Experimental radiofrequency ablation near the portal and the hepatic veins in pigs: differences in efficacy of a monopolar ablation system

BACKGROUND: We sought to compare the efficacy of a monopolar radiofrequency ablation system in vivo near the portal vein and the hepatic veins in porcine liver. MATERIALS AND METHODS: Radiofrequency ablation of healthy livers near the portal vein and the hepatic veins was performed in 10 pigs with a multitined expandable electrode. Volumes and diameters of zones of ablation were assessed by magnetic resonance imaging. RESULTS: Volumes (16.0 +/- 5.5 mL, P = 0.001) and diameters (4.0 +/- 0.7 cm, 3.3 +/- 0.7 cm, 3.0 +/- 0.6 cm, P 相似文献   

射频针刀联合仙灵骨葆胶囊治疗老年骨质疏松椎体压缩骨折PVP术后疼痛的临床疗效观察

[目的]观察射频针刀联合仙灵骨葆胶囊口服治疗老年骨质疏松椎体压缩骨折经皮椎体成形（PVP）术后疼痛的临床疗效。[方法]将60例骨质疏松性椎体压缩骨折（OVCF）患者均采取PVP手术治疗,并随机分为治疗组和对照组各30例,对照组术后行腰背部痛点射频针刀治疗配合口服阿仑膦酸钠片、罗盖全以及钙尔奇D片,治疗组在对照组基础上服用仙灵骨葆胶囊。对比两组治疗前、治疗3个月、6个月后视觉模拟（VAS）评分、腰椎活动功能Oswestry残损指数评分（ODI）、腰椎及股骨颈骨密度变化评分、椎体骨折后Cobb角恢复率评分。临床疗效采用OVCF的治疗指南进行评价。使用SPSS18.0进行统计分析。[结果]治疗后两组患者VAS评分、腰椎活动功能ODI评分及两组椎体后凸Cobb角较治疗前明显降低,腰椎及股骨颈骨密度变化评分较治疗前明显提高,同组治疗前后差异有统计学意义（P<0.05）;治疗后3个月、6个月,治疗组VAS评分、ODI评分及椎体后凸Cobb角均低于对照组,治疗组腰椎及股骨颈骨密度变化评分高于对照组,两组间比较差异具有统计学意义（P<0.05）。治疗后,对照组椎体后凸Cobb角恢复率明显低于治疗组,两组间比较差异具有统计学意义（P<0.05）;治疗后,治疗组和对照组有效率分别为96.67%、80.00%,两组疗效相当,两组间比较差异无统计学意义（P>0.05）。[结论]射频针刀联合仙灵骨葆胶囊治疗OVCF能有效、快速缓解PVP术后患者腰背部疼痛,改善腰椎功能,促进骨密度增加,降低骨质疏松性骨折的再次发生率,值得临床推广运用。     

超声引导下激光与射频消融治疗小肝癌对血清肿瘤标志物的影响及超声造影评价

目的 探讨超声引导下激光与射频消融治疗小肝癌对血清肿瘤标志物的影响及超声造影评价。方法选取76例小肝癌患者作为研究对象,分为观察组（超声引导下激光消融治疗）与对照组（超声引导下射频消融治疗）,各38例,对比1个月完全消融率,评估治疗前、治疗后4周的甲胎蛋白（lpha-fetoprotein,AFP）、异常凝血酶原Ⅱ（abnormal prothrombin-Ⅱ,PIVKA-Ⅱ）、磷脂酰肌醇蛋白聚糖3(glypican3,CPC3),观察并发症情况（局部疼痛、腹腔出血、胆道出血、胆漏、腹腔感染）,以及2年生存率、2年内无进展生存率及生存时间。结果 观察组的1个月完全消融率高于对照组（P<0.05）。治疗前,两组AFP、PIVKA-Ⅱ、CPC3比较,差异无统计学意义（P>0.05）;治疗后,观察组的AFP、PIVKA-Ⅱ、CPC3低于对照组（P<0.05）。观察组的局部疼痛、腹腔出血、胆道出血发生率低于对照组（P<0.05）;观察组胆漏及腹腔感染发生率低于对照组,差异无统计学意义（P>0.05）。观察组2年生存率、2年内无进展生存率及生存时间高于对照组（P&l...     

射频消融治疗室上性心动过速10例报告

作者报告了１０例室上性心动过速，共１１条径路的射频消融的成功经验。介绍了左侧显性旁路、隐匿性旁路及房室结双径路射频导管改良的基本方法以及定位标准。     

低温等离子射频消融并分部位手术治疗阻塞性睡眠呼吸暂停低通气综合征

目的探讨等离子低温射频消融术并扁桃体摘除术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效分析和总结。方法选取经多导睡眠图(PSG)检查并确诊的OSAHS的患者67例,用等离子低温消融术并分部位行扁桃体摘除术治疗,术后6个月行多导睡眠仪监测与术前比较以确定疗效。结果术后随访6个月,与治疗前比较,最低血氧饱和度(LSpO2)显著提高(P<0.01);呼吸暂停低通气指数减低,差异有统计学意义(P<0.01)。结论等离子低温射频消融术合并扁桃体摘除术具有较好的临床疗效,较单纯UPPP手术治疗更方便、有效、微创,有较好的应用前景。     

右前游离壁房室旁路射频消融术中Swartz鞘、小弯标测消融电极导管的应用价值

目的:评价Swartz鞘、小弯标测消融电极导管在右前游离壁房室旁路射频消融术中应用价值。方法:1998年5月至2004年12月共44例经心内电生理证实的右前房室旁路患者,其中男性26例,女性18例,年龄12￣57岁(平均20.1±6.8)。显性旁路34例,隐匿旁路10例,8例院外射频消融失败,4例6个月内复发。心动过速史1￣20年。抗心律失常药物难以有效预防发作。停用抗心律失常药物5个半衰期以上后,常规穿刺静脉和放置电极导管行心内电生理检查。在R0Swartz鞘管支持下,将小弯标测消融电极导管于右房上部塑型为倒“U”字形,使用旋转导管、适当增减导管弯度和推送导管三种力量,在三尖瓣环处移动标测确定消融靶点,以30￣50W的功率消融房室旁路。结果:44例患者有效消融靶点位于右前游离壁。所有患者消融均获成功。无并发症出现。平均手术时间61.3±22.6min,X光曝光时间22.4±8.6min。随访8个月～18个月,无一例复发。结论:右前游离壁房室旁路射频消融中Swartz鞘支持下应用小弯标测消融电极导管能提高消融成功率,有较高的应用价值。     

分化型甲状腺癌术后颈淋巴结持续或复发治疗进展

颈淋巴结复发是分化型甲状腺癌复发中最主要的一部分,其治疗的主要方案为再手术治疗.近年来一些如主动监测、射频消融、放射性碘治疗等代替手术治疗的方案逐渐被提出.部分治疗手段的效果及并发症仍有争议,再手术仍是首选的治疗方式,再术后的放射性碘治疗可能不会改善病人的预后,射频消融应仅限应用于不适合再次手术治疗的病人.     

Simultaneous Endocardial and Epicardial Delineation of 3D Reentrant Ventricular Tachycardia

BackgroundMechanisms of scar-related ventricular tachycardia (VT) are largely based on computational and animal models that portray a 2-dimensional view.ObjectivesThe authors sought to delineate the human VT circuit with a 3-dimensional perspective from recordings obtained by simultaneous endocardial and epicardial mapping.MethodsHigh-resolution mapping was performed during 97 procedures in 89 patients with structural heart disease. Circuits were characterized by systematic isochronal analysis to estimate the dimensions of the isthmus and extent of the exit region recorded on both myocardial surfaces.ResultsA total of 151 VT morphologies were mapped, of which 83 underwent simultaneous endocardial and epicardial mapping; 17% of circuits activated in a 2-dimensional plane, restricted to 1 myocardial surface. Three-dimensional activation patterns with nonuniform transmural propagation were observed in 61% of circuits with only 4% showing transmurally uniform activation, and 18% exhibiting focal activation patterns consistent with mid-myocardial reentry. The dimensions of the central isthmus were 17 mm (12 to 28 mm) × 10 mm (9 to 19 mm) with 55% exhibiting a minimal dimension of <1.5 cm. QRS activation was transmural in 63% and located 43 mm (34 to 52 mm) from the central isthmus. On the basis of 6 proposed definitions for epicardial VT, the prevalence of an epicardial circuit ranged from 21% to 80% in ischemic cardiomyopathy and 28% to 77% in nonischemic cardiomyopathy.ConclusionsA 2D perspective oversimplifies the electrophysiological circuit responsible for reentrant human VT and simultaneous endocardial and epicardial mapping facilitates inferences about mid-myocardial activation. Intricate activation patterns are frequently observed on both myocardial surfaces, and the epicardium is functionally involved in the majority of circuits. Human reentry may exist within isthmus dimensions smaller than 1 cm, whereas QRS activation is often transmural and remote from the critical isthmus target. A 3-dimensional perspective of the VT circuit may enhance the precision of ablative therapy and may support a greater role for adjunctive strategies and technology to address arrhythmogenic tissue harbored in the mid-myocardium and subepicardium.     

Increasing radiofrequency ablation volumes with the use of internally cooled electrodes and injected hydrochloric acid in ex vivo bovine livers

Purpose: We used an impedance-controlled generator with an internally cooled electrode to perform radiofrequency ablation (RFA) in ex vivo bovine livers, with a single injection of either 38.5% sodium chloride (NaCl) or 10% hydrochloric acid (HCl), to determine the relative effects of these two solutions on tissue impedance, temperature and ablation volume.

Materials and methods: We performed 10 ablations each with injections of NaCl (NaCl-RFA), HCl (HCl-RFA) or nothing (RFA-alone), with a power setting of 200 W for 15?minutes. We recorded tissue impedance before and after injection. We logged temperatures obtained from thermocouple probes positioned 5, 10, 15 and 20?mm from the internally cooled RF electrode. After ablation, we measured ablation zone longitudinal and transverse diameters, and we calculated a spherical ratio (SR) for each ablation.

Results: Mean post-injection impedance of 30.3 (standard deviation [SD] 2.5) ohms for HCl was significantly lower than that of 55.4 (SD 3.5) ohms for NaCl (p?<?.001). Mean maximum temperatures recorded at each respective distance from the RFA electrode were all highest for HCl-RFA and lowest for RFA-alone (p?<?.001). Mean longitudinal and transverse diameters after HCl-RFA (5.50 [SD 0.25] cm and 5.28 [SD 0.22] cm, respectively) were significantly larger than those after NaCl-RFA (4.24 [SD 0.35] cm and 3.55 [SD 0.43] cm, respectively) and after RFA-alone (3.60 [SD 0.10] cm and 2.70 [SD 0.13] cm, respectively) (p?<?.001). Mean SR after HCl-RFA (0.93, SD 0.02) was significantly higher than mean SR after NaCl-RFA (0.76, SD 0.06) and RFA-alone (0.72, SD 0.04) (p?<?.001).

Conclusion: Monopolar, impedance-controlled RFA, with an internally cooled electrode and a single 10% HCl injection may allow larger tumors to be treated, potentially resulting in improved patient outcomes.     

手术切除与经皮射频消融在小肝癌治疗中的价值探讨

目的评价手术切除与经皮射频消融（PRFA）在小肝癌治疗中的价值。方法我院小肝癌患者99例分为两组,分别给于手术切除和PRFA,对两组术后不良反应、术后1年复发率进行比较。结果两组患者术后不良反应,包括术后体温恢复时间,ALT升高例数,胆红素升高例数,经比较无差异;对于直径≤3cm的肿瘤,手术治疗与PRFA治疗组患者术后1年的肿瘤复发率差异没有显著性;但是直径3～5cm的肿瘤,手术治疗组在术后1年的肿瘤复发率明显低于PRFA治疗组。结论手术治疗与PRFA均是一种创伤小、恢复快、安全性高的治疗方法 ,对于肿瘤直径≤3cm的,两者疗效等同;对于肿瘤直径3～5cm的,以手术治疗为宜。