结节吸收率,分析与结节吸收率相关的内部因素（结节超声表现）和外部因素（治疗相关表现）。方法 评估2016年1月至2018年1月期间接受MWA治疗的173例患者的173个甲状腺良性结节,中位体积4.23(2.27～9.00) mL。以第二年随访为终点,根据结节体积缩小特征,分为不完全吸收组（<100%体积缩小率）和完全吸收组（100%体积缩小率）。分析MWA后影响结节体积缩小的内部因素和外部因素。结果 几乎所有结节在MWA后体积明显缩小,73个结节在MWA后24个月达到100%体积缩减,即吸收率100%。随访1、6、12和24个月时,所有甲状腺良性结节的体积缩小率分别为18.0%, 78.7%, 89.0%, 94.5%。多因素分析显示,结节体积[校正后OR(AOR)=1.1,95%CI:1.0～1.2,P=0.04]、结节边缘（AOR=4.4,95%CI:1.4～13.8,P=0.01）、结节单位体积消融能量（AOR=1.0,95%CI:1.0～1.0, P<0.01）和结节外周血流阻塞（AOR=2.9,95%CI:1.1～7.4...     

超声引导下经皮热消融治疗低风险甲状腺乳头状微小癌的安全性和有效性

目的 评价超声引导下经皮热消融治疗低风险单灶性甲状腺乳头状微小癌(PTMC)的安全性和有效性.方法 纳入2017年6月-2019年6月解放军联勤保障部队第928医院收治的单灶PTMC患者,在超声引导下进行经皮热消融治疗.热消融后立即使用超声造影评估消融程度,分别于热消融后1、3、6、12、18个月测量消融区域大小及检测...     

超声引导下射频消融对甲状腺占位性病变治疗的研究进展

我国甲状腺疾病的发病率逐年增高,目前对甲状腺占位性病变的治疗方法包括药物治疗、外科手术和介入治疗等。近年来介入技术已成为部分甲状腺占位性病变的首选治疗方法,尤其以超声引导下的介入治疗为著。本文就超声引导下射频消融技术对甲状腺占位性病变治疗的应用作一综述。     

Percutaneous ultrasound-guided thermal ablation for intrahepatic cholangiocarcinoma

Objective

The objective of this study was to evaluate the treatment efficacy and overall survival (OS) of percutaneous ultrasound-guided thermal ablation by means of microwave ablation or radiofrequency ablation for intrahepatic cholangiocarcinoma (ICC).

Methods

18 patients with 25 ICC nodules underwent ultrasound-guided thermal ablation with curative intention. 8 patients were primary cases and 10 were recurrent cases after curative resection. The local treatment response, complications and survivals were analysed.

Results

Complete ablation was achieved in 23 (92.0%, 23/25) nodules (diameter, 0.7–4.3 cm; mean, 2.5±0.9 cm) and incomplete ablation was found in 2 (8.0%, 2/25) larger tumours (6.4 and 6.9 cm in diameter). No death associated with the treatment was found. The major complication rate was 5.5% (1/18). The follow-up periods ranged from 1.3 to 86.2 months (mean, 20.5±26.3 months; median, 8.7 months). OS rates for all patients at 6, 12, 36 and 60 months were 66.7%, 36.3%, 30.3% and 30.3%, respectively. By univariate analysis, the patient source (primary or recurrent case) was found to be a significant prognostic factor for OS rates (p=0.001). The patient source (p=0.001) and the number of nodules (p=0.038) were found to be significant prognostic factors for recurrence-free survival. OS rates for the primary ICC at 6, 12, 36 and 60 months were 87.5%, 75.0%, 62.5% and 62.5%, respectively.

Conclusion

Percutaneous ultrasound-guided thermal ablation is a safe and effective therapeutic technique for ICC. Acceptable survival can be achieved in primary ICCs, whereas the prognosis of recurrent ICCs is relatively poor.Intrahepatic cholangiocarcinoma (ICC) is a malignant tumour that arises from the epithelial cells of intrahepatic bile ducts (beyond the second order bile ducts). It constitutes approximately 5–30% of primary liver cancer, and the worldwide incidence of this malignancy has been increasing in recent years [1-6]. ICC often shows higher malignant grade and poorer prognosis than those of hepatocellular carcinoma (HCC). Until now, surgical resection has been the optimal therapy for ICC, offering a potential for curative treatment. However, many patients with tumours are not candidates for surgical resection because of the advanced stage of the disease at presentation, anatomical limitations and medical comorbidities. The high recurrence rate after resection and the lack of a valid treatment option also contribute to the poor prognosis. Currently there is no randomised study showing a survival benefit for a specific chemotherapeutic regimen. On the other hand, external radiotherapy does not show a significant impact on survival or quality of life [7-9].Image-guided thermal ablation by means of radiofrequency ablation (RFA) or microwave ablation (MWA) has been proven to be a viable option for the treatment of liver cancers, owing to its remarkable advantages, such as minimal invasiveness, easy performance, repeatability and cost-effectiveness [10-13]. In suitable cases, thermal ablation can be used as a curative option for HCC; however, the efficacy of thermal ablation for ICC lacks sufficient evidence [10]. In the present study, we analysed the local treatment response, complications and survival of 18 patients with ICC who had undergone ultrasound-guided thermal ablation.     

Factors influencing exercise-related transient abdominal pain

PURPOSE: Exercise-related transient abdominal pain (ETAP) is a widely experienced but poorly understood problem. This study examined the influence of age, gender, body mass index (BMI), training status, and sporting activity on the experience of ETAP and shoulder tip pain (STP). STP may occur as a result of referred pain from tissues innervated by the phrenic nerve; these tissues are implicated in theories proposed to explain ETAP. METHODS: A total of 965 regular sporting participants were surveyed from six sporting activities: running, swimming, cycling, aerobics, basketball, and horse riding. RESULTS: The prevalence (r = -0.28, P < 0.01) and severity (r = -0.17, P < 0.01) of ETAP decreased with age. Gender, BMI, and training status had no affect on the prevalence or severity of ETAP, but respondents who trained more frequently reported experiencing ETAP less often. Younger respondents were more inclined than the older respondents to report ETAP on the left side of the abdomen (P < 0.05). The prevalence (r = -0.11, P < 0.01) and severity (r = -0.37, P < 0.01) of STP decreased with age. STP was described as more severe (r = 0.23, P < 0.05) by respondents with high BMI values. Gender and training status had no influence on the experience of STP. Controlling for all other factors, ETAP was respectively 10.5 and 9 times more common (P < 0.01) in running and horse riding than cycling. STP was 13 times more common in running than cycling. CONCLUSION: Training status alters the frequency of occurrence of ETAP but has little effect on the incidence or severity of the pain. Further, ETAP and STP decrease with age but are not related to gender or BMI.     

Factors influencing the degree and outcome of acute beta-blockers poisoning

Since severe and fatal poisoning with beta-blockers due only to beta-receptor blockade is unlikely, a prospective and partly retrospective analysis of 67 patients with beta-blockers poisoning was done in five-year period in order to determine the factors influencing the degree and outcome of acute poisoning. According to pharmacological properties of drugs, the patients were divided in groups: group I--50 patients with propranolol, group II-A--10 patients with atenolol and group II-B--7 patients with metoprolol poisoning. Electrocardiogram (ECG), 24-h ECG monitoring, toxicological screening (determination of beta-blockers in blood, urine and lavage by high performance liquid chromatography) and biochemical analysis were performed in all patients. Significantly smaller number of patients with serious poisoning was observed in group II-B. Patient's age did not correlate with the degree of poisoning, but significant correlation was found between preexisting disease, ingested dose and the time elapsed before the treatment started. Analysis of pharmacological properties showed that membrane stabilizing activity and lipophilicity of the drug might be the important determinants of the toxicity, while the role of cardioselectivity was lost in an overdose.     

超声引导下微波消融治疗甲状腺良性腺瘤的体积缩小率与消融时间的相关性研究

目的：探讨超声引导下甲状腺良性腺瘤微波消融治疗后体积缩小率与消融时间的相关性。方法：收集75例甲状腺良性结节微波消融患者，术后1、3、6个月及1年复查并记录消融区体积，计算相应体积缩小率，并分析体积缩小率与单位体积消融时间的相关性。结果：①根据疗效判定，分为治愈、有效、好转、无效4组，分别两两比较单位体积消融时间，除好转组与失败组外，其他各组之间差异均有统计学意义（均P<0.05）；②消融术后体积缩小率与单位体积消融时间呈负相关，随着消融时间缩短，结节体积缩小率增大。结论：超声引导下微波消融治疗甲状腺良性腺瘤疗效确切，并发症发生率低。在甲状腺良性腺瘤消融完全的情况下，有效控制消融时间，可提高肿瘤体积缩小率。