肝动脉化疗栓塞联合微波消融与单独肝动脉化疗栓塞治疗大肝癌疗效meta分析

目的 对比肝动脉化疗栓塞(TACE)联合微波消融(MWA)与单独TACE治疗大肝癌的临床疗效.方法 计算机辅以人工检索国内外关于MWA+TACE与单独TACE治疗大肝癌效果对比的临床对照试验.纳入分析患者生存率和肿瘤反应及并发症.结果 符合条件的16篇文献1199例患者纳入分析.Mem分析结果显示:TACE+MWA组1、2、3年生存率优于单独TACE组,差异均有统计学意义(P＜0.01).TACE+MWA组CR和PR高于单独TACE组,差异均有显著统计学意义(P＜0.01).TACE+MWA组SD和PD低于单独TACE组,差异均有统计学意义(P＜0.01).结论 TACE+MWA对于大肝癌的治疗要优于单独TACE治疗.     

微波消融治疗单发5cm以下肝细胞肝癌预后及其影响因素分析

目的 探讨微波消融(MWA)治疗单发5 cm以下肝细胞癌的预后及其影响因素.方法 回顾性分析2011-2013年就诊患者资料,随访期至2016年3月.结果 按照入选标准,共纳入603例患者,完全消融率为5.8％ (35/603),不同肿瘤直径组别间完全消融率差异无统计学意义(P=0.056).严重并发症发生率为1.7％(10/603),平均生存期时间(59.6±1.9)个月,1、2和3年总生存率分别为94.7％、81.9％及71.8％.不同年龄、肿瘤直径之间总生存率无明显差异(P=0.225、0.777),不同性别和复发间隔时间之间总生存率差异有统计学意义(P=-0.029、＜0.001).单因素及多因素分析表明,性别、术前白蛋白水平及复发间隔时间是总生存率的影响因素(P值=0.035、0.006及＜0.001).结论 MWA治疗单发肝细胞癌疗效确切,具有安全、微创等特点,不同年龄、肿瘤直径之间总生存率无明显差异,性别、术前白蛋白水平以及肿瘤复发间隔时间是影响患者总生存率的独立影响因素.     

Comparison of Therapeutic Efficacy and Clinical Parameters Between Recombinant Human Thyroid Stimulating Hormone and Thyroid Hormone Withdrawal in High-Dose Radioiodine Treatment with Differentiated Thyroid Cancer

Purpose

High-dose radioiodine treatment (HD-RIT) after injection of recombinant human thyroid stimulating hormone (rh-TSH) has become widely used. This study compared the therapeutic efficacy of HD-RIT and clinical parameters between rh-TSH supplement and thyroid hormone withdrawal (THW) after total thyroidectomy in patients with differentiated thyroid cancer.

Methods

We retrospectively reviewed 266 patients (47 male and 219 female; age, 49.0 ± 10.9 years) with differentiated thyroid cancer detected from September 2011 to September 2012. Patients comprised THW (217, 81.6 %) and rh-TSH (49, 18.4 %). Inclusion criteria were: first HD-RIT; any TN stage; absence of distant metastasis. To evaluate the complete ablation of the remnant thyroid tissue or metastasis, we reviewed stimulated serum thyroglobulin (sTg), I-123 whole-body scan (RxWBS) on T4 off-state, and thyroid ultrasonography (US) or [F-18]-fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) 6–8 months after HD-RIT. We defined a complete ablation state when all three of the follow-up conditions were satisfied; <2.0 ng/ml of the sTg, I-123 RxWBS (−), and thyroid US or F-18 FDG PET/CT (−). If one of the three was positive, ablation was considered incomplete. We also compared various clinical biomarkers (body weight, body mass index, liver and kidney function) between THW and rh-TSH groups.

Results

The rates of complete ablation were 73.7 % (160/217) for the THW group and 73.5 % (36/49) for the rh-TSH group. There was no significant difference between the two groups (p = 0.970). The follow-up aspartate transaminase (p = 0.001) and alanine transaminase (p = 0.001) were significantly higher in the THW group. The renal function parameters of blood urea nitrogen (p = 0.001) and creatinine (p = 0.005) tended to increase in the THW group. The change of body weight was + Δ0.96 (±1.9) kg for the THW group and was decreased by -Δ1.39 (±1.5) kg for the rh-TSH group. The change of body mass index was 0.4 (±0.7) kg/m² in the THW group and was decreased by −0.6 (±0.6) kg/m² in the rh-TSH group.

Conclusions

Consistent with previous studies, the rates of complete ablation between the THW and rh-TSH groups were not significantly different. The clinical parameters, as we mentioned above, were elevated for THW group but were irrelevant for the rh-TSH group. The findings favor HD-RIT after rh-TSH, especially for patients with chronic liver and kidney disease.     

超声引导下经皮射频消融治疗黏膜下子宫肌瘤的有效性和安全性

 目的 探讨超声引导下经皮射频消融治疗黏膜下子宫肌瘤的有效性和安全性。方法 回顾性分析2016-03至2017-11收治的78例有症状的黏膜下子宫肌瘤,计算子宫肌瘤的完全消融率并评价治疗结果,比较术后3个月子宫肌瘤体积、血红蛋白(Hb)定量及子宫肌瘤症状及健康相关生活质量问卷(UFS-QOL)评分。观察和记录治疗过程中及治疗后随访期间患者出现的各种不良反应及并发症。结果 射频消融后3、6、9、12个月病灶体积缩小率分别为65.3%、75.6%、81.5%和91.6%。治疗3个月后,体积减少(35.1±9.7)cm³,血红蛋白增加(31.9±44.05 )g/L,UFS-QOL评分中SSS评分减少(24.7±13.2),HRQL评分增加(17.3±18.65),差异均有统计学意义(P＜0.01)。术后3 d检查未发现严重并发症。结论 超声引导下经皮射频消融治疗黏膜下子宫肌瘤是一种安全有效的治疗方法,适合对子宫保留有需求的患者。     

Percutaneous radiofrequency ablation of renal cell carcinomas in patients with solitary kidney: 6 years experience

Objective

In this study we attempt to present our clinical experience in RFA under CT-guidance, in patients with renal cell carcinoma in a solitary kidney.

Material and Method

Between October 2000 and June 2005, 18 patients with solitary kidney and renal cell carcinoma underwent percutaneous CT-guided radiofrequency ablation in our institution. Tumors diameter ranged from 1 to 7 cm and there was no evidence of spread beyond the kidney. The RFA-system used was with expandable needle electrode (7 or 9 arrays). Technical success, recurrence and survival rate and complications were accessed. Patients were available for clinical and laboratory evaluation at a mean follow-up time of 31.2 months (range: 12–72 months).

Results

In all cases the electrode was successfully placed at the lesion. The 18 tumors were treated with totally 24 RFA sessions. In small (1–3 cm) exophytic tumors technical success was 85.7%. Residual disease was totally seen in 6/18 tumors which required a 2nd RFA session. The recurrence rate was 11.1% but no recurrence was noticed in tumors less than 3 cm in diameter. No major complications were observed. Serum creatinine values were normal in 17/18 patients till the 3rd-month follow-up. Survival ranged from 12 to 72 months.

Conclusion

RFA is an acceptable alternative for patients with small RCCs in a solitary kidney, which are not ideal candidates for surgical resection as their renal function must be preserved. They have an immediate solution to their clinical problem, under a minimally invasive therapy with no serious complications.     

Navigator respiratory‐triggered diffusion‐weighted imaging in the follow‐up after hepatic radiofrequency ablation—initial results

Purpose

To evaluate diffusion alterations after hepatic radiofrequency (RF) ablation using a navigator respiratory‐triggered diffusion‐weighted imaging (NRT‐DWI) sequence with regard to potential diagnostic information for detection of local tumor progression (LTP).

Materials and Methods

One hundred forty‐eight consecutive follow‐up magnetic resonance (MR) examinations of 54 patients after hepatic RF ablation were reviewed. Apparent diffusion coefficient (ADC) values of ablation zones and liver parenchyma were assessed using a single‐shot echoplanar imaging sequence with the NRT technique. ADC values of ablation zones and adjacent signal alterations identified in NRT‐DWI were analyzed with regard to LTP.

Results

Mean ADC values of ablation zones (119.9 ± 30.5 × 10^?5 mm²/sec) and liver (106.3 ± 21.2 × 10^?5 mm²/sec) differed significantly (P = 0.0003). No evident changes in ablations' ADC values over time could be identified. ADC values obtained from the entire ablation zone did not significantly differ regarding the presence of LTP. In 58 examinations, hyperintense areas in the periphery of the ablation zone were detected on the NRT‐DWI. Corresponding ADC values were significantly lower in patients with LTP (102.1 ± 22.4 versus 130.8 ± 47.6 × 10^?5 mm²/sec; P = 0.0124).

Conclusion

NRT‐DWI is useful in the follow‐up imaging after RF ablation. ADC‐based evaluation of signal alterations adjacent to the ablation zone may contribute to the identification of LTP and nontumoral posttreatment tissue changes. J. Magn. Reson. Imaging 2009. © 2009 Wiley‐Liss, Inc.

     

105例射频消融治疗肝脏肿瘤的不同介导方式的比较

目的探讨和比较不同方式介导的射频联合瘤内无水酒精注射治疗肝癌的有效性与安全性。方法总结分析射频联合瘤内无水酒精注射治疗原发性肝癌及转移性肝癌病人105例的临床资料,其中经皮超声介导56例、经皮CT介导12例、腹腔镜介导9例、开腹术中26例、经皮超声+腹腔镜2例。结果手术时间最短为经皮超声介导为(0.8±0.3)h,最长为开腹术中为(3.6±2.5)h(P<0.01),恢复时间最短为经皮CT及超声介导为(2.9±2.2)d和(3.0±0.8)d,最长为开腹术中为(10.3±2.3)d(P<0.01);原位复发率最高是经皮CT介导达16.6%,并发症发生率经皮CT介导为最高达8.3%,但无统计学意义;3年生存率各种介导方式无明显差异。常见的并发症为发热、疼痛、肝功能受损、出血,极少发生严重并发症或与操作相关的死亡。结论各种介导方法各有优点,应根据实际情况选择相应的介导方法,各种方法中以经皮超声介导最为简单可靠。     

调整Kappa角及光学切削直径对准分子激光原位角膜磨镶术后的影响

目的　评价调整光学切削直径及Kappa角后对准分子激光原位角膜磨镶术（laser in situ keratomileusis，LASIK）后效果的影响。方法　选取2017年1月至12月在我院行LASIK手术的高度近视患者313例（626眼），根据切削直径分成两组，试验组157例314眼，切削直径设定为6.0 mm，对照组156例312眼，切削直径设定为6.5 mm。试验组患者激光切削前修正Kappa角，对照组不做修正。患者术前进行裸眼视力、主视眼确定、验光、眼压、暗室下瞳孔直径、泪液分泌试验、裂隙灯、散瞳验光、眼底检查、pentacam测量角膜厚度、角膜地形图测量角膜前后表面及Kappa角等检查。术后1 d、1周、1个月随访，并检查裸眼视力、角膜厚度、波前像差及夜间视力、光晕、眩光等情况。比较两组患者角膜厚度变化、手术所用时间以及两组患者术后的高阶像差的差异。结果　试验组与对照组患者年龄分别为18～44（24.19±5.33）岁、18～42（25.08±4.91）岁，屈光度分别为（-7.47±1.04）D、（-7.61±1.12）D。两组年龄、屈光度比较差异均无统计学意义（均为P>0.05）。试验组与对照组患者术前Kappa角分别为，X轴:（210±40）μm、（200±30）μm，Y轴:（190±30）μm、（220±40）μm，差异无统计学意义（P=0.210）。两组手术前后的角膜厚度及术后角膜基质床的厚度差异均无统计学意义（均为P>0.05）。试验组与对照组的手术时间分别为（15.56±1.89）s和（20.83±3.03）s，差异有统计学意义（P=0.000）。试验组的总高阶像差和垂直慧差的变化均明显低于对照组（均为 P<0.01），但两组间的水平慧差差异无统计学意义（P>0.05），对照组的球差低于试验组（P<0.01）。结论　LASIK手术中科学合理地调整Kappa角可有助于提高患者术后的视觉质量。     

微波凝固对变应性鼻炎患者T淋巴细胞亚群的影响及意义

目的　探讨常年性变应性鼻炎 (PAR)患者细胞免疫功能状态及微波凝固治疗的作用机制。方法　观察组 2 5例PAR患者分别于微波治疗前以及治疗 1个月后应用免疫组化法检测鼻粘膜上皮和外周血CD3、CD4、CD8、CD4/CD8水平。健康对照组 1 5例亦作相应检测。结果　PAR患者治疗前鼻粘膜及外周血CD3、CD4明显高于正常人 ,CD8低于正常人 ,CD4/CD8比值升高 ,与正常人比较差异有显著性 (P <0 .0 5)。微波治疗后CD4明显减少 ,CD8升高 ,CD4/CD8接近于健康对照组。结论　PAR患者存在明显的细胞免疫功能障碍 ;微波局部凝固治疗可改善PAR患者的细胞免疫状况。