射频消融房室交界区的实验研究

20条犬经导管射频消融后,14条发生完全性房室传导阻滞。无严重并发症发生。消融部位呈凝固性坏死,边缘清楚。消融术不损伤电极导管。     

EFFICACY OF LAPAROSCOPIC RADIOFREQUENCY ABLATION FOR HEPATOCELLULAR CARCINOMA COMPARED TO PERCUTANEOUS RADIOFREQUENCY ABLATION WITH ARTIFICIAL ASCITES

Aim: Hepatocellular carcinoma (HCC) nodules close to the liver surface exhibit high recurrence compared to those in distal parts of the liver. Moreover, when nodules remain adjacent to the gastrointestinal tract or gallbladder, severe complications such as perforation of those organs may occur due to invasive therapy. Percutaneous radiofrequency ablation (PRFA) with artificial ascites or laparoscopic radiofrequency ablation (LRFA) are used to treat these patients to avoid complications. The purpose of the present study was to assess the efficacy and safety of these two methods. Methods: Subjects comprised 74 patients (48 men, 26 women; mean age, 68.5 ± 8.0 years; range, 46–89 years) with 86 HCC nodules. PRFA with artificial ascites was carried out for 37 patients (44 nodules) and LRFA was used for 37 patients (42 nodules). Clinical profiles were compared between groups. Results: No significant differences in clinical profiles were found between patients treated by PRFA or LRFA. Mean number of treatments was significantly lower for LRFA (1.0 ± 0.0) than for PRFA (2.1 ± 1.0, P < 0.001). Mean number of PRFA treatments was 2.2 ± 1.0 in patients with HCC nodules >2 cm in diameter, whereas all tumors were completely ablated with only one session of LRFA. The safety margin was significantly wider for LRFA than for PRFA. Conclusion: LRFA is a better treatment option for ablation of HCC nodules >2.0 cm in diameter.     

LAPAROSCOPIC RADIOFREQUENCY ABLATION FOR HEPATOCELLULAR CARCINOMA

Radiofrequency ablation (RFA) is one of the best curative treatments for hepatocellular carcinoma in selected patients, and this procedure can be applied either percutaneously or laparoscopically. Although the percutaneous approach is less invasive and is considered the first choice, RFA with laparoscopic guidance is highly recommended for patients with a relative contraindication for percutaneous RFA, such as lesions adjacent to the gastrointestinal tract, gallbladder, bile duct and heart. Recent advances in laparoscopic ultrasound have widened the indication for laparoscopic ablation. In the present paper, we review the indications, advantages, prognosis and safety of laparoscopic RFA for hepatocellular carcinoma.     

射频消融治疗室上性心动过速病例分析

８０例行射频消融术（ＲＦＣＡ）的室上性心动过速患者中，５２例房室折返性心动过速有５３条旁路，射频阻断４９条，成功率９２％。例１第２次ＲＦＣＡ后出现Ⅲ度房室传导阻滞（Ａ－ＶＢ），１周后安装ＤＤＤ起搏器；１例大头导管在升主动脉打结；１例术后有左下肢静脉血栓形成；２例术后１个月复查Ｂ型超声示轻度主动脉瓣关闭不全。２６例房室结折返性心动过速射频全部成功，１例术后出现１度Ａ－ＶＢ，１例出现左侧气胸。２例房内折返性心动过速射频成功。初步认为射频消融治疗室上性心动过速有一定的并发症（包括Ⅲ度Ａ－ＶＢ）。     

射频消融治疗阵发性室上性心动过速430例临床分析

以射频消融430例阵发性室上性心动过速患者,成功率97.2%。其中房室结双径路103例。慢径消融98例,快径消融5例,全部获得成功。房室旁路327例,共计347条旁路,315例(96.3%)患者的333条旁路(96.0%)被阻断。平均随访6±4个月,10例房室旁路复发,其中3例合并心动过速者成功地进行了第2次消融。未见严重并发症。     

射频消融犬心室肌的实验观察

射频消融8只犬心室肌,病理损伤为类圆形均匀的凝固性坏死,边界清晰,损伤范围与所用能量不相关。术中无严重并发症。     

射频消融治疗顽固性室性心动过速八例临床分析

经导管射频消融治疗8例顽固性室性心动过速。术中以心室起搏标测定位,成功5例,失败3例,无并发症。     

CP37: FOLLOW-UP OF PACEMAKER AFTER RADIOFREQUENCY ATRIOVENTRICULAR JUNCTION ABLATION

PURPOSE OF STUDY: Follow-up dynamic of dual chamber pacing with auto switch mode(ASM) function after atrioventricular (AV) junction ablationin patients with paroxysmal atrial fibrillation (AF) was evaluated. METHODS: In 65 patients (42 male, 23 female), mean age 667,9 years withparoxysmal AF radiofrequency (RF) ablation of AV junction withimplantation of DDDR pacemaker with ASM function were performed.Each patient was evaluated every 3 months during a 15,32,3month period. We analysed the quantity of mode switching eventsand their duration, maximal atrial rate during paroxysm andproportion of atrial sensing-ventricular pacing (As-Vp), atrial-ventricularpacing (Ap-Vp) and VVI pacing (Vp). The atrial statistic ofpacemaker was the point of special assessment. RESULTS: According the results of atrial statistic sensing of AF paroxysmswas adequate. In the first 3 months of after operation pacemakerdetection of high atrial rate was checked by external Holtermonitor. The number of paroxysmal AF episodes recorded duringfirst 3 months were 5917,2 and during the last – 41,211,2(p=0,01); the decrease of duration in mode switching was from192,551,1 min to 98,541,2 min (p&#60;0.05); the durationof each AMS event shortened significantly – from 7,83,1min to 1,91,3 min (p=0,02). The proportion of As-Vp was similar(p=NS) in both pacing modes. Symptomatic improvement was reportedby all patients, while hospital visits were for ordinary pacemakerfollow-up. No patient experienced pacemaker dysfunction in termsof sensing and pacing threshold. CONCLUSION: AV junction ablation with permanent DDDR pacing with ASM isa reliable method of arrhythmia control and improvement of qualityof life. It seems that atrial pacing may be a stabilising factorin patients with paroxysmal AF even if they have intact sinusnode function. Results of atrial statistic of pacemaker shouldbe implemented for analysis and correction of pacemaker programin patients with AF.     

右前间隔房室旁路的自右房侧射频消融术

右前间隔房室旁路是整个导管消融中较为困难的部位。我们以射频电流消融4例均获成功。消融部位为希氏束导管正上方。3例患者记录到旁路电位。旁路与希氏束的平均距离为4.9 mm。当大头导管记录到大A小V波且无或仅有微小希氏束波时放电。1例并发不完全性右束支阻滞。平均随访8个月无复发。     

电视胸腔镜肺楔形切除11例报导

我院从1994年年底到1996年7月应用电视胸腔镜外科手术24例,其中作肺楔形切除11例。用于治疗的7例,用于诊断的4例。肺肿瘤8例,良性肿瘤3例,转移性肿瘤5例。另外是机化性肺炎1例,特发性肺肺纤维化1例,支气管扩张1例。肿瘤大小1.5～4.Scm直径。所有病人均作全身麻醉,双腔支气管插管,单肺通气。3例病人因病灶较大,作辅助小切口5～7cm。这样以手指探查病灶和常规开胸手术器械也可以通过此切口进行操作。1例支气管扩张,因出血改开胸手术。全组病人引流管均于48小时拔除仅1例并发肺不张,引流管放置11天。3例良性肿瘤病人术后平均住院8.6天。4例用于诊断的病例均取得病理诊断,无漏气、切口感染和手术死亡等并发症。     

ENDOSCOPIC MANAGEMENT OF BILIOCUTANEOUS FISTULA AFTER PERCUTANEOUS RADIOFREQUENCY ABLATION THERAPY FOR HEPATOCELLULAR CARCINOMA

Our patient was a 70‐year‐old man with hepatocellular carcinoma (HCC) and liver cirrhosis (Child–Pugh B). He had a history of distal gastrectomy with Billroth II reconstruction for duodenal ulcer and hepatectomy for HCC. One month after percutaneous radiofrequency ablation (RFA) for recurrent HCC, biliocutaneous fistula was observed. The cholangiogram demonstrated leakage of contrast material from an intrahepatic duct into the fistula, and a nasobiliary catheter was placed. Subsequently, the discharge of bile steadily decreased and stopped. Follow‐up cholangiogram revealed no evidence of bile leakage. Biliocutaneous fistula is an extremely rare complication after percutaneous RFA, and the present case report suggests that endoscopic drainage is the first‐line therapy for bile leaks after RFA.     

射频消融左侧旁道有效消融点标准探讨

报道３０例预激综合征左侧旁道射频消融（ＲＦＣＡ）有效和无效消融点放电前的电生理特点。结果表明：①显性旁道有效消融点特征为房室传导时间极短（≤３０ｍｓ），房波和室波间无等电位线，室波等于或超前标测电极室波；②隐匿旁道有效消融点特征为逆传房波紧随室波后，室波和房波间无等电位线，逆传房波等于或超前标测电极房波。认为ＲＦＣＡ中正确识别上述特征有助于提高消融疗效和减少放电次数。     

阵发性室上性心动过速射频消融术前后心率变异性的比较

目的探讨射频消融术(RFCA)后心率变异性(HRV)的改变.方法选择阵发性室上性心动过速患者51例,男27例,女24例,年龄25～48岁,平均(39.5±4.7)岁,其中左侧房室折返性心动过速23例,右侧房室折返性心动过速16例,房室结折返性心动过速12例.应用24h动态心电图观察心率变异性各时域指标(SDNN、SDANN、SDANN Index、RMSSD、PNN50)、频域指标(LFnu、HFnu).结果RFCA术前各指标值比对照组低,术后3d所有HRV的各项频域及时域指标均较RFCA前显著降低,而术后2个月各项指标虽仍较RFCA前降低,但差异无统计学意义.结论射频电流对心脏自主神经有一定的损伤,在术后2个月可基本恢复.     

经导管射频消融左侧房室旁道治疗顽固房室折返性心动过速

本文报道经导管射频消融术治疗12例预激综合征合并房室折返性心动过速(AVRT)患者,旁道皆位于左侧,11例成功,1例失败。射频消融术属根治性疗法,效果确实可靠,是治疗顽固性快速心律失常可供选择的新方法。     

射频消融房室旁路的复发原因分析

总结了１２２例１２４条房室旁路（ＡＰ）射频消融术（ＲＦＣＡ）的复发率，并对复发的可能原因作了初步分析。结果为：１２４条ＡＰ经２～２５（１３．５±７．１）个月随访５条复发，复发率为４．０３％（５／１２４）。其中显性与隐性ＡＰ复发率分别为１．２３％（１／８１）和９．３０％（４／４３），Ｐ＜０．０５；左游离壁与间隔分别为２．５％（２／８０）和７．５％（３／４０），Ｐ＞０．０５；左侧与右侧分别为３．３％（３／９０）和３．１％（１／３２），Ｐ＞０．０５。复发时间为０．５～６０（１５．４±２５．４）天。复发可能与消融点不够精确、ＡＰ粗大位置深在、ＡＰ功能特性与部位、消融能量不足、观察时间不够等因素有关。提示需对行ＲＦＣＡ患者进行随访。     

心脏不同部位的微波消融比较

利用２４５０ＭＨｚ微波（固定功率５０Ｗ，消融时间３０秒），对离体猪心脏不同部位组织进行消融比较。结果：左室前壁损伤范围大于左室乳头肌、主动脉瓣和二尖瓣环下以及右侧房室交界区（Ｐ＜０．０５）；室间隔的损伤范围大于右侧房室交界区（Ｐ＜０．０５）；主动脉瓣环下、二尖瓣环下及右侧房室交界区损伤范围之间无显著差异（Ｐ＞０．０５）；５０Ｗ、３０秒的能量可引起左右心房、右室前壁的透壁性损伤，但无穿孔。结论：同等微波条件下，消融心脏不同部位的组织，其损伤范围有显著差异。应依据组织的性质，选择合适的消融功率及时间。     

射频球襄成形术预防动脉腔内成形术后再狭窄的实验研究

本文将射频球囊成形术应用于动脉粥样硬化狭窄模型，观察球囊表面电极直接释放射频能量并结合压力对动脉粥样硬化狭窄的作用，同时以单纯球囊成形术为对照。结果表明，射频球囊成形术后血管狭窄程度从平均６０％以上降低至平均１７％以下，明显低于对照组（Ｐ＜０．０５），术后４周再狭窄程度明显低于对照组。超微结构也显示，射频球囊成形术后血管平滑肌细胞增殖数量减少，提示该项技术对防止动脉腔内成形术后再狭窄可能是一项有希望的措施。