超声引导经皮双极射频消融治疗肝癌的局部疗效观察

目的观察超声引导经皮双极射频消融治疗肝癌的局部疗效。方法选取我院2012年5月~2013年10月收治、以治愈性治疗为目的的24例肝癌患者32个病灶,对所有患者均采取超声引导下经皮双极射频消融进行治疗,术后1个月观察患者影像学(超声造影、增强CT或增强MRI)检查结果,以评价局部疗效,以后每3个月随访一次,以观察患者复发情况。结果病灶完全消融(CA)率96.9%(31/32),其中最大径3cm病灶CA率为100%(27/27),最大径≥3cm病灶CA率为80%(4/5);原发性肝癌完全CA率95.7%(22/23),转移性肝癌CA率100%(9/9)。所有患者均未出现严重并发症及与手术相关的死亡。随访2~19个月,局部复发率为6.3%(2/32)远处复发率为33.3%(8/24)。结论超声引导下经皮双极射频消融治疗肝癌安全可靠、局部疗效确切,对小肝癌尤其明显。     

Lateral femoral cutaneous nerve conduction v somatosensory evoked potentials for electrodiagnosis of meralgia paresthetica.

The aim of this study is to compare sensory nerve conduction with somatosensory evoked potentials of the lateral femoral cutaneous nerve to determine which is the most reliable electrodiagnostic method to assess meralgia paresthetica. Thirty patients with unilateral clinically defined meralgia paresthetica and 30 controls were studied with both methods. The main outcome measures were sensory action potential side-to-side amplitude ratio, somatosensory evoked potentials side-to-side latency difference, and side-to-side amplitude ratio. Sensory nerve conduction was abnormal in all patients: only four participants had abnormal somatosensory evoked potentials with double derivation (Fz/Cz and Ci/Cc) recording, and eight participants had abnormal findings with Fz/Cz derivation. Overall, this study demonstrates that sensory nerve conduction is the more reliable method for meralgia paresthetica electrodiagnosis. In fact, only very serious nerve damage regularly induces abnormal somatosensory evoked potentials, which is not recommended for routine electrodiagnostic study of meralgia paresthetica.     

Bidirectional tachycardia eliminated with radiofrequency ablation

This report describes an unusual case of bidirectional tachycardia eliminated with radiofrequency ablation. The tachycardia had alternating right and left bundle branch block morphology on a beat-to-beat basis and was successfully eliminated by ablating the right and left bundle branch block ventricular ectopic beats present during sinus rhythm.     

超声引导经皮双极射频消融治疗良性甲状腺结节的局部疗效观察

正甲状腺良性结节通常无需处理,但随着结节增大可能影响美观或有压迫不适感,此时多需要治疗。射频消融(radiofrequency ablation,RFA)作为一种微创治疗方式,目前临床已广泛用于甲状腺结节的治疗~([1])。本组旨在对行超声引导经皮双极RFA治疗的良性甲状腺结节的局部疗效进行分析。     

Treatment of bone tumours by radiofrequency thermal ablation

Radiofrequency thermal ablation (RFTA) is considered the treatment of choice for osteoid osteomas, in which it has long been safely used. Other benign conditions (chondroblastoma, osteoblastoma, giant cell tumour, etc.) can also be treated by this technique, which is less invasive than traditional surgical procedures. RFTA ablation is also an option for the palliation of localized, painful osteolytic metastatic and myeloma lesions. The reduction in pain improves the quality of life of patients with cancer, who often have multiple morbidities and a limited life expectancy. In some cases, these patients are treated with RFTA because conventional therapies (surgery, radiotherapy, chemotherapy, etc.) have been exhausted. In other cases, it is combined with conventional therapies or other percutaneous treatments, e.g., cementoplasty, offering faster pain relief and bone strengthening. A multidisciplinary approach to the management of these patients is recommended to select the optimal treatment, including orthopaedic surgeons, neurosurgeons, medical and radiation oncologists and interventional radiologists.     

超声引导下射频消融治疗子宫肌瘤的临床应用进展

目子宫肌瘤是女性生殖器最常见的良性肿瘤,多发于30~50岁的育龄妇女。子宫肌瘤的传统治疗方法是手术切除,包括子宫切除术和肌瘤剔除术,但手术创伤大、恢复期长。随着微创医疗技术的发展和女性认知的提高,越来越多的子宫肌瘤患者选择疗效好且保留子宫的微创治疗方法。射频消融是常用的治疗子宫肌瘤的微创方法,其安全性和有效性已被临床证实,术后患者症状改善,生活质量提高,复发率低。本文依据穿刺路径和超声引导方式不同分将其归纳为经腹部超声引导、腹腔镜术中超声引导、经阴道超声引导和经宫颈宫腔内超声引导4种射频消融方式,并从原理、方法、消融途径、有效性、安全性及对生育功能影响等方面对4种子宫肌瘤消融方法进行简要综述。     

Reversible cardiomyopathy after radiofrequency ablation of lateral free-wall pathway-mediated incessant supraventricular tachycardia

Incessant supraventricular tachycardia leading to reversible cardiomyopathy has been reported. Cardiomyopathy usually only develops after prolonged episodes of tachycardia at a significant heart rate. Left ventricular free-wall pathways rarely cause fast and incessant tachycardia. Therefore cardiomyopathy has not been reported with left ventricular free-wall pathway-mediated supraventricular tachycardia. We report on two cases of left ventricular free-wall-mediated supraventricular tachycardia leading to reversible cardiomyopathy after radiofrequency ablation. These cases illustrate the difficulty in diagnosing tachycardia-mediated cardiomyopathy, as the tachycardia may be clinically silent. In addition, they emphasize the importance of making this diagnosis, as the cardiomyopathy is reversible.     

CT引导经皮射频消融术治疗肝癌分析

目的 探讨CT引导下经皮射频消融术(RFA)治疗肝脏恶性肿瘤的疗效.方法 选择2016年3月至2018年10月我院收治的肝脏恶性肿瘤患者76例,采用随机数字法分为观察组38例和对照组38例,观察组进行经皮RFA治疗,对照组采用肝动脉灌注化疗栓塞术(TACE)治疗,对比两组治疗后的肿瘤缓解情况,对所有患者进行至少2年的随...     

脉冲射频刺激联合普瑞巴林治疗带状疱疹后遗三叉神经痛的临床效果

目的 探讨脉冲射频刺激联合普瑞巴林治疗带状疱疹后遗三叉神经痛的临床效果,为临床治疗该病提供参考依据.方法 选取我科室于2017年2月至2020年2月收治的358例带状疱疹后遗三叉神经疼痛者为研究对象,以随机数字表法将其分为对照组和观察组,各179例.对照组给予普瑞巴林治疗,观察组给予脉冲射频刺激联合普瑞巴林治疗.比较两...     

冷循环射频消融术治疗晚期肺癌的护理

目的：探讨冷循环射频消融术治疗晚期肺癌的护理方法。方法：对40例CT引导镇痛麻醉下行冷循环射频消融术治疗的晚期肺癌患者进行全面细致的护理,包括术前健康教育、术中配合护理、术后并发症观察护理和心理护理。结果：40例患者在镇痛麻醉下进行冷循环射频消融术,全部完成治疗,1例发生术口灼伤,余未发生严重并发症。结论：术前做好心理护理、术中密切配合、术后注意观察并及时处理并发症,对于提高成功率,减少并发症发生有重要意义。     

Tissue temperature-controlled radiofrequency ablation

During radiofrequency energy delivery, the catheter tip temperature can be significantly lower than the tissue temperature. The authors performed tissue temperature-controlled radiofrequency ablation in vitro and evaluated the effects of cooling, electrode to tissue contact, and target tissue temperature on lesion size. Pieces of porcine ventricle were immersed in a bath of isotonic saline solution at 37 degrees C. Radiofrequency energy was controlled by the tissue temperature as measured with a thermocouple needle placed 2 mm beneath the ablation electrode. Radiofrequency power was delivered for 30 seconds and limited to 50 W. A total of 81 radiofrequency ablations was performed with different electrode to tissue contact forces (0.04 N, 0.36 N, and 0.67 N) and target tissue temperatures (50 degrees C, 60 degrees C, and 70 degrees C) using an irrigated (27 ablations, 20 mL/min irrigation flow rate) or a nonirrigated ablation catheter. Twenty-seven nonirrigated applications were performed with fluid flow maintained by the pump of the thermostat and another 27 applications without flow. Every combination was applied three times and the average values were used for evaluation. For tissue target temperatures of 50 degrees C, 60 degrees C, and 70 degrees C, the lesion volume for nonirrigated ablations was on average 21 +/- 8 mm3, 45 +/- 23 mm3, and 109 +/- 45 mm3, respectively, and for irrigated ablations 12 +/- 7 mm3, 37 +/- 20 mm3, and 92 +/- 30 mm3, respectively. In both application groups the lesion size did not correlate with the electrode to tissue contact force. In the nonirrigated ablation group there was no difference in lesion size between the group with fluid flow and those without. Lesion size during tissue temperature-controlled radiofrequency delivery increases with increasing target tissue temperature and becomes independent of flow and electrode to tissue contact.     

射频消融术后尿潴留患者的护理

分析86例射频消融术后患者出现尿潴留的不同原因，包括不习惯床上排尿、精神因素、疼痛等。护理对策包括：减少卧床时间，心理护理，变换体位，物理诱导，术后多饮水等，结果81例患者排尿成功，只有5例(5．8％)男性前列腺肥大患者需要导尿。     

使用射频自凝刀治疗子宫肌瘤的护理配合

2003年4月-2004年3月选择自愿接受射频自凝刀治疗并经B超检查发现孤立的直径≤5cm的子宫肌瘤患者104例,在B超引导下经阴道、宫颈将射频自凝刀插入肌瘤进行治疗,笔者主要报道术前、术中及术后护理配合要点:由于是新开展项目,术前向患者及其家属介绍本方法的优点,使患者以良好的心态配合治疗;术中密切观察患者面色、呼吸、心率、血压的变化及有无腹痛,及时清除自凝刀头上粘连的气化组织,保证治疗效果;术后注意观察腹痛、阴道流血水样分泌物的情况,及有无发热。     

超声引导下经皮微创消融治疗甲状腺结节的应用

超声引导下热消融治疗甲状腺结节是一种安全有效的微创介入治疗技术,可治疗多种类型的甲状腺结节。主要方法有射频、微波、激光消融及无水乙醇注射治疗等,目前以射频消融使用最为广泛。激光消融是近年来发展起来的一种新的微创治疗方法,关于甲状腺结节激光消融治疗的文献报道尚少。本文将对上述几种消融方法治疗甲状腺结节的优、缺点进行综述,推荐甲状腺结节的最佳治疗方法—激光消融,为以后的研究提供参考。     

超声引导下射频消融治疗肝癌的疗效分析

目的分析经皮射频消融(RFA)治疗肝癌的疗效。方法 33例肝癌患者的40个肿块接受了经皮肝穿射频消融治疗,行超声造影检查评估RFA的治疗效果,并随访观察其复发情况。结果射频消融治疗后,直径<3 cm的肿瘤完全消融率95%,直径≥3 cm的肿瘤完全消融率79%;单个病灶的完全消融率86%,多发病灶者完全消融率75%。结论射频消融治疗肝癌的完全消融率与肿瘤的大小有关。     

超声引导下颈神经根脉冲射频治疗带状疱疹神经痛的临床研究

目的:探讨超声引导下颈神经根脉冲射频治疗上肢带状疱疹神经痛的临床疗效.方法:采用前瞻性随机对照研究方法,符合入组标准的上肢带状疱疹神经痛病人采用随机数字表法分为超声组(n=36)和透视组(n=37).受累颈神经根超声引导下脉冲射频42℃360 s.主要终点指标:术后1天、2周、4周、12周和24周疼痛数字评分法(num...     

Idiopathic ventricular fibrillation successfully terminated by radiofrequency ablation of the distal Purkinje fibers

A 21-year-old woman was admitted for evaluation of recurrent episodes of syncope. She had several spontaneous and abrupt loss of consciousness episodes while at the emergency department, caused by sustained and nonsustained ventricular fibrillation episodes. Each episode was initiated by a certain premature ventricular complex, which remained the same in subsequent ventricular fibrillation episodes. She had a total of eight more episodes of ventricular fibrillation during her admission, despite administration of intravenous antiarrhythmic agents. A diagnosis of idiopathic ventricular fibrillation was made. Radiofrequency catheter ablation was performed, targeting the distal Purkinje system. Ventricular fibrillation was noninducible after the procedure, and the patient has been symptom-free for the past 1 year.     

Prospective randomized comparison of cooled radiofrequency versus standard radiofrequency energy for ablation of typical atrial flutter

In patients with atrial flutter, conventional RF ablation may not result in complete isthmus block. This prospective, randomized study tested the hypothesis that the cooled RF ablation is safe and facilitates the achievement of isthmus block with fewer RF applications than with standard ablation for typical atrial flutter. Isthmus ablation was performed in 59 patients (40 men, 64 +/- 14 years) with type I atrial flutter using standard RF (n = 31) or cooled RF (n = 28) catheters with crossover after 12 unsuccessful RF applications. The endpoint was bidirectional isthmus block or a total of 24 unsuccessful RF applications. After the first 12 RF applications, 17 (55%) of 31 standard RF and 22 (79%) of 28 cooled RF patients had bidirectional isthmus block (P < 0.05). After the remaining patients crossed over to the alternate RF ablation system and underwent up to 12 more RF applications, bidirectional isthmus block had been demonstrated in 27 (87%) of 31 standard RF and 25 (89%) of 28 cooled RF patients (P = NS). Isthmus block was not achieved within 24 RF applications in four standard and three cooled RF patients. Mean measured tip temperatures for cooled RF were lower than for standard RF (38.5 degrees C +/- 6.98 degrees C vs 57.2 degrees C +/- 7.42 degrees C, P < 0.0001). Peak temperatures were also lower for cooled RF compared to standard RF (45.7 degrees C +/- 22.7 degrees C vs 63.4 degrees C +/- 9.87 degrees C, P < 0.0001). Importantly, mean power delivered was significantly higher for cooled than for standard RF (42.3 +/- 9.48 vs 34.0 +/- 14.0 W, P < 0.0001). There were no serious complications for either ablation system. During a 12.8 +/- 3.76-month follow-up, there were two atrial flutter recurrences in the cooled RF group and four in the standard RF group (P = NS). In patients with type I atrial flutter, ablation with the cooled RF catheter is as safe as, and facilitates creation of bidirectional isthmus block more rapidly than, standard RF ablation.