超声引导下射频消融治疗甲状腺良性结节27例

目的 探讨超声引导下经皮射频消融(RFA)治疗甲状腺良性结节的临床效果.方法 选取2012年12月至2014年11月在超声引导下行经皮RFA术治疗的27例甲状腺结节患者,术后1、3、6个月超声观察病灶变化,计算体积及病灶缩小率,彩色多普勒血流成像(CDFI)和超声造影检测病灶血流信号消失程度.结果 经皮RFA术均成功,无中转开放手术,术后造影病灶处均无血流灌注;术中感牙痛2例,停止消融牙痛即缓解.1例消融后有声音嘶哑,未处理,3个月后声音恢复.RFA治疗后1、3、6个月,结节体积均有不同程度的缩小,CDFI和超声造影检测病灶内均无血流信号和血流灌注,与治疗前比较差异均有统计学意义(P＜0.05).在随访过程中,消融区未出现对比剂重新填充的现象.高频超声检查显示,3枚结节在术后6个月完全消失,22枚结节消融于1年后直径缩小1/2,8枚结节消融于1年后直径缩小至不足1/2.与术前比较,治疗后1年内,所有结节直径明显缩小,数据具有统计学意义(P＜0.05).术后1周甲状腺功能指标有明显改变,术后1个月恢复术前水平.结论 超声引导下的RFA治疗能有效缩小并使其结节性甲状腺肿结节体积及直径消失,并发症较少,不影响甲状腺功能,创伤小,临床效果显著,是一种可行、安全、有效的治疗方法.     

Symptomatic nonfunctioning parathyroid cysts: Role of simple aspiration and ethanol ablation

Objectives

To evaluate the outcomes of simple aspiration and ethanol ablation in the management of symptomatic nonfunctioning parathyroid cyst (PC).

Methods

We performed simple aspirations for 12 PCs in 12 patients from March 1997 to June 2010. PC was diagnosed if the aspirated fluid was clear colorless and showed an elevated parathyroid hormone (PTH) level. Ethanol ablation (EA) was performed for recurrent PCs. Simple aspirations were performed using 23-gauge needles and EAs using 18-gauge needles with 99% ethanol under ultrasound (US) guidance. We evaluated cyst volume, cosmetic score, symptom score, and complications.

Results

Mean follow-up period of all patients was 19.2 ± 12.9 months (median, 15.0 months; range, 7–40 months). Simple aspiration was successful in four patients, and the mean volume reduction after simple aspiration was 98.2 ± 3.5% (range, 92.9–100%). In eight recurrent cases, EA resulted in a significant decrease in volume (P = 0.012), as well as in cosmetic (P = 0.011) and symptom (P = 0.01) scores at last follow-up; however two cases of primary failure of EA was treated by repeat EA. No major complications occurred in any patient.

Conclusions

For symptomatic nonfunctioning PCs, simple aspiration could be a first line procedure for diagnosis and treatment, while EA can be a subsequent treatment modality for recurrent cases.     

甲状腺良性结节射频消融治疗的应用进展

甲状腺结节是临床上常见的疾病,并且大多数结节为良性。甲状腺良性结节经射频消融（RFA）治疗后,体积能明显缩小,甚至消失。从而改善结节引起的相关症状。近年来RFA已逐渐成为甲状腺良性结节的首选治疗方法。本文是对近些年来甲状腺良性结节RFA治疗的研究情况进行综述,从而为临床相关治疗研究提供指导及依据。     

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.     

Diagnostic performance of combined elastosonography scoring and high-resolution ultrasonography for the differentiation of benign and malignant thyroid nodules

Aim

To evaluate the diagnostic performance of the combined use of elstosonography (USE) scoring and high-resolution ultrasonography (HRUS) for the differentiation of benign and malignant thyroid nodule.

Patients and methods

Forty-seven consecutive patients with 66 thyroid nodules were enrolled in the present study. Thyroid surgery had been already planned for all the patients. All of them were submitted to high-resolution ultrasonography and elastography scoring at the same sitting. The latter was determined with 5-point scoring method. The examination results were compared against pathological findings as the gold standard of reference.

Results

The sensitivity, specificity, accuracy, positive predictive, and negative predictive values of HRUS in the differential diagnosis of thyroid nodules were 92.0%, 72.9%, 60.1%, 95.0%, and 63.1%, respectively, while that of ultrasound elastography scoring were 75.4%, 85.5%, 86.7%, 71.4%, and 90.5%, respectively. Combined use of both US techniques resulted in a higher diagnostic performance as it showed 95.4%, 94.8%, 95.2%, 82.3% and 98.8% sensitivity, specificity, accuracy, positive predictive, and negative predictive values, respectively.

Conclusions

The use of combined USE and HRS for the differentiation of benign and malignant thyroid nodules resulted in a high diagnostic performance and a significant statistical difference as compared to HRUS or USE alone (P = 0.003).     

射频消融治疗肺部恶性肿瘤的临床护理

目的 探讨CT引导下射频消融(RFA)治疗肺恶性肿瘤的护理策略.方法 对21例肺恶性肿瘤患者的31个瘤体进行CT引导下射频治疗.结果 所有患者均顺利完成了RFA治疗.手术并发症有少量气胸、液气胸、血痰、疼痛和轻度发热,进行对症处理及护理后缓解,无一例死亡,全部患者没有出现其他严重并发症.结论 对RFA治疗肺部恶性肿瘤患者进行术后精心护理,及时观察并发症并对症处理,有助于促进患者康复.     

Fluorine- 18-fluorodeoxyglucose positron emission tomography for assessment of patients with unresectable recurrent or metastatic lung cancers after CT-guided radiofrequency ablation: Preliminary results

OBJECTIVES: We compared the diagnostic value of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) with that of computed tomography (CT) following radiofrequency ablation (RFA) of inoperable recurrent or metastatic cancers in the lung. METHODS: Twelve patients (9 males and 3 females; 5 had recurrent lung cancer and the other 7 had metastatic nodules from a variety of primary cancers) were treated by RFA for 17 pulmonary nodules. FDG-PET was performed before and 2 months after RFA, and the mean standardized uptake value (SUV) was calculated. The response evaluation was based on the percent reduction relative to the baseline and the absolute values of SUV on FDG-PET performed at 2 months after RFA. We compared the response evaluations made based on findings of FDG-PET and CT at 2 and > or =6 months (mean 10.2) after RFA. RESULTS: The percent reduction in uptake at 2 months was significantly lower in nodules considered progressive (69.6 +/- 18.6%) than nonprogressive disease (38.7 +/- 12.5%; p < 0.01) based on CT findings at > or =6 months after RFA. The absolute SUV at 2 months was significantly higher in nodules considered progressive (2.61 +/- 0.75) than nonprogressive disease (1.05 +/- 0.67; p < 0.01) based on CT findings at > or =6 months post-RFA. CONCLUSION: Although our pilot study comprised few cases of various histopathological types of cancers in the lung, the results suggest that FDG-PET could predict regrowth on subsequent follow-up CT. Regrowth could be diagnosed earlier by FDG-PET than by CT, and nodules with residual uptake and with <60% reduction of uptake relative to baseline on FDG-PET at 2 months after ablation might require additional therapy.     

MR-guided radiofrequency ablation of hepatic malignancies at 1.5 T: initial results

Purpose

To assess the feasibility of magnetic resonance (MR)‐guided radiofrequency ablation (RFA) of hepatic malignancies using a high‐field MR scanner.

Materials and Methods

A total of 10 patients with 14 primary (N = 1) or secondary (N = 13) hepatic malignancies underwent MR‐guided RFA using a closed‐bore 1.5 T MR scanner. Lesion diameters ranged from 2.0 cm to 4.7 cm. RFA was performed using a 200‐W generator in combination with a 3.5‐cm LeVeen electrode applying a standardized energy protocol.

Results

RFA was technically feasible in all patients. Necrosis diameter ranged from 2.5 cm to 6.8 cm. The mean follow‐up period is 12.2 ( 1 - 18 ) months. In nine out of 10 patients, local tumor control was achieved. For this purpose, a second CT‐guided RFA was required in two patients. In four patients, multifocal hepatic tumor progression occurred, with the treated lesion remaining tumor‐free in three of these patients. Two patients showed extrahepatic tumor progression. Four patients remained tumor‐free. No major complications occurred.

Conclusion

MR‐guided RFA of hepatic malignancies in a closed‐bore high‐field MR scanner is technically feasible and safe. It can be advantageous in locations considered unfavorable for CT‐guided puncture or in patients in which iodinated contrast material is contraindicated. J. Magn. Reson. Imaging 2004;19:342–348. © 2004 Wiley‐Liss, Inc.

     

TACE联合RFA治疗膈下肝脏恶性肿瘤22例

目的 评价TACE联合RFA治疗膈下肝脏恶性肿瘤的安全性和疗效.方法 22例膈下肝脏恶性肿瘤患者共有26个病灶,单例病灶数目≤3个,直径≤5 cm.所有患者先行1～2次TACE术,术后3～5周行CT引导下RFA治疗,RFA术后4～8周复查MRI评价疗效.所有患者随访12 ～ 30个月,观察并发症和疗效.结果 22例患者26个病灶RFA术中未出现任何严重并发症,术后MRI复查22个(84.6％)病灶达到完全消融,4个(15.4％)病灶经2次RFA后达到完全消融.结论 TACE术可使肝脏恶性肿瘤病灶缩小,轮廓更加清晰,联合RFA治疗膈下肝脏恶性肿瘤更加安全、精确、有效.     

超选择性肾动脉栓塞术联合射频消融治疗肾癌的临床应用

目的 探讨超选择性肾动脉栓塞术联合射频消融(RFA)治疗肾癌的疗效.方法 分析2009年1月至2011年4月9例肾癌患者超选择性肾动脉栓塞联合RFA.患者均在超选择性肾动脉栓塞术后3～7 d,在CT引导下行RFA.术后1个月行肾脏病灶穿刺活检和CT增强检查评价其疗效.结果 9例患者随访1～6个月,未发现.肾脏肿瘤增大,...     

CT引导下经皮射频消融治疗肾上腺转移性肿瘤的初步疗效

目的 探讨CT引导下经皮射频消融(RFA)治疗肾上腺转移癌的近期疗效、安全性和不良反应.方法 肾上腺转移癌患者共19例,病灶总数24个,肿瘤直径为1.5-7.8 cm,平均直径3.5 cm.19例患者原发灶来源于肺癌6例,肝癌5例,肾癌5例,结肠癌3例.经RFA治疗3个月后行CT增强扫描评价肿瘤治疗效果.结果 上述24个病灶经消融治疗后,CT增强扫描显示20个肿瘤完全消融;其余4个病灶在治疗后仍有部分残留组织强化区,提示有残留肿瘤,未完全消融.5例患者出现血压波动,6例患者术后出现轻微疼痛,2例患者在术后出现一过性血尿.其余患者无严重并发症.结论 CT引导下RFA治疗肾上腺转移癌是一种安全、有效、并发症少的微创治疗方法.     

二维超声造影评价射频消融治疗子宫肌瘤效果的临床意义

目的评价二维超声造影(2D-CEUS)在射频消融(RFA)治疗子宫肌瘤中的意义。方法接受RFA治疗的子宫肌瘤患者110例,共176枚肌瘤,156枚为肌壁间肌瘤,20枚为黏膜下肌瘤,其中12枚为有蒂黏膜下肌瘤。全部病例在RFA前后1 d内进行2D-CEUS,观察病灶区血供变化,测量肌瘤体积、消融范围,得出灭活率。结果12枚有蒂黏膜下肌瘤完整取出。164枚在体肌瘤射频治疗后2D-CEUS表现:154枚肌瘤原部位无造影剂灌注,提示消融完全,灭活率达(98.30±22.03)%;10枚肌瘤边缘线性增强或瘤内片状增强区,考虑治疗不全,其灭活率仅为(51.09±1.96)%。结论 2D-CEUS可以客观反映肿瘤的血流灌注状态,对选择治疗方案和判断疗效有着较高的实用价值。     

经皮射频消融术治疗椎体肿瘤合适消融时间的实验研究

目的 探索经皮射频消融术(RFA)治疗兔椎体肿瘤模型不同消融时间的疗效及安全性.方法 采用CT引导经皮穿刺法将VX2瘤块接种入新西兰大白兔的腰椎内,成功建立20只兔椎体肿瘤模型.将其随机分为A、B两组,每组10只.测量肿瘤椎体的核素标准化摄取值(stand uptake value,SUV),然后对实验动物行消融治疗.A组消融持续时间3 min,B组为5 min,观察治疗后24 h动物急性瘫痪发生情况.治疗后第1天和第7天,实验动物再次接受PET-CT检查,测定椎体肿瘤的SUV值,然后取肿瘤标本行病理检查.比较两组动物RFA术后的瘫痪率以及治疗前后不同时间点的肿瘤SUV值有无差异.结果 A、B两组动物射频后的瘫痪发生率差异有统计学意义(1/10比6/10、P＜0.05).两组肿瘤模型消融前的SUV值分别为4.60±0.47、4.48±0.45,治疗后第1天分别为0.94±0.08、0.92±0.07,治疗后第7天分别为0.93±0.04、0.95±0.06.两组椎体肿瘤的SUV值在治疗前、后差异有统计学意义(F=3 257.87、P＜ 0.05),两组之间则差异无统计学意义.病理结果显示两组肿瘤模型的肿瘤细胞明显坏死,均未见明显残存肿瘤细胞.结论 应用RFA治疗兔椎体肿瘤,消融时间持续3 min已能有效杀伤椎体肿瘤细胞,且严重并发症的概率小.延长消融时间疗效无显著增加,但可能增加神经损伤的风险.     

影像引导下射频消融治疗的现状与进展

影像引导下射频消融(RFA)治疗是一种安全、近期疗效肯定、并发症少的微创介入治疗方法.现已广泛应用于肝癌、肺癌、肾上腺恶性肿瘤、骨肿瘤及脾功能亢进的治疗.RFA与动脉栓塞化疗、化学消融或经皮穿刺椎体成形术等联合应用,是一种新型的综合性介入治疗肿瘤的方法,将会进一步提高肿瘤治疗的疗效.     

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。     

脾脏射频消融治疗门脉高压性脾功能亢进的研究进展

脾脏射频消融是治疗门脉高压性脾功能亢进症安全、有效的微创手段.术后可以减小脾脏体积、纠正脾功能亢进,增加肝动脉血流量从而明显改善肝脏功能,并可诱导肝脏增大/再生.但影响其疗效的因素较多,许多潜在的机制仍有待进一步的阐明.     

射频消融联合肝动脉化疗栓塞治疗肝癌的应用

以超声、CT等为主要引导方式的经皮射频消融(RFA)等局部热消融技术在肝癌治疗中发挥了重要的作用.然而,对血供丰富的较大肝癌疗效受限.经肝动脉化疗栓塞(TACE)可有效减少肝癌的血供,并具有创伤小,适应证广,并发症少等特点,成为肝癌患者姑息治疗及术前、术后新辅助治疗的有效手段之一.因此,富血供肝肿瘤RFA治疗前应用TACE,通过栓塞肿瘤供血动脉造成肿瘤缺血,进而减少血流带走热量,可扩大消融范围提高RFA疗效,是肝癌RFA联合治疗常用的方法.本文针对RFA联合TACE治疗肝癌的应用现状及疗效进行综述.     

Carto3三维电生理标测在阵发性室上性心动过速射频消融术中应用的初步研究

目的 评估Carto3三维电生理标测系统导引下施行阵发性室上性心动过速(PSVT)射频消融(RFA)术的可行性、有效性及安全性.方法 回顾性收集2015年3月至2016年2月接受Cano3三维电生理标测系统导引下RFA治疗的28例PSVT患者(Carto组),2014年3月至2015年2月接受X线导引下RFA治疗的36例PSVT患者(X线对照组),对比两组术中X线辐射时间、手术成功率、手术时间、并发症及复发率等差异.结果 Carto组术中X线辐射时间(2.6±2.3) min,显著低于X线组(15.8±9.5) min(P＜0.001),其中8例房室结折返性心动过速(AVNRT)患者零X线辐射.Carto组、X线组手术功率分别为28/28(100％)、35/36 (94.4％) (P＞0.05),手术时间分别为(162.7±34.4) min、(149.4±46,2) min(P＞0.05).Carto组无并发症发生,X线组1例AVNRT患者消融中出现一过性Ⅱ°房室传导阻滞.随访6个月,两组均无复发患者.结论 Carto3三维电生理标测系统导引下PSVT RFA安全有效,显著降低X线辐射时间,部分AVNRT患者可实现零X线辐射,不增加手术时间及手术风险.     

门静脉癌栓微波消融及射频消融治疗80例分析

目的 报道两种针对肝癌门静脉癌栓的治疗技术,并比较其疗效.方法 本研究共纳入162例肝癌合并门脉癌栓的患者.治疗组中80例患者在经肝动脉插管化疗栓塞术(TACE)基础上接受了直接微波消融术、射频消融等治疗方案,对照组82例患者仅接受TACE术.结合文献报道及医疗实践,我们探讨了合理的标准手术流程并分析了临床结果.结果 未观察到严重并发症.术后3个月时复查肝脏增强MRI显示5例(6.2％)患者静脉癌栓完全消失,14例(17.5％)患者静脉癌栓明显缩小,43例(53.8％)静脉癌栓稳定,18例(22.5％)静脉癌栓进展.治疗组门静脉癌栓进展显著慢于对照组(P＜0.001).结论 直接微波消融术用于肝内段门静脉癌栓,经皮肝穿刺门静脉消融导管术用于肝外段门静脉癌栓上较为安全有效.     

早期非小细胞肺癌CT引导射频消融治疗60例临床分析

目的：评价CT引导射频消融（RFA）治疗不能手术切除或拒绝手术的早期非小细胞肺癌（NSCLC）的有效性、安全性及局部控制效果。方法2007年3月—2010年3月对60例早期NSCLC患者进行CT引导下68次RFA。全组患者病理学分型为：鳞状细胞癌23例（38.3%）,腺癌31例（51.7%）,大细胞癌2例（3.3%）,鳞腺癌4例（6.7%）。病灶直径平均大小3.8 cm（1.8～6.8）。观察总体生存率、肿瘤特异性生存率及局部无进展生存率。结果全组病例均能完成RFA,平均消融时间为35 min（18～63 min）,术中常见并发症是气胸17例（28.3%）,无围手术期死亡。中位局部无进展生存（local progression-free survival, LPFS）时间28个月,中位生存时间为32个月,局部无进展生存率1、2、3年分别为94.6%、83.1%、73.6%。结论 CT引导RFA治疗不能手术切除或拒绝手术的早期NSCLC安全、有效,可明显提高局部无进展生存率。