Osteoid Osteoma: CT-Guided Radiofrequency Ablation Using a Water-Cooled Probe

Background The purpose of this study was to assess the safety and efficacy of computed tomography (CT) guided percutaneous radiofrequency (RF) ablation of osteoid osteoma by using the water-cooled probe. Methods During the period from July 2002 to February 2006, fifty-one patients with osteoid osteomas localized in femur (29), tibia (10), calcaneus (2), talus (2), metatarsus (2), humerus (1), sacrum (1), scapula (1), olecranon (1), patella (1) and thoracic vertebra (1) were treated with CT-guided RF ablation using the Cooltip™ Tyco Healthcare probe. Mean age was 20 (range, 3.5–57 years) and male to female ratio was 36/15. Mean follow-up period was reported 2 years (range, 9–51 months). The procedures were carried out under general anesthesia and the patients were discharged from the hospital within 24 h. Results Technical failure was reported in only one procedure. Pain disappeared postoperatively in all the patients within 2–3 days and no patients needed analgesic treatment after a week. All patients were allowed fully weight bear and function without limitation after the procedure. Recurrence of the pain was observed in one patient who was treated successfully with a second ablation. Our primary and secondary clinical success rates were 98 and 100% respectively. In one case, wound infection was observed after the procedure as the only post-operative complication in our series. Conclusion CT-guided percutaneous RF ablation of osteoid osteomas using the water-cooled probe is a safe, effective and minimally invasive procedure with high success rate and lack of relapses.     

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

A biomechanical study comparing simulated lytic vertebral metastases treated with laser-induced thermotherapy (LITT) and vertebroplasty versus vertebroplasty alone. To investigate the effect of tumor ablation using LITT prior to vertebroplasty on biomechanical stability and cement fill patterns in a standardized model of spinal metastatic disease. Vertebroplasty in the metastatic spine is aimed at reducing pain, but is associated with risk of cement extravasation in up to 10%. Six pairs of fresh-frozen cadaveric thoracolumbar spinal motion segments were tested in axial compression intact, with simulated metastases and following percutaneous vertebroplasty with or without LITT. Canal narrowing under load, pattern of cement fill, load to failure, and LITT temperature and pressure generation were collected. In all LITT specimens, cement filled the defect without extravasation. The canal extravasation rate was 33% in specimens treated without LITT. LITT and vertebroplasty yielded a trend toward improved posterior wall stability (P = 0.095) as compared to vertebroplasty alone. Moderate rises in temperature and minimal pressure generation was seen during LITT. In this model, elimination of tumor by LITT, facilitates cement fill, enhances biomechanical stability and reduces the risk of cement extravasation.     

低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术治疗颈椎间盘突出症的效果

目的 评价低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术治疗颈椎间盘突出症的效果.方法 具有头痛、头晕、颈肩臂痛等症状的颈椎病患者56例,年龄33～61岁,采用随机数字表法,将患者随机分为2组(n=28):胶原酶盘外溶解术组(C组)和低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术组(R组).两组手术均在CT引导下进行,术后6个月采用改良划线法评价疗效.结果 C组患者头痛、头晕和颈肩臂痛缓解率分别为86％、79％和93％,R组分别为96％、93％和100％,差异均有统计学意义(P＜0.05).结论 低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术治疗颈椎间盘突出症的效果优于单独应用胶原酶盘外溶解术.     

益生菌对炎性肠病小鼠肠屏障功能的影响

目的 研究益生菌植物乳杆菌(LP)对炎症状态下肠屏障的修复机理.方法 以白介素-10基因敲除(IL-10-/-)小鼠为炎性肠病模型,采用简单随机法(随机表)将空白对照(WT)小鼠和IL-10-/-小鼠分成4组:WT组、WT+ LP组、IL-10-/-组和IL-10-/-+ LP组,每组10只.分别灌饲Ringer液或LP溶液,持续4周.每周记录小鼠肠炎的临床表现,实验结束后收集小鼠结肠组织,进行病理评分和形态观察,ELISA法检测结肠组织促炎细胞因子肿瘤坏死因子-α(TNF-α)和干扰素-γ(IFN-γ)浓度,利用Ussing Chamber技术对小鼠结肠通透性及电生理变化进行分析,并用Western blot和免疫荧光分析法对结肠上皮细胞紧密连接蛋白进行定量和定位研究.结果 与WT组相比,IL-10-/-组小鼠腹泻、直肠脱垂和体重丧失较明显(P＜0.01);TNF-α和IFN-γ浓度明显升高(P＜0.01);病理表现为大量炎性细胞浸润,偶见透壁性溃疡和隐窝脓肿形成;超微电镜提示紧密连接结构破坏;紧密连接蛋白( ZO-1、occludin、claudin-1)表达明显降低(P＜0.01)且伴有异常分布;结肠上皮细胞甘露醇通透性升高(P＜0.001),跨膜电阻值降低(P＜0.001).LP干预4周后,与IL-10-/-组相比,LP能显著改善肠道炎症的临床和病理表现,阻止紧密连接超微结构破坏,促进紧密连接蛋白的表达(P＜0.01),降低结肠上皮细胞甘露醇通透性(P＜0.001),升高跨膜电阻值(P＜0.001),降低了TNF-α和IFN-γ的浓度(P＜0.01),减轻了肠道炎症.结论 LP能通过促进肠上皮细胞间紧密连接蛋白的表达修复受损肠屏障功能,从而减轻肠道炎症.     

管状胃-食管吻合对近侧胃切除术后胃食管反流的影响

目的探讨管状胃-食管吻合对食管胃交界部腺癌近侧胃切除术后胃食管反流的影响。方法对54例采用开腹手术,行传统残胃-食管吻合术;83例采用腹腔镜辅助手术,行管状胃-食管吻合术的患者进行回顾性分析。结果两组均无围手术期死亡、吻合口瘘、吻合口狭窄及胃排空障碍的发生;两组患者术后1个月、3个月时体重较术前均有下降,但两组间差异无统计学意义（P〉0.05）;管状胃-食管吻合术组术后1个月、3个月时反流性疾病问卷评分低于残胃组[（9.99±4.69）vs.（15.09±7.98）,P〈0.01]、[（9.39±4.58）vs.（14.30±7.87）,P〈0.01],管状胃组术后1个月、3个月时胃食管反流病的发生率低于残胃组[（13.25%vs.53.70%）,P〈0.01]、[（10.84%vs.48.15%）,P〈0.01]。两组间差异均有统计学意义。结论腹腔镜辅助近侧胃切除术管状胃-食管吻合安全,可靠,可降低术后胃食管反流,提高患者生活质量。     

肝动脉球囊阻断下单次射频消融治疗中大肝癌的初步临床应用

目的 探讨肝动脉球囊阻断下单次射频消融(BORFA)在治疗无法手术切除的中大肝癌中的临床疗效.方法 对11例原发性肝癌患者(12个肿瘤结节,肿瘤直径4～8 cm)行BORFA治疗,术后监测和随访肝功能变化、并发症、局部复发和消融坏死范围.结果 本组病例中每个肿瘤结节均行单次消融,消融平均时间为68±15 min;消融坏...     

超声造影检查在肾肿瘤射频消融术后疗效评估中的应用价值

目的 探讨实时超声造影(CEUS)检查在肾肿瘤射频消融(RFA)术后疗效评估中的作用.方法 对47例肾肿瘤患者(肾癌40例,肾血管平滑肌脂肪瘤7例)49个病灶行RFA治疗,其中经腹腔镜下RFA 30例,开放手术RFA 17例.术后1周行常规超声及CEUS检查,观察造影剂在动脉相与实质相的灌注情况,评价病灶消融范围,并与增强CT结果比较.影像学上病灶无增强被认为是消融完全. 结果 49个病灶完全消融47个(95.9%).CEUS显示肾消融灶最大径为2.4～10.0 cm,平均(4.6±1.5)cm,其中消融灶大于原病灶者45个、与原病灶相同者3个、小于原病灶者1个.CEUS提示RFA术后原病灶有局部强化6例,其中2例经增强CT证实.以增强CT结果作为诊断标准,CEUS对RFA术后残留灶诊断的敏感性为100.0%,特异性为91.8%.术后平均随访11(4～21)个月,患者均存活. 结论 CEUS检查与CT结合对评价肾肿瘤RFA术后疗效具有实用价值.

Abstract：

Objective To discuss the utility of contrast-enhanced ultrasonography (CEUS) in the assessment of treatment efficacy of radiofrequency ablation (RFA) in patients with renal tumors.Methods Forty-seven patients (40 renal cell carcinomas and 7 angiomyolipomas of kidney) with 49 renal tumors were treated with RFA. Tumors were ablated by laparoscopy-assisted (n= 30) and open surgical (n= 17) RFA. The CEUS and contrast-enhanced CT were performed 1 week after treatment to assess the necrotic area. Technical success was defined as elimination of areas that enhanced at imaging within the entire tumor. Results Forty-seven (95. 9%) of 49 tumors were successfully ablated. The mean length of the major axis at the maximal necrotic area was 4. 6 cm. Compared with the lesions before RFA, the necrotic areas were bigger in 45 patients, identical in 3 patients, and smaller in 1 patient. Six lesions showed a residual enhancement at the portion adjacent to the normal renal parenchyma on follow-up CEUS, while 2 were confirmed by CT scans. The sensitivity and specificity of CEUS for detection of residual tumors were 100. 0% and 91.8%, respectively. All patients survived in the follow-up period ranging from 4 to 21 months. Conclusion CEUS combined with CT could be useful for evaluating treatment efficacy of RFA for renal tumors.     

巩固性重复射频消融对甲胎蛋白阴性肝细胞癌射频消融后局部肿瘤进展的疗效

目的 探讨甲胎蛋白(AFP)阴性肝细胞癌(HCC)患者在射频消融(RFA)获得影像学完全消融后,以安全边界(SM)≥1 cm为目标的巩同性重复RFA(CRRFA)对于局部肿瘤进展的影响.方法 课题组在2002年7月至2009年7月间,共收治152例完全消融的AFP阴性HCC.其中,影像学分析显示肿瘤周边部分区域SM＜1 cm者110例,所有区域SM≥1 cm者42例.在SM＜1 cm的110例患者中,59例在首次RFA后6个月内接受了CRRFA,其余51例选择了临床观察随访.然后,据此将符合纳入标准的病例分为窄SM-CRRFA组(n=41)和窄SM-单次RFA组(n=37).此外,还从42例SM≥1.0 cm者,选择符合纳入标准的病例纳入宽SM-单次RFA组(n=30).对三组患者的局部无瘤生存率进行了比较.结果 窄SM-CRRFA组1年、2年、3年、4年和5年局部无瘤生存率分别为97.1%、90.9%、69.6%、47.2%和33.0%;窄SM-单次RFA组分别为85.9%、66.5%、43.5%、15.8%和0.0%;宽SM-单次RFA组分别为92.7%、83.7%、59.3%、36.9%和9.2%.三组间局部无瘤生存率差异有统计学意义(χ2=14.789,P=0.001).两两比较结果 显示,窄SM-CRRFA组和宽SM-单次RFA组的累积局部无瘤生存率均明显高于窄SM-单次RFA组(χ2分别为9.353和5.375,P值分别为0.002和0.020);窄SM-CRRFA组与宽SM-单次RFA组局部无瘤生存率差异无统计学意义(χ2=1.785,P=0.182).结论 对于直径3～5 cm的AFP阴性HCC,RFA治疗后SM≥1 cm是影响局部肿瘤控制效果的重要因素;对于SM＜1 cm者,CRRFA可显著提高局部无瘤生存率.

Abstract：

Objective To retrospectively evaluate the role of consolidative repeat radiofrequency ablation (CRRFA) based on safety margin (SM) analyses in local tumor control for alpha-fetoprotein (AFP) negative hepatocellular carcinoma (HCC) patients who had been shown to have radiological complete ablation (CA) with radiofrequency ablation (RFA). Methods From July 2002 to July 2009,152 AFP negative HCC patients who were shown to have radiological CA with RFA therapy were retrospectively analyzed. Among them, 110 patients had a SM of less than 1 cm and the other 42 patients had a SM of 1cm or more. Among 110 patients with SM less than 1 cm, fifty nine patients accepted CRRFA within 6 months after the first RFA and 51 did not. From these patients, a narrow SM-CRRFA group (n=41) and a narrow SM-single RFA group (n=37) were enrolled respectively. The wide SM-single RFA group (n= 30) was enrolled from the 42 patients with a SM of 1 cm or more.The LTP (local tumor progression)-free survival rate of the 3 groups were compared with a log-rank test. Results One-, two-, three-, four-, and five-year LTP-free survival rates respectively were 97. 1%, 90.9%, 69.6%, 47.2%, and 33. 0% in the narrow SM-CRRFA patients. 85.9%, 66. 5%,43.5%, 15.8%, and 0. 0%, in the narrow SM-single RFA patients, and were 92.7%, 83.7%,59.3%, 36. 9%, and 9.2% in the wide SM-single RFA patients. There were statistically significant differences (χ2 = 14. 789, P= 0. 001) between the groups. Conclusions An ablation zone with an SM of 1 cm or greater was the most important factor for local control of AFP negative HCC ranging from 3 to 5 cm in diameter. For these patients with a SM of less than 1 cm, CRRFA improved the overall local control outcomes.     

超声内镜下注射A型肉毒毒素治疗贲门失弛症的临床研究

对１０例经上消化道钡餐、内镜和食管动力检测确诊为贲门失弛症的病人,在超声内镜辅助下于食管下段扩约肌（ＬＥＳ）分４点注射Ａ型肉毒毒素８０Ｕ（每点２０Ｕ）,对治疗前后主要症状打分,测定治疗前后食管下段扩约肌压力（ＬＥＳＰ）,进行统计学分析,以评价其疗效。治疗前病人主要症状打分为６．１０±２．０２;治疗后为１．３０±１．２７,差异有显著性意义（Ｐ＜０．０１）。ＬＥＳＰ治疗前为（５．０５±１．５６）ｋＰａ,治疗后为（３．３６±１．５１）ｋＰａ,差异有显著性意义（Ｐ＜０．０１）。无明显的不良反应和合并症发生。超声内镜下注射肉毒毒素治疗贲门失弛症为一简单、安全、有效的方法。     

Double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct

We report a case of double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct. A 73-year-old woman was admitted to the hospital complaining of upper abdominal pain. Endoscopic retrograde cholangiography showed a stenotic lesion in the lower common bile duct and no visualization of the cystic duct or gallbladder. Enhanced computed tomography revealed a heterogeneously enhanced tumorous lesion around the lower bile duct in the pancreatic head. A diagnosis of cancer arising from the cystic duct that entered the lower part of the common hepatic duct was made by intraductal ultrasonography, which showed an intraluminal protruding lesion in the cystic duct. Isolated gallbladder cancer was also diagnosed, by abdominal computed tomography. She underwent pancreaticoduodenectomy with dissection of regional lymph nodes. Histological examination revealed moderately differentiated adenocarcinoma of the cystic duct and well-differentiated adenocarcinoma of the gallbladder. Double cancer of the cystic duct and gallbladder is extremely rare, and this case also suggests a relationship between a low junction of the cystic duct and neoplasm in the biliary tract.