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。     

An Unusual Case Of Right Ventricular Outflow Tract Tachycardia

In this report, we describe an unusual case of right ventricular outflow tract (RVOT) tachycardia with episodes of repetitive monomorphic ventricular tachycardia (VT), paroxysmal sustained VT and incessant monomorphic VT of the same morphology. Diltiazem, adenosine, or metoprolol failed to interrupt these arrhythmias. However, administration of intravenous propafenone completely eliminated all ventricular ectopic activity. Electrophysiologic study performed off propafenone showed that the ventricular ectopic activity originated from a single locus at the anterior wall of the RVOT. Two radiofrequency applications at this site resulted in complete elimination of ventricular ectopic activity.     

Electrophysiologic characteristics of atrial tachycardia originating from the right pulmonary veins or posterior right atrium: double potentials obtained from the posterior wall of the right atrium can be useful to predict foci of atrial tachycardia in right pulmonary veins or posterior right atrium

INTRODUCTION: The right pulmonary veins (RPVs) and posterior wall of the right atrium (PRA) are anatomically located adjacent to each other. The aim of this study was to demonstrate the electrophysiologic characteristics of atrial tachycardia (AT) originating from the PRA or RPVs. METHODS AND RESULTS: A total of 26 consecutive patients with AT originating from the RPVs or PRA underwent detailed atrial endocardial mapping and successful radiofrequency catheter ablation. Eight foci were found in the PRA and 18 foci in the RPVs. Analysis of P wave configuration showed that lead V1 was the most helpful in distinguishing the AT foci between these two sites. In all cases, double potential (DP) configurations were recorded from several electrodes of a multielectrode catheter placed in the PRA, and the first DP component (FP) was the earliest potential recorded from the right atrium during the tachycardia. The amplitude of the FP was higher than that of the second DP component (SP) for AT foci originating in the PRA, whereas the reverse occurred for those in the RPV. The activation sequence of the FP was from superior to inferior for the AT foci in the superior RPV, whereas the reverse occurred for the AT foci in the inferior RPV. CONCLUSION: P wave configuration in lead V1 is helpful in distinguishing AT foci between those originating in the PRA and RPVs. The DPs obtained from the PRA can be useful in predicting whether AT foci originate from the PRA or RPVs.     

小影像Koch三角及其房室结射频消融应注意的问题

为探讨小影像Koch三角房室结折返性心动过速 (AVNRT)病人射频消融时应注意的问题 ,右前斜位 30°透视下 ,将最大希氏束 (HBE)电位记录处与冠状静脉窦口 (CSo)处的影像距离容纳不下 3个 8F加硬大头电极者定义为小影像Koch三角 ,对 16例小影像Koch三角的AVNRT病人 ,参照慢径消融法行射频消融。结果 :16例病人中 ,成功消融靶点位于CSo水平以下者 12例 ,与CSo位于同一水平者 3例 ,位于CSo水平以上者 1例。 16例病人经消融后房室传导跳跃现象消失者 14例 ;跳跃现象存在 ,但无心房回波 ,异丙肾上腺素亦不能诱发AVNRT者 2例。上述 12例中有 1例于术中出现一过性房室阻滞 (AVB) ,术后 2 4h发生Ⅱ度Ⅱ型AVB ,出院后随访 3个月未能恢复正常 ,因心率为 38～ 5 0次 /分 ,并伴有脑供血不足症状 ,遂置入永久心脏起搏器。其余病人经过 3.5± 1.2 (0 .5～ 5 )年的随访 ,无AVNRT复发 ,亦无AVB发生。结论 :对于小影像Koch三角AVNRT病人的射频消融 ,应突破常规消融时的区位划分概念 ,主要在CSo前下方寻找并消融慢径 ,并根据放电后反应及时调整消融参数。     

全军心律失常介入治疗资料总汇

目的汇总分析全军心律失常介入治疗资料,了解此领域工作的现状与不足。方法由全军心血管内科专业委员会组织对2005年1月1日至2006年12月31日期间全军医疗单位心律失常介入治疗资料进行注册登记和统计分析。结果①此次注册共收到全军40家医院共9 934例注册资料。开展射频消融(RFCA)工作的医院共33家,注册病例数6 242例,其中开展三维标测技术治疗快速心律失常的医院有9家,病例数达180例;开展心脏器械置入治疗工作的医院共39家,病例数3 656例。②6 242例RFCA注册资料总成功率97.45%,复发率2.12%,并发症发生率0.54%。各类心律失常中,房室折返性心动过速(AVRT)最多,房室结折返性心动过速(AVNRT)次之,AVRT和AVNRT成功率始终保持在较高的水平,而心房颤动(AF)的复发率最高。34例并发症中血管并发症和完全性房室传导阻滞占绝大部分。③多家单位开展了新型三维标测系统治疗复杂快速性心律失常。180例注册病例中,AF最多、共110例(61.11%),成功率99.09%,复发率24.55%;非特发性室性心动过速(non-IVT)次之、共26例(14.44%),成功率88.46%,复发率8.33%;其余类型心律失常完成例数较少。④3 656例心脏器械置入病例总成功率99.92%(3 653/3 656),并发症发生率1.94%(71/3 653)。在各种器械置入适应证中,病窦综合征占最大比例,其次为房室传导阻滞。双腔起搏比例远超过心室单腔起搏。三腔双心室起搏器及埋藏式心脏转复除颤器的临床应用尚较少。结论全军心律失常介入治疗发展迅速。     

Radiofrequency Catheter Ablation of Posteroseptal Accessory Pathways–Results of a Step-by-Step Ablation Approach

Introduction: Transcatheter radiofrequency ablation of posteroseptal accessory pathways (AP) is challenging. A number of different interventional approaches have been suggested by different groups. The selection of the initial approach is crucial in order to reduce radiation exposure and the number of unsuccessful lesions applied. We present our ablation technique as guided by a simplified electrocardiographic analysis of the delta wave polarity and the electrophysiologic mapping results. Methods and Results: Out of 35 manifest APs encountered in the right (n=17) or the left posteroseptum (n=18) in 35 patients, 34 were successfully ablated. Despite their left sided location, 7 of the 18 left sided APs were ablated after switching from an initial arterial to a venous approach looking for an appropriate target site in the right posteroseptal space or within the coronary sinus network. The other 11 left sided APs were ablated in the mitral ring, on 2 occasions, on their atrial aspect through a retrograde transmitral approach. On the contrary, 16 of the 17 right sided APs were successfully ablated exclusively through a venous approach. Fourteen of these were ablated in the right posteroseptum, in 2 cases, only after reaching their ventricular aspect. Two right sided APs were interrupted in the coronary sinus os and the middle cardiac vein respectively. Conclusion: It appears that even though the electrocardiographic and electrophysiologic location of the AP in the posteroseptal space helps select the appropriate initial approach, it does not always guarantee a successful ablation procedure in the expected site of the corresponding atrioventricular ring. Not uncommonly, it will be necessary to look after intermediate target sites within the coronary sinus to improve the overall ablation success rate.     

Novel imaging techniques of the esophagus enhancing safety of left atrial ablation

This report describes different imaging techniques of the esophagus in four patients during radiofrequency catheter ablation of atrial fibrillation in the left atrium. A novel use of a mixture of barium cream and gadolinium diglutamate allowed esophageal imaging during magnetic resonance angiography of the left atrium and pulmonary veins. Barium cream used during computer tomography angiographic imaging of the left atrium and pulmonary veins allowed esophageal imaging. The esophagus was also imaged with an electroanatomic mapping system. Esophageal and left atrial imaging helped to avoid catheter ablation in left atrial tissue overlapping the esophagus.     

Effect of ultrasound-guided pulsed radiofrequency on intercostal neuralgia after lung cancer surgery: A retrospective study

This retrospective study investigated the effect of ultrasound-guided pulsed radiofrequency (UGPRF) on intercostal neuralgia (ICN) after lung cancer surgery (LCS).This retrospective observational study analyzed the outcome data of UGPRF on ICN in 80 patients with LCS. All those patients were allocated into a treatment group (n = 40) and a control group (n = 40). All patient data were collected between January 2018 and November 2019. The primary outcome was pain intensity (measured by numerical rating scale, NRS). The secondary outcomes were sleep quality (measured by Pittsburgh Sleep Quality Index, PSQI), anesthetic consumption, and treatment-related adverse events.After treatment, patients in the treatment group showed better outcomes in NRS (P < .01), PSQI (P < .01), and anesthetic consumption (P < .01), than patients in the control group. No treatment-related adverse events were documented in both groups in this study.The results of this study found that UGPRF may benefit patients for pain relief of ICN after LCS.     

Survival comparison between radiofrequency ablation and surgical resection for patients with small hepatocellular carcinoma: A systematic review and meta-analysis

Objective:This study aimed to evaluate and compare the long-term therapeutic efficacy of radiofrequency ablation (RFA) versus that of surgical resection in small hepatocellular carcinoma (HCC).Methods:Relevant articles in English from PubMed, EMBASE, and the Cochrane Library were retrieved. Pooled hazard ratios (HRs) were calculated to assess the prognostic value of RFA compared with that of surgical resection.Results:A total of 19 studies involving 15,071 patients were included. The combined HRs (95% confidence interval [CI]) of RFA for recurrence/relapse-free survival (RFS) and overall survival (OS) were 1.55 (95% CI = 1.29-1.86, I² = 72.5%) and 1.61 (95% CI = 1.29-2.01, I² = 60.4%), respectively, compared with surgical resection. In subgroup analyses according to study design, both RFS and OS of the prospective subgroups showed statistical significance, and no statistical heterogeneity existed between studies.Conclusion:Our clinical data suggest that surgical resection offers better long-term oncologic outcomes than RFA.