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991.
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目的探讨Ensite系统标测室性心律失常的方法,并评价其指导射频消融的有效性和安全性。方法入选症状性室性期前收缩(室早)或室性心动过速(室速)患者98例,年龄(42±16)岁,其中男43例,女55例。经外周血管进非接触多极球囊导管至右心室或左心室三维重建心腔。心室激动时根据虚拟单极电位的等电位图,结合起搏和激动标测对起源点和突破口及优势传导通道进行消融。结果消融即时成功率95%(93/98)。起源于右心室流出道占96种,间隔部和游离壁各82、14种,起源于其他不典型部位21种,三尖瓣环8种。起源后传导突破呈快反应点爆发方式占78%(91/117),采用点消融覆盖相近的起源点和突破口;呈慢反应突破方式占22%(26/117),采用线性或片状消融策略。随访(6±3)个月,3例复发,1例经再次消融成功。结论 Ensite心内非接触式标测系统用于室性心律失常的三维标测有效安全。室速或室早自最早起源点后经优势传导通道向突破口传导有两种传导方式。 相似文献
995.
William Jarnagin William C Chapman Steven Curley Michael D'Angelica Charles Rosen Elijah Dixon David Nagorney 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2010,12(5):302-310
As the number of effective treatment options has increased, the management of patients with hepatocellular carcinoma has become complex. The most appropriate therapy depends largely on the functional status of the underlying liver. In patients with advanced cirrhosis and tumor extent within the Milan criteria, liver transplantation is clearly the best option, as this therapy treats the cancer along with the underlying hepatic parenchymal disease. As the results of transplantation has become established in patients with limited disease, investigation has increasingly focused on downstaging patients with disease outside of Milan criteria and defining the upper limits of transplantable tumors. In patients with well preserved hepatic function, liver resection is the most appropriate and effective treatment. Hepatic resection is not as constrained by tumor extent and location to the same degree as transplantation and ablative therapies. Some patients who recur after resection may still be eligible for transplantation. Ablative therapies, particularly percutaneous radiofrequency ablation and transarterial chemoembolization have been used primarily to treat patients with low volume irresectable tumors. Whether ablation of small tumors provides long term disease control that is comparable to resection remains unclear. 相似文献
996.
Study design: Retrospective, observational, open label.Objective: We investigated the efficacy of facet debridement for the treatment of facet joint pain.Summary of background data: Facet joint disease, often due to degenerative arthritis, is common cause of chronic back pain. In patients that don''t respond to conservative measures, nerve ablation may provide significant improvement. Due to the ability of peripheral nerves to regenerate, ablative techniques of the dorsal nerve roots often provide only temporary relief. In theory, ablation of the nerve end plates in the facet joint capsule should prevent reinnervation.Methods: All patients treated with endoscopic facet debridement at our clinic from 2003-2007 with at least 3 years follow-up were included in the analysis. Primary outcome measure was percent change in facet-related pain as measured by Visual Analog Scale (VAS) score at final follow-up visit.Results: A total of 174 people (77 women, 97 men; mean age 64, range 22-89) were included. Location of facet pain was cervical in 45, thoracic in 15, and lumbar in 114 patients. At final follow-up, 77%, 73%, and 68% of patients with cervical, thoracic, or lumbar disease, respectively, showed at least 50% improvement in pain. Mean operating time per joint was 17 minutes (range, 10-42). Mean blood loss was 40 ml (range, 10-100). Complications included suture failure in two patients, requiring reclosure of the incision. No infection or nerve damage beyond what was intended occurred.Conclusions: Our results demonstrate a comparable efficacy of endoscopic facet debridement compared to radiofrequency ablation of the dorsal nerve branch, with durable results. Large scale, randomized trials are warranted to further evaluate the relative efficacy of this surgical treatment in patients with facet joint disease. 相似文献
997.
微波热凝固治疗肝癌临床观察 总被引:2,自引:0,他引:2
目的:用频率为2450MHZ微波治疗机,14G深部组织间插入型电极,超声引导下经皮穿刺,微波热凝固治疗肝癌30例,观察疗效。方法:肿瘤直径3cm以下单结节型15例,3cm以上多发15例,微波功率60W每次60s,使电极尖端部2.5X1.5cm范围内可凝固坏死。3cm以下2~5次。3cm以上反复多次,直至完全凝固坏死。经增强CT评价坏死范围。根据坏死率(TN),缩小率(TR)判定疗效。结果:坏死率显效46.6%(14例),有效93%(28例)。缩小率有效21例(70%),肿瘤局部得以良好控制。结论:如配合肝动脉拴塞(TAE),肝动脉注药(TAI)治疗,可减少残存,控制复发,进一步提高疗效。 相似文献
998.
X. Lan L. Su Z. Ling Z. Liu J. Wu X. Yang B. Zrenner Y. Yin 《European journal of clinical investigation》2009,39(8):657-663
Background Although amiodarone plus angiotensin II receptor blockers (ARBs) and catheter ablation may improve sinus rhythm maintenance of paroxysmal atrial fibrillation (AF), their clinical efficacies have not been compared. This prospective cohort study was designed to compare clinical efficacy of catheter ablation and amiodarone plus losartan on sinus rhythm maintenance in patients with paroxysmal AF.
Materials and methods A total of 240 patients with paroxysmal AF were assigned to four groups. CPVA group ( n = 60) was treated with circumferential pulmonary vein ablation (CPVA), SPVI group ( n = 60) with segmental pulmonary vein isolation, AMIO group ( n = 60) with amiodarone and AMIO + LO group ( n = 60) with amiodarone plus losartan. The endpoint was documented recurrence of AF > 30 s by Holter or conventional 12-lead ECG in the 1-year follow-up period.
Results During 12 months of follow-up, the primary end point was reached in 28 patients in CPVA group, 14 patients in SPVI group, 25 patients in AMIO group and 13 patients in AMIO + LO group, respectively. The sinus rhythm in SPVI and AMIO + LO group were significant higher than that in CPVA and AMIO group ( P < 0·01 and 0·025), and no difference between CPVA and AMIO group. The maintenance rate of sinus rhythm in SPVI group was similar to that in AMIO + LO group.
Conclusions This study demonstrates that segmental pulmonary vein isolation in preventing AF recurrence is similar to amiodarone plus losartan, but it is superior to CPVA and amiodarone alone in patients with paroxysmal AF. Larger multicentre studies are needed to confirm its long-term outcomes. 相似文献
Materials and methods A total of 240 patients with paroxysmal AF were assigned to four groups. CPVA group ( n = 60) was treated with circumferential pulmonary vein ablation (CPVA), SPVI group ( n = 60) with segmental pulmonary vein isolation, AMIO group ( n = 60) with amiodarone and AMIO + LO group ( n = 60) with amiodarone plus losartan. The endpoint was documented recurrence of AF > 30 s by Holter or conventional 12-lead ECG in the 1-year follow-up period.
Results During 12 months of follow-up, the primary end point was reached in 28 patients in CPVA group, 14 patients in SPVI group, 25 patients in AMIO group and 13 patients in AMIO + LO group, respectively. The sinus rhythm in SPVI and AMIO + LO group were significant higher than that in CPVA and AMIO group ( P < 0·01 and 0·025), and no difference between CPVA and AMIO group. The maintenance rate of sinus rhythm in SPVI group was similar to that in AMIO + LO group.
Conclusions This study demonstrates that segmental pulmonary vein isolation in preventing AF recurrence is similar to amiodarone plus losartan, but it is superior to CPVA and amiodarone alone in patients with paroxysmal AF. Larger multicentre studies are needed to confirm its long-term outcomes. 相似文献
999.
1000.