自凝刀子宫内膜射频消融术与宫腔镜子宫内膜电切术治疗围绝经期功血的临床疗效比较

目的:比较自凝刀子宫内膜射频消融术（BBT）与宫腔镜子宫内膜电切术（TCRE）治疗围绝经期功血的临床效果。方法:选取2015年5月-2016年12月在河南省许昌市建安区人民医院妇产科接受治疗围绝经期功血的患者96例,采用随机数字法分为对照组和观察组,每组患者各48例。对照组患者运用宫腔镜子宫内膜电切术治疗,观察组患者运用自凝刀子宫内膜射频消融术治疗。比较两组患者的临床疗效、治疗前后性激素水平、子宫内膜厚度、治疗前后血红蛋白水平、术中情况、住院时间及并发症情况。结果:观察组患者的总有效率为98%,对照组患者总有效率为94%,两组患者总有效率比较,差异无统计学意义（P>0.05）。两组患者性激素包括促卵泡激素（FSH）、促黄体素（LH）、睾酮（T）、催乳素（PRL）、孕酮（P）及雌二醇（E2）水平在治疗前、治疗后均无统计学差异（P>0.05）。 观察组患者术中出血量、手术时间及住院天数分别为（10.36±6.03）mL、（12.64±2.64）min、（2.15±1.29）d优于对照组（26.26±8.16）mL、（22.61±3.61）min、（3.64±1.74）d,差异有统计学意义（P<0.05）。观察组患者术后出血、发热等并发症发生率为2.08%低于对照组14.58%,差异有统计学意义（P<0.05）。两组患者治疗前子宫内膜厚度和血红蛋白水平比较无统计学差异（P>0.05）。观察组患者治疗后子宫内膜厚度[（3.49±0.97）mm]薄于对照组[（5.21±1.24）mm],患者治疗后,血红蛋白[（121.37±8.04）g/L]高于对照组[（101.51±10.28）g/L]（P<0.05）。结论:自凝刀子宫内膜射频消融术对围绝经期功能失调性出血疗效显著,恢复快、安全性高,对患者的内分泌激素水平无明显影响,值得临床推广应用。     

超声弹性成像在甲状腺良性结节射频消融中的应用价值及相关动态分析

甲状腺结节是临床上常见的疾病,近年来,随着甲状腺结节经皮微波或射频消融治疗的创新研究与发展应用,消融治疗在临床上取得了肯定的效果[1-2].对于消融后疗效的影像评价,已有学者利用弹性超声探讨研究[3],但一般是进行消融前与消融后即刻的对比,鲜有关于后续随访的报道.本研究拟分析运用弹性成像评价经皮射频消融治疗人体甲状腺良性结节的可行性及动态随访治疗后病灶质地的变化情况,总结实际操作经验,为甲状腺射频消融的长期疗效的评估提供新的客观影像依据.     

三叉神经痛患者不同手术方式的成本效益分析

目的 分析药物控制不佳且从未接受过外科手术治疗的原发三叉神经痛患者通过手术[包括微血管减压术(MVD)、经皮射频神经根切断术(RFR)、立体定向放射治疗(SRS)]治疗后的花费-收益比.方法 回顾性分析2005-2013年89例首次接受外科手术治疗的原发三叉神经痛患者(其中行M VD 27例,行RFR 23例,行SRS 39例).评判标准(效果因数)包括面部疼痛(极佳:没有面部疼痛且无药物治疗;佳:没有面部疼痛但有药物治疗;欠佳:有面部疼痛但小于50%;差:≥50%的患者有面部疼痛或者需行二次手术)、面部麻木、花费等.结果 接受手术患者的平均年龄:M VD(50.4±14.3)岁,RFR(73.2±13.6)岁和SRS(72.6±11.8)岁,3组比较差异有统计学意义(P<0.05);每种手术方式平均花费金额:MVD 50274元,RFR 4539元,SRS 38512元(P<0.05);术后面部麻木患者的比例MVD 1.1%,RFR 52.2%,SRS 28.2%(P<0.05);两年内复发需要再次手术的患者比例MVD 26.0%,RFR 73.9%,SRS 30.7%(P<0.05);平均疼痛完全缓解期MVD为1.6年,RFR为2.1年,SRS为1.0年(P<0.05);花费-收益比MVD为31618元,RFR为1982元,SRS为39297元(P<0.05).结论 3种手术方式花费-收益比从低到高为RFR、M VD、SRS,即单位花费中RFR获得收益最高,其次是M VD和SRS.     

EnSite标测下射频消融对特发性右室流出道室性早搏患者的疗效及心肌酶学影响

目的 探讨EnSite标测指导下射频消融治疗特发性右室流出道室性早搏的临床效果及对心肌损伤的影响.方法 回顾性分析我院2013年1月至2016年1月收治的84例右室流出道室性早搏行射频消融手术治疗患者的临床资料,对比两组患者的手术效果.结果 本组中50例患者在常规电生理标测指导下实施射频消融手术(常规组)、34例患者在EnSite标测指导下射频消融治疗(EnSite组).EnSite组患者的标测时间、射频消融时间、X线曝光时间、手术时间均显著的低于常规组,差异具有统计学意义(P＜0.05).术前,EnSite组和常规组的室性早搏数量对比,差异不具有统计学意义(P＞0.05);术后,EnSite组的24 h室性早搏数量显著低于常规组(P＜0.05);术后72 h,EnSite组的CK、CK-MB、cTnT、AST、LDH、Mb、HBDH水平显著低于常规组(P＜0.05).结论 EnSite标测指导下射频消融治疗特发性右室流出道室性早搏能显著缩短操作时间、减轻对患者心肌造成的损伤,手术效果可靠.     

微波消融术治疗甲状腺良性结节疗效及对患者血清T3、T4与TSH水平的影响

目的 分析微波消融术（MWA）治疗甲状腺良性结节的临床疗效及对患者血清三碘甲状腺原氨酸（T3）、甲状腺素（T4）、促甲状腺激素（TSH）水平的影响。方法 选取2017年6月～2019年5月成都医学院第一附属医院、四川大学华西医院及西部战区总医院收治的102例甲状腺良性结节患者为研究对象,随机分为观察组（n=51）与对照组（n=51）,观察组行MWA,对照组行甲状腺结节切除术。比较两组手术情况,记录观察组术后6个月内结节消退情况,比较两组治疗前后甲状腺功能（T3、T4及TSH）及并发症发生率。结果 观察组手术时间、术后住院时间短于对照组（P＜0.05）;术后,观察组甲状腺结节体积不断缩小（P＜0.05）,且3、6个月甲状腺结节体积缩小率分别为30.45%、79.70%;治疗后,两组T3、T4下降,TSH水平增加,且观察组治疗后血清T3、T4低于对照组,TSH水平明显高于对照组（均P＜0.05）;观察组并发症发生率较对照组低（P＜0.05）。结论 MWA治疗甲状腺良性结节疗效较好,可有效保留患者甲状腺功能,促进结节消退,且创伤小,术后并发症发生率低,可在临床推广应用。     

实时超声引导微波消融术治疗子宫腺肌瘤的临床应用研究

目的 探讨实时超声引导微波消融术治疗子宫腺肌瘤的临床应用。方法 选取2015年1月～2019年1月收入我院子宫腺肌瘤患者37例为研究对象。采用超声造影评价患者的腺肌瘤消融率,常规超声评价瘤体缩小率。采用临床疗效评定标准来评价患者临床症状改善情况。结果 痛经改善率为78.9%(15/19),月经失调改善率为42.9%(9/21),贫血改善率为55.6%(10/18)。超声造影显示仅3例出现消融不完全,消融有效率为91.9%,术后行补充消融治疗,37例局限性子宫腺肌瘤平均消融率均达90%以上。与治疗前比较,治疗后3、6、12个月患者瘤体缩小率分别为60.8%、78.1%、93.1%,差异有统计学意义(P0.05)。与治疗前比较,治疗后临床症状有改善。结论实时超声引导微波消融术治疗子宫腺肌瘤患者,能够减小腺肌瘤体积,且能够明显改善患者临床症状,为子宫肌瘤患者提供新的治疗手段。     

超声引导射频消融术对131例肝癌的治疗及并发症探讨

目的：探讨超声引导射频消融术（RFA）对肝癌、肝转移癌的疗效。方法：对不能或不宜手术治疗的原发性肝癌82例，肝转移癌49例，共计131例，226个癌灶，行超声引导下射频消融治疗。结果：治疗后1d-1个月CT检查，可见203个癌灶被灭活，有效灭活率达90%(203/226个灶)；另有1例肝撕裂伤及1例肝癌破裂出血者行RFA止血成功。106例经3-26个月随访，生存率3个月或以上达98.1%(104/106例)，6个月或以上达85.7%(72/84例)，1年以上达73.7%(42/57例)，6例出现并发症（4.6%），包括出血，脓肿，胆瘘，胆囊炎等。结论：超声引导RFA具有疗效好，治疗周期短，患者创伤小，易接受，可反复治疗等优点。     

The effect of hepatic inflow occlusion on laparoscopic radiofrequency ablation using simulated tumors

BACKGROUND: The purpose of this study was to determine the effect of hepatic inflow occlusion (the Pringle maneuver) on laparoscopic radiofrequency (RF) ablation. METHODS: Using a previously validated agarose tissue-mimic model, 1-cm simulated hepatic tumors (three per animal) were laparoscopically ablated in five pigs with normal perfusion and then in five pigs with hepatic artery and portal vein occlusion. Energy was applied until tissue temperature reached 100 degrees C (warm-up) and thereafter for eight min. Specimens were examined immediately after treatment. RESULTS: Vascular occlusion was successful in all cases per color-flow Doppler ultrasound. Pringle time was 11.4 +/- 1.6 min. Warm-up time (2.7 +/- 1.4 vs 20.2 +/- 14.0 min) was significantly faster in the Pringle group. Ablation diameter (34.8 +/- 2.9 vs 24.7 +/- 3.1 mm), proportion of round/ovoid lesions (93% vs 20%), ablation symmetry (100% vs 40%), and margin distance (5.1 +/- 3.0 vs 1.1 +/- 1.2 mm) were significantly better for the Pringle group than the No Pringle group, respectively. CONCLUSION: Using a Pringle maneuver during laparoscopic RF ablation significantly enhances ablation geometry and results in larger margins.     

Laparoscopic transgastric esophageal mucosal resection: 4-year minimum follow-up

Background

The management of high-grade esophageal dysplasia has included surveillance, endoscopic ablative techniques, and esophagectomy. Herein we describe an alternative treatment, laparoscopic transgastric esophageal mucosal resection.

Methods

Laparoscopic transgastric esophageal mucosal resection was accomplished through an anterior gastrotomy. The mucosa was stripped from the Z-line to the proximal extent of the abnormal epithelium. The gastrotomy then was closed with a linear stapler, and a Nissen fundoplication was performed.

Results

Six patients with high-grade dysplasia of the distal esophagus underwent mucosal resection. After 4 to 7 years of endoscopic surveillance, all patients have regenerated squamous epithelium. One patient developed nondysplastic Barrett's esophagus after 2 years and was treated medically. Two strictures were treated successfully with dilatation.

Conclusions

Laparoscopic transgastric esophageal mucosal resection was a reasonable treatment for high-grade dysplasia in this small sample of patients. This technique is a potential alternative treatment for high-grade dysplasia of the esophagus.     

The biochemical efficacy of primary cryoablation combined with prolonged total androgen suppression compared with radiotherapy on high-risk prostate cancer： a 3-year pilot study

To gain beneficial effects in the management of high-risk prostate cancer, an integrated approach that combines local therapy and androgen deprivation therapy （ADT） was used. We compared biochemical responses between primary cryosurgical ablation of the prostate （CSAP） combined with prolonged ADT and radiation combined with ADT, which is the established modality in high-risk disease. A total of 33 high-risk patients received CSAP combined with ADT for 3 months before and up to 24 months after treatment. This patient group was matched with another 33 patients who had undergone three-dimensional conformal radiation therapy （3D-CRT） with the same protocol for ADT. Biochemical recurrence （BCR） was assessed by the American Society for Therapeutic Radiation Oncology （ASTRO） definition, the Phoenix definition and a prostate-specific antigen （PSA） cutoff of 0.5 ng mL^-1. Median follow-up was 61.0 ± 11.9 months for the CSAP ＋ ADT group and 86.0±15.8 months for the 3D-CRT ＋ ADT group. In the CSAP group, major complications including rectourethral fistula and incontinence were not noted. In the CSAP ＋ ADT group, 57.0% had BCR using the ASTRO definition, 21.2% using the Phoenix definition and 54.5% using a PSA cutoff of 0.5 ng mL^-1. In the 3D-CRT ＋ ADT group, 54.5%, 21.2% and 54.5% had BCR using the ASTRO, Phoenix and PSA definition, respectively. In the CSAP ＋ ADT group, the BCR-free survival （BRFS） was 54 ± 10 months using the ASTRO definition, 65 ± 5 months using the Phoenix definition and 51 ± 4 months using a PSA cutoff of 0.5 ng mL-1. In the 3D-CRT ＋ ADT group, the BRFS was 68 ± 12, 93 ± 19 and 70 ± 18 months using the ASTRO, Phoenix and PSA definition, respectively. By the log-rank test, the BRFS values for each group were not statistically different. This intermediate-term result indicated that primary CSAP combined with prolonged ADT offers a parallel biochemical response compared with radiotherapy in high-risk prostate cancer.