射频消融术治疗舌部静脉畸形

目的 探讨射频消融术治疗舌部静脉畸形的效果.方法 回顾性分析2013年7月至2014年7月收治的30例舌部静脉畸形的病例资料,从单侧病变到弥漫性广泛病变,其中23例接受了射频消融术,选取直径为0.5 mm的工作尖端的射频消融电极针,功率调至25 W,将工作尖端刺入距病变最底部即最深处约1 mm处,通电行消融工作15 ～30 s,其后依次退出电极针1 mm,直至距病变表面1 mm处,分别行多点消融.结果 15例单侧病变一期手术彻底消融;8例双侧均受累及病例,一期行一侧病变射频消融术,术后3～6个月再行二期射频消融手术,其中5例彻底消融.23例术后随访3个月至1年半,手术消融20例,无复发,且舌两侧对称,无明显瘢痕,外观满意.另外3例仍有部分残余.结论 射频消融术弥补了传统手术的不足,治疗舌静脉畸形基本达到治愈,无明显并发症,且外观良好.     

射频消融治疗前列腺癌

前列腺根治术无疑是早期前列腺癌患者的最佳治疗方式。但对于全身脏器功能欠佳不能耐受手术的患者，射频消融治疗以其微创、准确的特点，取得了可靠的疗效。本文就射频消融的原理、临床应用研究、适应证及影响因素作一综述。     

射频消融治疗前列腺癌

前列腺根治术无疑是早期前列腺癌患者的最佳治疗方式。但对于全身脏器功能欠佳不能耐受手术的患者,射频消融治疗以其微创、准确的特点,取得了可靠的疗效。本文就射频消融的原理、临床应用研究、适应证及影响因素作一综述。     

射频治疗肾癌的研究

随着近年来现代诊断成像技术的广泛应用,肾肿瘤的检出率明显增加,而对于孤立性肾癌、双侧肾癌的治疗手段相对局限,选择尽量保留肾功能和微创的方法可能是部分特定患者的唯一选择.射频消融治疗(Radio Frequency Ablation,RFA)是一种创伤小、恢复快的治疗肾肿瘤的方法.近年来,肿瘤的局部治疗作为微创治疗肿瘤的方法正在成为当今肿瘤治疗界的研究热点.本文对RFA技术在肾癌治疗的应用,从原理、研究进展、术后并发症、影像学观察、疗效、预后等进行综述.     

乳腺肿瘤射频消融治疗技术要点

射频消融因具有创伤小、并发症少等优点,成为乳腺肿瘤治疗的重要手段之一。本文回顾近十余年发表的相关文献,对射频消融治疗乳腺肿瘤过程中所涉及的技术流程,如适应证、禁忌证、引导方式、消融工具、消融时间、疗效评价等做一综述。     

难治性肝癌射频消融治疗策略

射频消融(RFA)治疗肝肿瘤的安全性及有效性已得到广泛认可。但对于难治性肝癌,RFA治疗难度及风险大幅提高。重视影像指导下的规范化治疗及个体化治疗及策略,对难治性肝癌将同样可获得较好的疗效及安全性。     

经皮射频消融术与腹腔镜肝切除术治疗原发性小肝癌的疗效及预后比较

目的:比较经皮射频消融术与腹腔镜肝切除术治疗原发性小肝癌的疗效及预后。方法:回顾性分析2012年1月—2014年12月间收治的140例原发性小肝癌患者资料,其中80例行射频消融术(消融组),60例行腹腔镜肝切除术(腔镜组)。比较两组患者术后血清肝功能指标与肿瘤标志物水平的变化、并发症发生率、根治率、复发率及生存率。结果:术前两组的基线资料、肝功能指标及肿瘤标志物水平均无统计学差异(均P0.05)。术后消融组肝功能指标先升后降,腔镜组则呈持续降低,消融组术后短期内丙氨酸氨基转移酶、天门冬氨酸氨基转移酶水平均明显高于腔镜组(均P0.05);两组术后肿瘤标志物水平均逐渐降低,两组间差异无统计学意义(均P0.05)。消融组术后并发症发生率明显低于腔镜组(3.75%vs. 20.00%,P=0.002)。两组根治率、复发率以及1、2、3年总生存率和无瘤生存率均无统计学差异(均P0.05)。结论:两种手术方式对原发性小肝癌的疗效及预后无统计学差异,射频消融术后并发症较少,但对短期肝功能存在一定损害。     

射频消融术治疗肝脏恶性肿瘤的研究进展

肝脏恶性肿瘤是临床常见的恶性肿瘤之一。目前手术切除被认为是唯一可能治愈肝肿瘤的方法,但仅有少数患者具备手术指征,化学治疗和放射治疗却无明显疗效。射频消融（radio frequency ablation,RFA）是在超声、CT或MRI引导下经皮肤或腹腔镜或开腹途径将射频针插入瘤体,通过微电极发射射频电流使组织中带电粒子高速震荡产热,致电极周围细胞凝固性坏死的治疗肿瘤的方法。RFA创伤小、对正常组织影响小、恢复快及疗效确切。RFA联合治疗在肝脏恶性肿瘤的治疗中发挥重要作用。     

二次切除手术与经皮射频消融治疗切除术后复发性肝细胞肝癌的临床疗效

目的探讨二次手术切除和经皮射频消融方法治疗肝细胞肝癌患者复发病例的临床疗效和生存状况。 方法回顾性分析2011年1月至2013年5月期间58例原发性肝细胞肝癌患者资料,其中二次手术切除的患者25例(二次切除手术组)、射频消融治疗的患者33例(RFA组)。采用统计软件SPSSl8.0分析,两组生化指标等计量资料的比较使用独立t检验,两组并发症发生情况情况、生存状况计数资料的比较使用χ²检验,检验水准取0.05,双侧概率。 结果两组患者治疗后TBIL、ALT、ALB、GGT指标RFA组均好于二次手术切除组(P<0.05);二次切除手术组患者并发症总的发生例次(34例次)明显高于RFA组(10例次)患者(P<0.05)。RFA组术后1年复发转移率(9.1%)和术后3年无瘤生存率(84.8%)均明显优于二次切除手术组(28.0%、56.0%),差异均有统计学意义(P<0.05)。 结论经皮射频消融技术对肝细胞肝癌患者术后复发的治疗效果优于二次手术切除,患者有更好的肝功能、肿瘤复发转移发生情况及长期无瘤生存率。     

Multilevel temperature-controlled radiofrequency for obstructive sleep apnea: extended follow-up.

OBJECTIVE: To determine long-term effectiveness of multilevel (tongue and palate) temperature-controlled radiofrequency tissue ablation (TCRFTA) for patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN AND SETTING: Prospective, 2-institution case series. Twenty-nine subjects with mild to moderate OSAS and who were at least 1 year from completion of multilevel TCRFTA were included, representing a subset of subjects who were enrolled in a previously published controlled trial. Exclusion criteria for this extended follow-up study included any additional treatment for OSAS after completion of TCRFTA. RESULTS: Median follow-up was 23 months. Daytime sleepiness and OSAS-related quality of life were significantly improved at extended follow-up (both P < 0.001). Median reaction time testing and apnea-hypopnea index (AHI) were also significantly improved at long-term follow-up (P = 0.03 and 0.01). Body mass index was unchanged (P = 0.94). CONCLUSIONS: Multilevel TCRFTA treatment of mild to moderate OSAS resulted in prolonged improvement in daytime somnolence, OSAS-related quality of life, psychomotor vigilance, and AHI in this group of subjects at extended follow-up.     

Laparoscopic liver resection assisted with radiofrequency

BACKGROUND: Radiofrequency-assisted laparoscopic liver resection is reported. METHODS: Patients suitable for liver resection were carefully assessed for laparoscopic resection. Patient and intraoperative and postoperative data were prospectively collected and analyzed. RESULTS: Eighteen patients underwent laparoscopic liver resection. All operations were performed without vascular clamping and consisting of tumorectomy (n = 9), multiple tumoretcomies (n = 2), segmentectomy (n = 2), and bisegmentectomies (n = 2). Mean blood loss was 121 +/- 68 mL, and mean resection was time 167 +/- 45 minutes. There was no need for perioperative or postoperative transfusion of blood or blood products. One patient developed pneumothorax during surgery as a result of direct puncture of pleura with the radiofrequency probe, and 1 patient had transient liver failure and required supportive care after surgery. The mean length of hospital stay was 6.0 +/-1.5 days. At follow-up, those with liver cancer had no recurrence. CONCLUSIONS: Radiofrequency-assist laparoscopic liver resection can decrease the risk of intraoperative bleeding and blood transfusion.     

等离子低温射频消融术治疗先天性会厌囊肿患儿的护理

对31例等离子消融术治疗会厌囊肿患儿实施围术期护理,包括做好术前准备和家长的心理护理,术后生命体征监测、呼吸道管理、预防出血感染等并发症护理,结果患儿均治愈出院,随访无复发.提示等离子低温消融手术更适用于婴儿会厌囊肿手术,针对患儿可能出现的各种症状,采取正确的围术期护理措施,及早发现并及时处理并发症,可确保取得良好的治疗效果.     

经电视胸腔胸交感神经切除术治疗手汗症50例

目的　探讨用电视胸腔镜外科技术治疗手汗症的可行性。方法　1995年以来应用电视胸腔镜外科(VATS)行部分胸交感神经切除术治疗手汗症50例。其中男性26例,女性24例;平均年龄26.7岁。患者主要症状为手掌、足底与腋下多汗,严重时成滴珠状。自行设计全麻下气管内插管,取30°半坐位、两臂伸展90°,VATS两孔径路,CO     

Laparoscopic radiofrequency–assisted liver resection

Laparoscopic liver resection has not yet gained wide acceptance among hepatic surgeons, mainly because of the difficulties encountered in dealing with possible intraoperative bleeding. A new technique of laparoscopic liver resection is presented. A 43-year-old man with a large and symptomatic hemangioma underwent a laparoscopic radiofrequency energy–assisted liver resection. After induction of pneumoperitoneum, four trocars were introduced and intraoperative ultrasonography and coagulative desiccation were performed along a plane of tissue 1 cm away from the edge of the lesion using the Cool-Tip radiofrequency probe and a 500-kHz, radiofrequency generator. The necrosed band of parenchyma then was divided and the specimen removed. The operative time was 300 min with a resection time of 240 min. The intraoperative blood loss was 75 ml. The postoperative course was uneventful and the patient was discharged on postoperative day 6. Laparoscopic radiofrequency–assisted liver resection is feasible, and with greater experience may contribute to the wider use of mini-invasive video-assisted liver surgery.     

射频消融辅助保脾术的疗效

目的 探讨RFA辅助保脾术治疗外伤性脾破裂的疗效.方法 回顾性分析2010年8月至2012年5月遂宁市中心医院收治的64例外伤性脾破裂患者的临床资料.采用射频凝固止血器直接在脾脏裂口周围凝固止血,观察临床效果.结果 64例行RFA辅助保脾术的患者中,35例行RFA辅助脾裂口止血术,29例行RFA辅助脾部分切除术,平均手术时间为(138 ±48) min,术中出血量为50 ～400 ml.63例患者保脾成功,1例因术后24 h大出血,再次行手术治疗,术中发现系胃短血管断裂出血(为第1次手术未发现所致),行脾全切除术.本组患者术后体温均有一过性升高,但经常规处理或观察数日后均下降至正常水平.63例保脾成功的患者,并发症发生率为6.3％(4/63),其中l例为胃破裂修补失败导致吻合口漏,再次修补后痊愈出院;1例为左侧胸腔积液,观察数日后自行吸收;1例为肺部感染,发热4d后经对症治疗体温控制;1例为脾窝少量积液,观察数日后自行吸收.全组患者术后放置引流管,术后第1天引流量为10 ～120ml,术后第2～3天为5～25 ml,于第3天全部拔除引流管.术后2周行CT检查示脾脏质地均匀,脾周无明显积液.本组患者住院时间为(14±4)d(8 ～40 d);术后1个月复查B超无明显脾周积液及脾坏死灶,且免疫功能检查示脾脏功能正常.结论 RFA辅助保脾术简单易行,安全可靠.     

脾部分切除治疗脾良性肿瘤(附16例报告)

目的:探讨脾部分切除术治疗脾良性肿瘤的疗效.方法:对16例脾良性肿瘤施行脾部分切除手术.其中6例采用脾部分切除加大网膜包裹残面术,10例采用脾部分切除加止血凝胶覆盖.对术后并发症进行统计.结果:16例中1例术后出现左膈下脓肿,1例脾部分坏死,余无并发症发生.平均住院时间12d.结论:脾部分切除术治疗脾良性肿瘤术后并发症少,住院时间短,是安全有效的手术.     

Impact of radiofrequency assisted hepatectomy for reduction of transfusion requirements

BACKGROUND: Liver parenchyma transection technique using heat coagulative necrosis induced by radiofrequency (RF) energy is evaluated in this series. METHODS: Between January 2000 and October 2004, 156 consecutive patients underwent liver resection with the RF-assisted technique. Data were collected prospectively to assess the outcome, including intraoperative blood loss, blood transfusion requirement, and morbidity and mortality rates. RESULTS: There were 30 major hepatectomies and 126 minor resections. While total operative time was 241 +/- 89 minutes, the actual resection time was 75 +/- 51 minutes. Intraoperative blood loss was 139 +/- 222 mL. Nine patients (5%) received blood transfusion, predominantly those receiving major hepatectomy (P = .006). Thirty-six patients (23%) developed postoperative complications, and the mortality rate was 3.2%. Mean hospital stay was 12 +/- 12 days. CONCLUSION: The RF-assisted technique is associated with minimal blood loss, a low blood transfusion requirement, and reduced mortality and morbidity rates and can be used for both minor and major liver resections.