Based on the experience of more than 10 000 times of radiofrequency ablation treatment and the clinical and basic research results of radiofrequency ablation treatment of liver cancer obtained during the period, the author shares the experience of radiofrequency ablation indication selection, preoperative preparation, concept of radiofrequency ablation and postoperative follow-up of liver cancer. The purpose is to explore how to improve the curative effect of RFA treatment for small liver cancer, and reduce local residue, recurrence, as well as relevant complications.
Microwave ablation (MWA), a form of thermal ablation in interventional radiology, uses electromagnetic waves to produce tissue-heating effects which generating tissue necrosis within solid tumors. Due to its exact effect, safety, high thermal efficiency, MWA became a minimally invasive surgery for lung cancer and a palliative treatment in patients who are nonsurgical candidate and solid tumors. MWA is accurate and effective for peripheral lung cancer and can effectively relieve airway obstruction, obstructive symptoms of pneumonia, atelectasis, breathing difficulties for central lung cancer. This review focuses on the application of MWA in the treatment of lung cancer.
ObjectiveTo evaluate the efficacy of hybrid ablation through compared with thoracoscopic epicardial ablation.MethodsIn this study, 108 patients with all long-standing persistent atrial fibrillation (LSPAF) received thoracoscopic epicardial ablation (TEA) after enrollment. There were 82 males and 26 females at age of 56.5±9.4 years. After blanking-period, patients off antiarrhythmic therapy with sinus rhythm were divided into a hybrid ablation (HA) group (50 patients) and a TEA group (58 patients). Only patients in the HA group received catheter ablation after randomization subsequently. In at least two-year observation period, cardiovascular risk factors were observed in all groups’ patients.ResultsThe mean follow-up duration was 17.3-41.8 (26.9±6.1) months and there was no significant difference between two groups [8.2-40.6 (27.5±5.7) months in the HA group and 17.3-41.8 (26.4±6.7) months in the TEA group]. The off antiarrhythmic agents (AADs) sinus rhythm rate was significantly higher in the HA group than that in the TEA group at the time of postoperative 6, 12, 24 and 36 months ［96.0%, 90.0%, 83.7%, 83.7% versus 79.3%, 75.9%, 67.3%, 63.1%, HR=0.415 (95%CI 0.206-0.923)].ConclusionWe can conclude that the efficacy of two-staged hybrid ablation for LSPAF is superior to thoracoscopic epicardial ablation alone. Patients can obtain benefit from a supplemental radiofrequency catheter ablation after blanking-period of surgical ablation, instead of those without a supplemental ablation.
【摘要】 目的 评估对于曾有急性心肌梗死的室性心动过速（VT）患者，导管消融（RA）减少植入式心脏转复除颤器（ICD）放电转律治疗的疗效和安全性。 方法 计算机检索Pubmed、EMbase、Cochrane图书馆、中国生物医学文献光盘数据库、中文科技期刊全文数据库、CNKI数字图书馆，纳入RA+ICD和单独使用ICD对比治疗VT患者的随机对照临床试验，对纳入的研究进行质量评价和Meta分析。 结果 共纳入2篇最近发表在国外一流杂志上面的临床随机对照研究，一篇发在《新英格兰杂志》，另外一篇发在《柳叶刀》。RA+ICD组纳入116例患者，其中有23例（20%）因为再发VT或者心室颤动（Vf）而进行了ICD放电转律治疗；ICD组纳入119例患者，其中有49例（41%）因为再发VT或者Vf而进行了ICD放电转律治疗。Meta分析结果显示，RA+ICD的组合相对于单独运用ICD来说，需要进行ICD放电转律治疗的人数较少，OR=0.33，95%CI（0.18～0.61），P=0.000 4。 结论 目前研究认为射频消融可能可减少需进行ICD放电转律治疗的人数，以后需要更多更大样本量的研究进一步证实该结果。【Abstract】 Objective To assess the efficacy and safety of radiofrequency catheter ablation (RA) for the prevention of defibrillator therapy with implantable cardioverter defibrillator (ICD) for patients who have had acute myocardial infarction with ventricular tachycardia (VT). Methods Randomized controlled trials on patients with VT who underwent RA and ICD versus ICD alone were searched from Pubmed, EMbase, the Cochrane Central register of controlled trials, China Biology Medicine database, Chinese Science and Technology Journal database and the CNKI digital library. Quality assessment and Meta analysis were carried out for the researches sought out from these databases. Results Two randomized controlled studies published on The New England Journal of Medicine and the Lancet were included in our study. RA plus ICD were used in 116 cases, among whom 23 underwent ICD shocks due to reoccurrence of VT or ventricular fibrillation (Vf). Single ICD was used in 119 cases among whom 49 underwent ICD shocks due to reoccurrence of VT or Vf The result of Meta analysis showed that the number of patients needing ICD shocks after RA plus ICD treatment was significantly lower than that after single ICD treatment. The statistical data of the comprehensive Meta analysis were OR=0.33, 95%CI (0.18-0.61), and P=0.000 4. Conclusion At present, it is believed that RA can be used for the prevention of defibrillator therapy, while the result should be confirmed by large sample research in the future.
ObjectiveTo analyze the clinical characteristics of stiff left atrial syndrome (SLAS) after Mei mini maze procedure for atrial fibrillation (AF), and to explore its risk factors and treatments. Methods We retrospectively analyzed the clinical data of the patients who underwent Mei mini maze procedure in Xinhua Hospital between 2010 and 2020. According to whether SLAS occurred in the early postoperative period, patients were divided into a SLAS group and a non-SLAS group. The basic data, perioperative echocardiogram and laboratory test indexes of the two groups were compared. Results A total of 1 056 patients were collected. There were 672 (63.6%) males with an average age of 63.6±9.3 years, including 489 patients with persistent AF and 567 patients with paroxysmal AF. Fourteen (14/1 056, 1.3%) patients developed SLAS, with an average occurrence time of 2.1±1.1 days after the surgery. The average follow-up time of the whole group was 21.4±7.8 months. Two patients in the SLAS group developed SLAS again after discharge, and the occurrence time was 3 weeks and 4 weeks after the operation, respectively; while no SLAS occurred after discharge in the non-SLAS group. Diabetes and small preoperative left atrial diameter were risk factors for SLAS after surgery. Patients with SLAS had a good prognosis after adequate diuretic therapy. Conclusion The incidence of SLAS after Mei mini maze procedure for AF is low, and it mostly occurs in the early postoperative period. After adequate diuretic treatment, the prognosis is good.
Abstract： Objectives To determine the atrial expression of the collagen Ⅰ, collagen Ⅲ and the transforming growth factorbeta 1 (TGF-β1) in patients with rheumatic heart disease (RHD) and permanent atrial fibrillation(PAF) and to investigate the relationship between the extent of atrial fibrosis and the effectiveness of radiofrequency maze procedure in patients with RHD and PAF. Methods A total of 40 patients with RHD and PAF (≥6 months) who underwent a radiofrequency maze procedure with concomitant valvular surgery were collected for the experimental group. We acquired 100 mg of the left auricle tissue in each patient and followed up these patients after 3, 6 months of [CM(158mm]surgery. Then we assigned these patients to nonAF group and persistent AF group according to the results of the 6month followup. Another 10 patients with RHD and sinus rhythm(SR) who underwent valvular surgery alone were assigned to SR group and their left auricle tissue was also obtained. In order to determine the extent of atrial fibrosis, we observed the amount of collagen volume fraction Ⅰ，Ⅲ(CVF-Ⅰ,CVF-Ⅲ) by semiquantitative analysis with picrosirius red staining method. Using the β actin protein as the endogenous reference gene, we detected the expressions of TGF-β1 mRNA by semiquantitative reverse transcriptionpolymerase chain reaction(RT-PCR) technique. Results Each group has the same clinical baseline. At 6month follow-up, 28 among the 40 patients were categorized into the nonAF group and 12 into the AF group. (1) Patients in the nonAF group and the AF group had higher mRNA expressions of TGF-β1, CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ compared with the SR group (F=6.487, P=0.003; F=3.711, P=0.032; F=3.697, P=0.032). The AF group had higher mRNA expressions of TGF-β1, CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ than the nonAF group (t=4.372, P=0.043; t=4.603, P=0.038; t=4.776, P=0.035). But the CVFⅢ had no significant differences among the three groups (P＞0.05). (2) The patients whose left atrial function recovered after Maze procedure had lower mRNA expression than those patients whose left atrial function did not recover in the nonAF group (t=5.570, P=0.027). (3) The TGF-β1 mRNA expression has a positive correlation with both the contents of CVF-Ⅰ and left atrial diameter (r=0.786, Plt;0.05; r=0.858, Plt;0.05). Multiple logistic regression analysis revealed that the mRNA expression levels of TGF-β1, CVF-Ⅰ and left atrial diameter were independently associated with the postoperative persistence of atrial fibrillation. Conclusion The extent of atrial fibrosis in patients with RHD and PAF may be related to the sinus rhythm restoration and maintenance after AF surgical radiofrequency ablation and the resumption of atrial function.
A new cool-tip radiofrequency (RF) ablation therapeutic instrument based on impedance control algorithm is introduced in this paper. The equipment is composed of hardware system and software system. The RF power output and real time data acquisition are completed by the hardware system, while the software is used mainly to finish the control of the ablation range, the core of which is impedance control algorithm, and it also used to complete the display of the real time data in the course of the experiment. The impedance algorithm has solved the problem of impedance increased rapidly during the RF ablation, which has also expanded the scope of ablation. The pig liver experiments showed that the impedance control algorithm had strong adaptability. It also obtained a result of ablation range up to 3.5~4.5 cm single needle. It has the high clinical practical value of one-time inactivation of 3~5 cm tumor.
目的 探索无法行手术及化放疗等治疗措施的原发性周围性肺癌患者行微波消融治疗的安全性及效果。 方法 我院 2013 年 12 月至 2015 年 11 月 39 例原发性肺癌患者（其中男 24 例、女 15 例，年龄 44～83 岁，中位年龄 67 岁）行微波消融治疗，肿瘤平均直径 3.5 cm。评价肿瘤局部疗效，随访时间 0.5～2.0 年。 结果 全组 39 例患者进行病灶消融后，病灶立即均质化，CT 值下降，供血终止，6 个月后病灶开始逐步缩小，瘢痕化。随访 39 例患者中有 3 例手术后生存 1.0～1.5 年因肿瘤全身广泛转移死亡；2 例患者手术后 6 个月复查增强 CT 见局部有少许血供予以再次消融；全组患者无 1 例严重并发症发生。 结论 微波消融对原发性小细胞肺癌患者的治疗效果佳、创伤小、手术风险小、安全性高。