CT-guided radiofrequency ablation of pediatric Wilms tumor in a solitary kidney

Although recent results of percutaneous imaging-guided radiofrequency ablation (RFA) of various tumors in adults are promising, RFA of tumors in children has been performed in only a small number of cases. We describe the treatment of Wilms tumor in a solitary kidney in a 5-year-old girl using percutaneous CT-guided RFA. The procedure provided short-term palliation in this child for whom partial or total nephrectomy carried high risk and low likelihood of success. Although it might only be useful ultimately as a temporizing measure, oncologists and surgeons might wish to consider RFA in children who would otherwise require dialysis and renal transplantation or who are poor surgical candidates. Various specific technical issues differentiate pediatric from adult tumor ablation, including the amount of intra-abdominal fat, need for smaller grounding pads, and potential systemic effects of tissue heating.     

CT-guided radiofrequency ablation following high-dose chemotherapy of a liver-metastasizing pancreatoblastoma with tumor thrombus in the portal vein

Pancreatoblastoma is a rare neoplasm encountered most commonly in infants and young children. Unresectable or metastatic tumors have a poor prognosis despite adjuvant chemotherapy or radiotherapy. We report the successful use of CT-guided radiofrequency ablation subsequent to intensive chemotherapy in an 8-year-old girl with liver-metastasizing pancreatoblastoma and with right and segment 4 portal vein tumor thrombosis. She has been in remission for 3 years.     

射频消融术治疗儿童房性心动过速的体会

目的总结射频消融术治疗儿童房性心动过速(AT)的体会,探讨儿童AT的电生理学特征、靶点标测和麻醉方法的特点。方法4例AT患儿行心内电生理检查和射频消融术,靶点标测采用程序激动标测方法,在左右房内移动标测寻找靶点,采用预设60~65℃温控放电消融。不配合患儿给予全身静脉麻醉,位于左房的AT施予房间隔穿刺术。结果经电生理检查证实,4例AT中2例为自律性AT,2例为折返性AT。特殊患儿经适当麻醉或房间隔穿刺后射频消融即刻成功。结论AT的射频消融成功率较高,但儿童生理解剖结构的特殊性使其射频消融具有与成人不同的特点,特别是其麻醉方法的选择有待进一步探讨。     

儿童经导管射频消融术的应用进展

快速性心律失常是儿童较常见的一类心律失常.持续或频繁的心动过速严重危害儿童的身心健康.在心内电生理检查的帮助下,各种心律失常的电生理机制不断阐明,同时诊疗技术也突飞猛进的发展,儿童快速性心律失常的治疗对策发生了重大变革,经导管射频消融术应运而生.经导管射频消融术是通过热效能,毁损心律失常病灶或阻断折返途径或房室传导,从而达到治疗的目的.儿童射频消融术的临床应用,彻底改变了药物治疗无法根治心律失常的历史.临床医师应全面评估心律失常对儿童的影响及可能的预后,严格掌握适应证.目前儿童房室折返性心动过速、房室结折返性心动过速、室性心动过速、房性心动过速、心房扑动的射频消融治疗已日趋成熟,成功率高,复发率低.并发症发生与手术医师的经验密切相关.     

Efficacy of percutaneous radiofrequency ablation of osteoid osteoma in children

Background Percutaneous radiofrequency (RF) ablation of osteoid osteoma has high technical and clinical success rates. However, there are limited data on its use in the treatment of osteoid osteoma in children. Objective To assess the safety and efficacy of CT-guided percutaneous RF ablation of osteoid osteoma in children and compare the outcomes with published data on its use in patients unselected for age. Materials and methods From January 2003 to July 2006, 23 children with osteoid osteoma were treated with CT-guided RF ablation using a straight rigid electrode. Their mean age was 11 years (range 3.5–16 years) and there were 15 boys and 8 girls. The procedures were carried out under general anaesthesia. Follow-up was performed to assess technical and clinical outcome. The mean follow-up period was 2.5 years (range 13–49 months). Results Technical success was achieved in 21 children (91.3%). Failure occurred in two children, in one due to failure to adequately localize the nidus within the dense sclerosis and in the other because of a short ablation time (2 min) because he developed hyperthermia. Clinical success was achieved in 18 patients within 2–5 days (primary clinical success rate 78.2%).These patients were allowed to fully weight-bear and function without limitation 1 week after the procedure. Pain recurrence was observed in two patients; one was treated successfully with a second ablation after 6 months (secondary clinical success rate 82.6%). Hyperthermia was observed in two patients during the procedure. Three other minor complications were observed: wound infection in one child and skin burn in two children. No major immediate or delayed complications were observed. Conclusion Percutaneous CT-guided RF ablation is an effective and safe minimally invasive procedure for the treatment of osteoid osteoma in children. It has high technical and clinical success rates that are slightly lower than those of patients with a wider range of ages.     

房间隔穿刺法对儿童及青少年患者左侧房室旁道的射频消融治疗

目的探讨房间隔穿刺方法（ＴＳ）对儿童及青少年患者左侧房室旁道射频消蚀（ＲＦＣＡ）的成功率及安全性。方法共有３０例患者，平均年龄为１３±３岁，心动过速史３～５年，其中６例是因为动脉逆行法（ＴＡ）失败或操作困难，而对其进行房间隔穿刺射频消融治疗的。结果３０例患者均成功的进行了ＲＦＣＡ，无一例发生与ＴＳ有关的并发症；操作时间９３±３５分钟，Ｘ线投照时间２７±１２分钟，放电功率１８±６Ｗ。结论ＴＳ法对儿童及青少年患者左侧房室旁道的ＲＦＣＡ具有较好的成功率和安全性；ＴＳ法可避免动脉系统有关的并发症，而且是ＴＡ法的重要补充     

麻醉意识深度指数在儿童射频消融术中应用的临床研究

目的分析麻醉意识深度指数(cerebral state index,CSI)与脑电双频指数(bispectral index,BIS)在监测儿童射频消融术中反映麻醉深度的相关性,评价CSI用于儿科监测的可行性。方法选择全麻下行心律失常射频消融手术的患儿36例,年龄7~15岁,ASAⅠ~Ⅱ级,给予丙泊酚2.5 mg/kg,顺式阿曲库铵0.1 mg/kg,芬太尼1μg/kg诱导后气管插管。麻醉维持期,设定BIS目标区间为60~70,采取闭环模式机器自动调整丙泊酚注药速度,瑞芬太尼0.25~0.33μg·kg^-1·min^-1持续泵注。记录患儿入室时(T 1)、诱导完成时(T 2)、手术开始时(T 3)、手术30 min(T 4)、手术60 min(T 5)、手术90 min(T 6)、停药时(T 7)、拔除气管插管时(T 8)、出室前(T 9)的CSI和BIS,并记录T 7~T 9时的改良清醒镇静评分(modified observers assessment of alertness/sedation scale,MOAA/S)。结果T 1~T 2诱导期、T 3~T 6维持期、T 7~T 9复苏期CSI与BIS的Spearman相关系数分别为0.87、0.84和0.69(P<0.05)。T 1、T 3~T 5时CSI低于BIS(P<0.05),T 8~T 9时CSI高于BIS(P<0.05),T 2、T 6、T 7时,CSI、BIS差异无统计学意义(P>0.05)。T 7~T 9复苏期,CSI与MOAA/S的Spearman相关系数为0.77(P<0.05);BIS与MOAA/S的Spearman相关系数为0.75(P<0.05)。结论在儿童静脉麻醉状态下,CSI与BIS具有良好的相关性,CSI可以用于监测麻醉深度。     

Electrogram patterns associated with successful radiofrequency ablation of accessory pathways in children

Electrograms observed prior to successful and unsuccessful ablation trials in 33 patients (362 attempts) with manifest pathways and 18 patients (194 attempts) with concealed pathways were compared to identify the electrogram patterns that are associated with successful radiofrequency ablation of accessory atrioventricular connections in young patients (mean age 12.7 years; range 4–22 years). Success was defined as permanent or transient interruption of conduction in the accessory connection. Predictors of success in patients with manifest pathways were local ventricular preexcitation (p = 0.0001), left-sidedness (43 or 174) of the accessory connection compared (p = 0.04) to right-sidedness (27 of 172), a probable Kent bundle potential (29 of 84 versus 39 of 256; p= 0.0001), and short antegrade atrioventricular conduction intervals (53.1 ± 31.9 ms versus 64.6 ± 32.0 ms; p= 0.02). Predictors of success in patients with concealed pathways were short ventriculoatrial conduction times (103.3 ± 35.8 ms versus 117.9 ± 34.8 ms; p = 0.01), and left-sided (42 of 125) pathways (p = 0.03; versus right-sided, 11 of 60). The presence of a Kent bundle potential was not significant. We conclude that specific electrogram patterns can predict successful ablation of either manifest or concealed accessory pathways. Use of these criteria may reduce the delivery of unnecessary energy to young myocardium.     

射频消融治疗儿童阵发性室上性心动过速

目的 探讨射频消融（ＲＦＣＡ）对儿童阵发性室上性心动过速（ＰＳＶＴ）的治疗价值。方法 连续收集１３例ＰＳＶＴ患者,通过标准１２导联体表ＥＣＧ和心内电生理检查确定ＰＳＶＴ类型和标测消融靶点,然后施行ＲＦＣＡ。结果 房室折返型心动过速（ＡＶＲＴ）１０例,房室结折返型心动过速（ＡＶＮＲＴ）３例,其中左侧游离壁旁道８例,右侧游离壁旁道２例,房室结双径路３例。ＲＦＣＡ成功率１００％。１例ＡＶＮＲＴ患者发生一     

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十余年来,射频导管消融(RFCA)广泛用于根治预激综合征、房室结折返性心动过速、房性心动过速、心房扑动、特发性室性心动过速和频发性室性早搏,取得极好的疗效。由于其成功率高、创伤小及相对安全,已成为根治上述心律失常的首选方法。RFCA用于治疗小儿快速型心律失常国内外均有     

射频消融术治疗小儿室上性心动过速的临床评价

目的 评价射频消融术治疗小儿阵发性室上性心动过速(PSVT)的临床安全性及疗效.方法 回顾性分析26例接受射频消融治疗患儿的临床资料.结果 除1例复发外,所有选择病例均消融成功,全部转为窦性心律,术后无并发症出现,远期随访观察无不良反应.结论 射频消融术治疗儿童室上性心动过速是安全有效的,对于条件适合的患儿可作为首选治疗方案.     

射频导管消融治疗小儿不同类型快速型心律失常1000例

目的 探讨射频导管消融(RFCA)治疗小儿不同类型快速型心律失常的成功率、复发因素、安全性及年龄对消融效果的影响.方法 接受心内电生理学检查及RFCA的快速型心律失常患儿1000例,年龄0.33 ～16.50岁[(7.6±3.8)岁].分析不同心动过速类型RFCA方法及效果、心动过速复发及并发症的发生情况,比较不同年龄组RFCA效果.结果 接受心内电生理检查患儿1000例,经心内电生理学检查证实房室折返性心动过速(AVRT) 560例(56％),房室结折返性心动过速(AVNRT) 210例(21％),室性心动过速/室性期前收缩(VT/PVC) 159例(15.9％),局灶性房性心动过速(rAT) 49例(4.9％),心房扑动/切口折返性房性心动过速(AF/IRAT) 22例(2.2％).958例患儿接受RFCA,首次消融成功率96.2％,复发率8.1％,其中经心电生理检查证实为原旁路/消融点复发5.3％,新的旁路/起源部位/心律失常类型2.8％.AVRT接受RFCA 533例,消融成功率98.0％,复发率8.4％,其中原旁路复发4.0％,新的旁路/心动过速类型4.4％.右前/中间隔旁路消融成功率较低(85.3％),原旁路复发率较高(31.0％).AVNRT接受RFCA 205例,消融成功率100％,复发率5.9％,其中原消融点复发4.9％.AF/IRAT接受RFCA 22例,消融成功率95.5％,随访无复发.FAT接受RFCA 46例,消融成功率84.8％.其中采用二维标测,消融成功率62.5％;采用三维标测指导冷盐水灌注消融成功率96.7％;2种方法消融成功率比较差异具有统计学意义(P＜0.05);复发10例(25.6％),其中7例起源于左/右心耳,均经外科心耳切除术后房性心动过速得以根治.VT/PVC接受RFCA 152例,消融成功率89.5％,复发率6.6％,其中原消融点复发5.9％.不同年龄组消融成功率比较差异无统计学意义.开展RFCA早期与晚期总体消融成功率及不同类型心动过速消融消融成功率比较差异无统计学意义,开展消融早期房室结折返性心动过速及左前侧壁房室旁路复发率显著高于晚期,差异有统计学意义(P＜0.05).RFCA并发症8例(0.84％),其中完全性房室传导阻滞2例、麻醉意外1例均发生于射频消融早期阶段,血管并发症5例,无死亡病例.结论 RFCA手术可安全而有效地用于治疗小儿快速型心律失常,成功率高,复发率低,是根治某些类型小儿快速型心律失常的首选方法;低龄儿RFCA成功率、复发率及并发症与其他年龄组患儿比较差异无统计学意义,但手术难度有所增加,需谨慎选择;采用三维标测指导射频导管消融可明显提高难治性心律失常的消融成功率;丰富的经验及熟练的操作是避免并发症发生的重要因素.     

CARTO3 系统指导下射频消融治疗儿童房室结折返性心动过速

目的探索儿童射频消融治疗房室结折返性心动过速(AVNRT)的安全方法。方法回顾分析2014年1月至2017年4月在CARTO 3系统指导下射频消融治疗的80例AVNRT患儿的临床资料。结果 80例AVNRT患儿中,男48例、女32例,平均年龄(11.74±2.49)岁;平均体质量(42.19±12.97)kg,6例(7.5%)体质量27 kg。患儿治疗中曝光时间(6.87±7.09)min,曝光量(10.71±7.02)m Gy,手术时间(80.81±29.14)min。成功率98.75%(1/80),复发率1.25%(1/80),并发症发生率1.25%(1/80),无死亡病例。结论严格把握手术适应症,在CARTO3系统指导下,结合解剖和电生理方法,采用能量滴定法对儿童进行射频消融治疗AVNRT安全有效。     

Preoperative chemotherapy and intraoperative radiofrequency ablation for unresectable solid pseudopapillary tumor of the pancreas

Solid pseudopapillary tumor (SPT) is rare primary tumor of the pancreas with low malignant potential affecting adolescent or young women. Radical surgical resection is the definitive treatment for long-term survival even in the patients with metastases. We report a case of 14-year-old girl who presented with unresectable SPT of the pancreas. She received preoperative chemotherapy with cisplatinum, ifosfamide, etoposide, and vincristine followed by intraoperative radiofrequency ablation of metastatic liver lesions with surgical resection of the primary tumor successfully. We demonstrate that all attempts should be made to resect or ablate the primary as well as the metastatic lesions for long-term survival.     

射频消融在儿童和青少年心律失常中的初步应用

目的：　观察射频消融 (RFCA)对儿童和青少年心律失常治疗的疗效。方法：　对42例患者用射频消融治疗心律失常,心律失常病史为1～9年,平均(5 .3± 1.2 )年。旁路消融在窦律、心室起搏或诱发房室折返性心动过速(AVRT)后,寻找最早心室激动点(EVA)或最早心房激动点(EAA) ;房室结折返性心动过速 (AVNRT)以后位或下位法标测靶点;室性心动过速(VT)和室性早搏(PVC)以起搏标测和激动标测相结合;心房扑动(AFL)行连续性线性RFCA ;心房颤动 (AF)行房室结慢径改良。结果：　 42例患者行RFCA ,成功 40例,1例AF患者行房室结改良时并发Ⅲ度房室传导阻滞(Ⅲ°AVB) ,术后2周未恢复,植入永久起搏器。结论：　RFCA对儿童和青少年心律失常的治疗有效而安全,但应严格掌握适应证