甲状腺结节微波热消融治疗的临床进展

甲状腺结节是临床常见疾病,其治疗方式目前主要以外科开放式手术为主,微创治疗一直是临床探索的热点。经超声引导下甲状腺结节微波热消融具有重要的临床意义。本文主要对微波热消融甲状腺结节的治疗指征、临床疗效及常见并发症进行综述。     

术前甲胎蛋白水平在热消融治疗肝细胞癌中的预后价值

目的探索术前甲胎蛋白(AFP)水平在热消融治疗肝细胞癌(HCC)病人中的预后价值。方法回顾性分析临床诊断为HCC病人305例,均为单发直径3 cm肿瘤,109例接受射频治疗,196例接受微波治疗,比较两组病人的远期疗效并统计分析病人的预后影响因素。结果 AFP≥400μg/L组和AFP400μg/L组病人1、3、5累积生存率分别为83.6%、66.9%、49.8%和96.2%、90.0%、74.7%(P=0.001),1、3、5累积复发率分别为36.3%、61.2%、75.2%和17.6%、38.9%、59.0%(P=0.003)。COX多因素分析中,AFP≥400μg/L是影响术后生存和复发的独立危险因素。射频组和微波组1、3、5年累积生存率分别为91.7%、79.5%、65.8%和94.8%、82.4%、69.4%(P=0.211)。1、3、5年复发率分别为24.1%、50.6%、61.1%和21.4%、40.1%、59.7%(P=0.424)。结论 AFP≥400μg与肝癌预后的生存和复发密切相关,可作为早期肝癌病人术后预后的指标。早期肝癌射频和微波消融远期疗效无明显差异。     

3种致病菌污染化验单后用微波炉消毒化验单的效果观察

针对易引起院内感染的铜绿假单胞菌，大肠埃希菌。金黄色葡萄球菌等致病菌污染化验单后造成院内感染。通过用这3种细菌的质控菌株和病原菌株污染化验单后用微波炉来消毒化验单，观察每次消毒化验单具体张数，具体时间和火力，得出最佳消毒时间，火力以及化验单厚度以达到杀死病原菌消毒的目的，从而控制院内感染。     

人脑胶质瘤手术加局部热化疗研究

目的　探讨脑胶质瘤手术加局部热化疗的可行性和安全性。方法　回顾性分析脑胶质瘤手术加术中、术后间断热化疗等综合治疗 2 4例患者 (综合组 )的资料 ,与同期手术治疗的 46例未行热化疗的脑胶质瘤患者 (对照组 )进行比较。热化疗方法是术中用双极电凝直接加热瘤体残腔化疗药 ,43～ 44℃ ,持续2 5min。术后第 2天始 ,隔日将化疗药注射入埋置于头皮下的Ommaya药囊中 ,并用微波辐射加温 45min ,共 9次。结果　综合组平均生存 3 0 .75个月 ,对照组平均生存 8.85个月 ,综合组较对照组生存年限延长 (P <0 .0 0 1) ,而并发症并未增加。结论　脑胶质瘤术中和术后间断局部热化疗可提高手术疗效 ,减少肿瘤复发 ;微波辅助术后局部化疗药液加温是安全可行的     

Clinical Guideline for Microwave Ablation of Bone Tumors in Extremities

Microwave ablation has been used to treat bone tumors in extremities for more than 30 years. With improved recognition, updated microwave equipment, and expanded clinical application, microwave ablation has recently been widely used to treat bone tumors. To standardize the application of microwave ablation in the clinical treatment of bone tumors in the limbs, research results and clinical experience involving the use of microwave ablation to treat bone tumors in the limbs have been summarized, and a clinical guideline has been designed. This guideline is aimed at providing a reliable clinical basis for indications, preoperative evaluation and decision‐making, perioperative treatment, complications, and other issues via evidence‐based medicine. Two aspects are considered—percutaneous microwave ablation and intraoperative microwave ablation of bone tumors in extremities. Ultimately, the guideline is intended to standardize treatment and improve the clinical efficacy of microwave ablation of bone tumors in extremities.     

开放微波消融联合椎体成形和钉棒系统内固定治疗胸腰椎转移瘤

目的:探讨开放微波消融联合椎体成形、钉棒系统内固定在胸腰椎转移性肿瘤治疗中的初步临床效果。方法:对2014年1月至2016年1月收治的12例胸腰椎转移癌行开放微波消融联合椎体成形、钉棒系统内固定治疗的患者进行回顾性分析,其中男6例,女6例;年龄30～75岁,平均55.6岁。转移癌类型:肺转移癌5例,乳腺转移癌2例,甲状腺转移癌2例,肾转移癌2例,肝转移癌1例。转移部位:胸椎转移癌7例,腰椎转移癌5例。Tomita预后评分主要集中在3～6分。脊髓神经功能按ASIA分级:C级3例,D级1例,E级8例。术前的VAS评分为8.3±0.4,术后1、3、6个月以及末次随访时采用视觉模拟评分(visual analogue scale,VAS)评价临床效果。结果:12例患者手术出血量500～2 050 ml,平均850 ml。手术时间3.5～5.5 h,平均4.5 h。术中无神经损伤病例。术后发生脑脊液漏3例,经保守治疗后自愈。切口浅表感染2例,经换药后愈合。肺部感染1例。无深部感染、下肢血栓等并发症。术后12例患者均获得随访,时间9～40个月,平均28.6个月。临床症状均有明显改善,下肢运动功能不同程度的恢复,ASIA分级2例C级恢复至D级,1例C级恢复不明显,1例D级恢复至E级。1例患者术后10个月死于原发性肝癌。随访期间1例患者局部肿瘤复发。术后第1、3、6个月以及末次随访时VAS评分分别为2.7±0.6、2.5±0.4、2.6±0.5、2.5±0.5,与术前比较明显改善(P0.05)。结论:开放微波消融联合椎体成形、钉棒系统内固定治疗胸腰椎转移瘤效果肯定,术中出血量较少、手术时间较短、术后疼痛缓解明显、肿瘤复发率低。     

微波透热治疗恶性肿瘤210例观察

应用微波透热治疗恶性肿瘤２１０例，近期疗效：原发癌９５例，临控１０例，显效３０例，临控显效率４２％；转移癌１１５例，临控１５例，显效３９例，临控显效率４７％。微波透热综合治疗可提高对放、化疗不敏感，常规治疗无效的难治愈恶性肿瘤的治疗效果。     

Inclusion of fenofibrate in a series of mesoporous silicas using microwave irradiation

A selection of porous silicas were combined with a model drug using a recently developed, controlled microwave heating process to determine if the application of microwave irradiation could enhance subsequent drug release. Five mesoporous silica types were investigated (core shell, core shell rehydrox, SBA-15, silica gel, SYLOID®) and, for comparison, one non-porous silica (stober). These were formulated using a tailored microwave heating method at drug/excipient ratios of 1:1, 1:3 and 1:5. In addition, all experiments were performed both in the presence and absence of water, used as a fluidising media to aid interaction between drug and support, and compared with results obtained using more traditional heating methods. All formulations were then characterised using differential scanning calorimetry (DSC), powder X-ray diffraction (XRD), scanning electron microscopy (SEM) and Fourier transformation infrared spectroscopy (FT-IR). Pharmaceutical performance was investigated using in vitro drug release studies. A significant enhancement in the release profile of fenofibrate was observed for formulations prepared using microwave heating in the absence of water for five of the six silica based formulations. Of all the formulations analysed, the greatest extent of drug release within the experimental 30 min was the 1:5 core shell rehydrox achieving a total of 86.6 ± 2.8%. The non-porous (stober) particles did not exhibit an increased release of the drug under any experimental conditions studied. This anomaly is thought to be a result of the comparatively small surface area of the silica particles, thus preventing the adsorption of drug molecules.     

不同治疗方法对不同程度慢性宫颈炎的疗效对比

目的：比较药物、微波、药物与微波联合治疗不同程度慢性宫颈炎的临床效果。方法回顾性分析2012年12月~2013年12月来我院就诊的216例慢性宫颈炎患者,按照就诊顺序分为药物组、微波组及联合组,各72例,药物组采用爱宝疗浓缩液治疗,微波组采用微波治疗仪治疗,联合组采用爱宝疗浓缩液联合微波治疗仪治疗。结果微波组、联合组有效率高于药物组（P＜0.05）,药物组愈合时间为5~6周的患者数高于微波组及联合组,微波组愈合时间为3~4周的患者数高于药物组及联合组,联合组愈合时间小于3周的患者数高于药物组及微波组（P＜0.05）。微波组阴道排液时间为7~14d的患者数高于联合组,联合组阴道排液时间小于7d的患者数高于微波组（P＜0.05）。结论微波联合爱宝疗浓缩液治疗不同程度慢性宫颈炎疗效确切。     

全面护理干预在慢性咽炎患者中的应用

目的：探讨微波联合雾化治疗慢性咽炎的护理干预措施及其临床意义。方法选取2010年7月~2013年5月本院耳鼻喉科收治的慢性咽炎患者140例,均行微波配合中西药物雾化吸入治疗后,将其随机分为常规护理组和护理干预组,常规护理组给予常规护理措施,护理干预组在常规护理的基础上实施心理干预、健康教育、饮食管理等全面护理干预,对比两组患者的药物治疗时间、口腔溃疡发生率、治疗有效率及护理满意率。结果与常规护理组比较,护理干预组患者的药物治疗时间显著缩短,口腔溃疡发生率显著降低（P<0.01）;护理干预组患者的治疗有效率为100.0%,较常规护理组（92.9%）提高（P<0.05）;护理干预组的护理满意度为90.0%,较常规护理组（75.7%）提高（P<0.05）。结论对于慢性咽炎患者,在行微波联合雾化治疗时实施全面的护理干预,可提高患者的治疗依从性,从而有效缩短治疗时间,提高治疗效果和护理满意度。