立体定向脑损毁术治疗帕金森病的研究进展

立体定向脑损毁术或称消融术(LT)是指通过立体定向微创技术损毁脑内特定组织结构从而治疗神经系统疾病的手术方法,主要包括磁共振引导超声聚焦消融术(MRgFUS)、伽马刀(GK)及射频消融术(RF)等.对于药物反应欠佳的帕金森病(PD)患者,LT可明显改善临床症状(如僵直、震颤、异动症等),减少药物用量,提高长期生活质量,...     

立体定向射频毁损术治疗三叉神经痛13例分析

三叉神经痛是临床上最常见的神经病理性疼痛,发病机制尚不完全清楚,因而至今尚无满意的治疗方法[1]。2007年6月-2011年10月,我们采用反戴立体定向仪结合CT定位卵圆孔,行射频毁损术治疗三叉神经痛13例,疗效满意。现分析报告如下。     

脑立体定向手术治疗难治性精神分裂症的护理

精神疾病是在内外致病因素的影响下,大脑功能发生紊乱,导致认知、情感、行为与意志精神活动不同程度障碍的一类疾病〔1〕。脑立体定向手术是目前治疗难治性精神分裂症效果较好且创伤小的手术,此手术具有微创、安全、有效等优点〔2〕。2004年5月~2006年4月我科采用脑立体定向手术治疗难治性精神分裂症102例,取得良好效果,现将有关护理报道如下:1临床资料本组共102例,男57例,女45例,年龄20~46岁,平均27.6岁。病程5~16年,平均8.5年。所有病例均符合中国精神疾病分类方案与诊断标准第2版修订本(CCMD-2-R)精神分裂症诊断标准。经头部CT或MRI…     

立体定向毁损杏仁核簇不同亚核团和扣带回前区治疗难治性精神分裂症

采用CRW立体定向仪和PICKER螺旋CT定位，用RADONICS毁损仪毁损杏仁核不同亚核团和扣带回前部治疗精神分裂症35例，并进行了一年的随访。以临床疗效总评量表（CGI）评定疗效标准为指标，评定病人疗效，旨在探讨立体定向毁损杏仁核不同亚核团和扣带回治疗难治性精神分裂症的可行性和疗效。用WEISS量表对35例病人手术前后的智力进行评定，总疗效评定结果：显著进步21例，进步8例，稍进步5例，无变化1例，无恶化者；手术后病人的智力未见明显损害。结果提示，根据精神分裂症患者的症状选择性地毁损杏仁核的不同亚核团可提高手术治疗的效果。     

立体定向手术对难治性精神分裂症患者生活质量的影响

目的:探讨多靶点调控、立体定向手术对难治性精神分裂症患者生活质量的影响作用。方法：对2001－03－2002－04住院经立体定向手术治疗、出院后回归社会达6个月以上的51例难治性精神分裂症患者术前、术后的生活质量变化进行了评定和对照研究。结果：术后生活质量的随访结果明显高于术前，尤其表现在躯体、心理和社会功能三个维度，差异性显著（P＜0．05）。结论：立体定向手术能够提高难治性精神分裂症患者的生活质量。     

脑立体定向术治疗精神分裂症的麻醉管理体会

治疗难治性精神分裂症的微侵袭手术方法——“脑立体定向多靶点射频热凝术”即在脑立体定向下射频热凝选择性毁损脑部的局限区域或某些纤维联系,来调整脑的功能,消除或改善精神症状,它以其定位准确、创伤小和疗效显著等优点得到迅速推广。由于精神分裂症患者有其特殊性,特别是伴有难以控制的冲动攻击行为的狂躁者,不能配合医生进行手术操作。今对这类患者的麻醉实施和管理体会进行回顾分析。     

临床护理路径在脑立体定向术治疗难治性精神病患者中的应用

临床路径（clinicalpathway,CP）是针对医生、护士和其他相关专业人员而制定的针对某种疾病或手术最适当的、具有顺序性和时间性的临床服务计划,以加快患者康复,减少资源浪费,使患者获得最佳和持续改进的照顾品质。临床护理路径（clinicalnursingpathway,CNP）简称CNP,是为患者制定的在住院期间带有鲜明个体针对性的护理计划,是对特定的患者群体,依据每日标准护理计划为一类特殊患者所设定的住院护理图式。     

难治性精神分裂症CT表现及多靶点联合毁损术后CT征象分析

目的:探讨难治性精神分裂症(TRS)的CT表现和多靶点联合毁损术后CT影像特点.方法:对464例TRS患者术前CT和56例TRS患者术后CT表现进行回顾性分析,并测量毁损灶体积.56例TRS患者术后疗效评定为Ⅰ～Ⅱ级37例,Ⅲ～Ⅳ级19例;Ⅰ～Ⅱ级患者术后2～10 d行CT扫描25例、40～90 d 16例,19例Ⅲ～Ⅳ级患者术后6～7个月行CT扫描.结果:TRS患者的主要CT表现为脑萎缩,发生率为36.2%(168/464),其中皮质型脑萎缩占25%(116/464).术后2～10d,毁损灶呈类圆形和柱形者为93.3%(140/150),片状不规则形为6.7%(10/150);术后40～90 d,病灶呈类圆形和柱形为66.2%(65/96),片状不规则形为33.8%(31/96).结论:术前CT扫描可作为筛选TRS手术患者的一种手段,脑萎缩患者选择手术治疗应慎重;术后不同时期CT扫描可客观评价手术疗效,为手术方案改进、并发症的预防和处理提供参考.     

浅谈脑立体定向术治疗精神分裂症的护理

精神分裂症是一种以思维、感觉、情感和行为等多方面障碍和精神活动与环境不协调为主要表现的疾病,多发于青壮年。约占我国住院精神病的50%,慢性精神病的60%〔1〕。脑立体定向术作为治疗难治性精神病的一种有效手段〔2~4〕,具有微创、安全、有效等优点。1术前护理1.1心理护理多     

立体定向脑内核团毁损术治疗精神分裂症的麻醉处理

近年来立体定向脑内核团毁损已成为治疗难治性精神分裂症的有效手段。现将我院2006—10～2008—01开展的全麻下立体定向脑内核团毁损术65例体会报告如下。     

肺癌射频消融治疗

近年来射频消融广泛应用肺癌治疗上,目前尚未建立严格的适应症及禁忌症标准,随着操作技术的不断发展,已在临床上取得显著的近期疗效,具有操作方便,并发症轻,患者痛苦少等特点,未来发展的关键在于改进电极针,提高射频技术,联合其它疗效等以提高疗效,并建立更合理的包括影像检查技术在内的疗效评价标准。     

立体定向术对难治性精神分裂症患者脑脊液中DA、HVA及PRL的影响

目的 :探讨立体定向术对精神分裂症患者脑脊液 (CSF)中多巴胺 (DA)、高香草酸 (HVA)及催乳素 (PRL)的影响。方法 :立体定向术治疗难治性精神分裂症 ;高效液相色谱 -电化学检测法测定手术前后患者CSF中DA及HVA ,放射免疫分析法测定PRL。结果 :精神分裂症患者手术前CSF中DA( 3 .2 3± 0 .3 6) μmol·L-1、HVA( 1.99± 0 .49) μmol·L-1水平显著高于对照组 ( 2 .44±0 .3 2 ) μmol·L-1,PRL水平 ( 0 .99± 0 .3 1)ng·ml-1显著低于对照组 ( 1.48± 0 .46) μmol·L-1;手术后DA( 2 .49± 0 .3 5 ) μmol·L-1、HVA( 1.42± 0 .2 8) μmol·L-1水平显著下降 ,PRL水平 ( 1.5 4± 0 .5 1)ng·ml-1显著上升。结论 :支持精神分裂症中枢DA亢进假说 ,DA可以抑制PRL的释放 ,立体定向手术具有明显的抗DA能神经阻滞作用     

Ultrasound-guided percutaneous thermal ablation of hepatocellular carcinoma using microwave and radiofrequency ablation

AIM: To investigate the therapeutic efficacy of thermal ablation for treatment of hepatocellular carcinoma (HCC) using microwave and radiofrequency (RF) energy application. MATERIALS AND METHODS: A total of 190 nodules in 97 patients (84 male, 13 female; mean age 53.4 years, range 24-74 years) with HCC were treated with microwave or RF ablation in the last 4 years. The applicators were introduced into the tumours under conscious analgesic sedation by intravenous administration of fentanyl citrate and droperidol and local anaesthesia in both thermal ablation procedures. The patients were then followed up with contrast-enhanced computed tomography (CT) to evaluate treatment response. Survival was analysed using the Kaplan-Meier method. RESULTS: Complete ablation was obtained in 92.6% (176/190) nodules. The complete ablation rates were 94.6% (106/112) in microwave ablation and 89.7% (70/78) in RF ablation. The complete ablation rates in tumours/=4.0 cm were 93.1, 93.8 and 86.4%, respectively. Local recurrence was found in 9.5% nodules and the rates in tumours/=4.0 cm in diameter were 3.4, 9.9 and 31.8%, respectively. In the follow-up period, 7.1% nodules ablated by microwave and 12.8% by RF presented local recurrence. The 1, 2 and 3-year distant recurrence-free survivals were 47.2, 34.9 and 31.0%, respectively. Estimated mean survival was 32 months, and 1, 2 and 3-year cumulative survivals were 75.6, 58.5, and 50.0%, respectively. One and 2 years survivals of Child-Pugh class A, B and C patients were 83.8 and 70.4%, 78.2 and 53.2%, 36.3 and 27.3%, respectively. CONCLUSION: Thermal ablation therapy by means of microwave and RF energy application is an effective and safe therapeutic technique for hepatocellular carcinoma. Large tumours can be completely ablated, but have a significantly higher risk of local recurrence at follow-up.     

腹腔镜射频消融治疗原发性肝癌的研究

目的：评价腹腔镜射频消融（RFA）治疗原发性肝癌的可行性、安全性及疗效。方法：51例原发性肝癌在全麻下行腹腔镜RFA治疗,共72个瘤体,平均最大肿瘤直径（3．4±1．0）cm。合并肝硬化49例、慢性结石性胆囊炎5例,糖尿病4例,凝血功能障碍10例。结果：51例均顺利完成腹腔镜RFA治疗,12例行腹腔镜胆囊切除术。未出现严重并发症。肿瘤完全坏死率为95．8％。随访12～58个月（平均35个月）,6例发现肝内新病灶,11例射频治疗部位复发,再次采用经皮RFA治疗9例,12例死于肿瘤复发或肝功能衰竭。结论：腹腔镜RFA治疗原发性肝癌安全可行,治疗效果可靠,但应选择瘤体位于肝脏表面或临近胆囊而且不宜手术切除的病例进行治疗。     

Actual role of radiofrequency ablation of liver metastases

The liver is, second only to lymph nodes, the most common site for metastatic disease irrespective of the primary tumour. More than 50% of all patients with malignant diseases will develop liver metastases with a significant morbidity and mortality. Although the surgical resection leads to an improved survival in patients with colorectal metastases, only approximately 20% of patients are eligible for surgery. Thermal ablation and especially radiofrequency ablation emerge as an important additional therapy modality for the treatment of liver metastases. RF ablation shows a benefit in life expectancy and may lead in a selected patient group to cure. Percutaneous RF ablation appears safer (versus cryotherapy), easier (versus laser), and more effective (versus ethanol instillation and transarterial chemoembolisation) compared with other minimally invasive procedures. RF ablation can be performed by a percutaneous, laparoscopical or laparotomic approach, and may be potentially combined with chemotherapy and surgery. At present ideal candidates have tumours with a maximum diameter less than 3.5 cm. An untreatable primary tumour or a systemic disease represents contraindications for performing local therapies. Permanent technical improvements of thermal ablation devices and a better integration of thermal ablation in the overall patient care may lead to prognosis improvement in patients with liver metastases.     

无水酒精注射术联合射频消融术与单纯射频消融术治疗小肝癌的疗效比较

目的比较无水酒精注射术（PEI）联合射频消融术（RFA）治疗方案与单纯RFA治疗小肝癌的疗效。方法回顾分析我院2006年1月～2008年1月进行的68例小肝癌射频消融治疗患者的临床资料。68例中37例行PEI联合RFA术,31例行单纯RFA术。比较两组肿瘤完全消融率,复发率,复发时间,术后1、2、3年生存率等情况。结果 PEI联合RFA组肿瘤完全消融率91.89%,局部复发率10.81%,局部复发时间（14.22±3.48）月,1、2、3年的生存率分别为89.19%、81.08%和72.97%。单纯RFA组肿瘤完全消融率70.97%,局部复发率32.26%,局部复发时间（9.15±2.68）月,1、2、3年的生存率87.10%、77.42%和48.39%。PEI联合RFA组在肿瘤完全消融率、局部复发率、复发时间、术后3年生存率方面好于单纯RFA组。结论 PEI联合RFA治疗小肝癌疗效优于单纯RFA治疗,在小肝癌的治疗中有重要临床应用价值。     

射频治疗肝脏恶性肿瘤的CT评价(附35例分析)

目的 :应用螺旋CT评价射频治疗肝癌的近期疗效。方法 :对 35例肝癌 35个病灶射频治疗术前、后肿瘤大小、密度的变化、肿瘤凝固性坏死的形态、范围及术后CT增强扫描的特征进行观察。其中术前进行肝动脉碘油及明胶海绵碎块栓塞 2 3例。结果 :35例肝癌射频术后 5min均有增大 ,术前、后肿块最大径分别为 5 .75± 2 .84cm和 6 .2 2± 1 .1 2cm ,统计学无显著性差异 (P >0 .0 5)。病灶CT值术后 5min均减低 ,术前、后病灶CT值分别为 45 .3± 6 .33Hu和 32 .8± 7.83Hu,均有显著性差异 (P <0 .0 5)。术后 5min 94.2 8% (33/ 35)的病灶呈不同程度凝固性坏死。随访 1～ 1 1个月 ,平均随访 4个月 ,71 % (2 5/ 35)病灶较原病灶缩小 ,2 9% (1 0 / 35)病灶扩大 ,病灶CT值减低 1 1Hu±。CT增强 1 0例 ,其中 5例坏死区表现为无强化 ,5例残留灶 /复发灶显示为结节状或花环状强化。结论 :螺旋CT可准确评价肝癌射频治疗的效果 ,并提示射频结合肝动脉栓塞治疗有助于提高疗效     

Image-guided radiofrequency ablation (RFA) of spinal tumors

Purpose

To evaluate retrospectively the efficacy and safety of radiofrequency ablation (RFA) in patients with spinal tumors.

Materials and methods

Forty-one patients (25 men, 16 women; age range, 46–82 years) with nonresectable primary or secondary tumor involvement of the spine unresponsive to chemo- and radiotherapy received RFA treatment.Two radiofrequency ablation systems, one with a cool-tip electrode and one with an expandable electrode catheter, were used. Both systems work impedance controlled with a power output of 150– 200 W. Each coagulation cycle lasted 12–15 min depending on tumor impedance. Several single RFA cycles of 15 min each were used for overlapping RFAs in tumors with diameters of more than 3 cm. Temperature was kept between 50 °C and 120 °C and was chosen according to spinal cord distance and patient heat tolerance during the ablation. Multi-slice computed tomography (CT) combined with C-arm fluoroscopy guided the intervention.Efficacy outcomes were assessed after about 6 weeks, 6 months, and more than 6 months using standardized questionnaires and indices regarding tumor pain, pain disability, functional activities, quality of life, neurological status, and tumor progression.

Results

RFA significantly reduced tumor-induced pain within 6 weeks, improved daily activities, and maintained quality of life. Mean time to tumor progression was 730 ± 54 days (Kaplan–Meier estimate). No RFA-associated complications were reported.

Conclusion

RFA of primary and secondary spinal tumors, which were unresponsive to chemo- and radiotherapy and prone to progression, is a safe, resource-saving, and highly effective percutaneous technique in patients with nonresectable spinal tumors.