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Precise ablation therapy for primary liver cancer

In 2022, there were 367.7 thousands new cases and 316.5 thousands deaths of primary liver cancer in China. Radiofrequency ablation (RFA) is one of the radical treatments for liver cancer. It has the characteristics of definite curative effect, minimal invasion and low cost. In patients with early liver cancer, the curative effect is similar to surgical resection. The concept and practice of precision surgery provide new ideas for improving the efficacy of RFA. Based on the RFA treatment experience of more than ten thousand cases, the author’s team has carried out research on the precise ablation treatment of primary liver cancer. Now, the author will combine the existing literature and our team’s experience to discuss the application and prospect of the precise surgery concept in RFA treatment.

Progress in diagnosis and treatment strategies for multiple primary lung cancer

Multiple primary lung cancer is a special type of lung cancer. Its detection rate is increasing year by year, and there is no clear diagnosis and treatment strategy, which makes the diagnosis and treatment become a hotspot in clinical work. The molecular genetics is gradually changing the status quo of relying only on imaging and tumor-free interval to distinguish lung metastasis from multiple primary lung cancer, and it is an effective method for differential diagnosis and prediction of biological behavior of lung cancer. Based on our experience and other studies, it is recommended that surgical treatment should be preferred when there is no contraindication. The advantages and disadvantages of bilateral thoracoscopic surgery for bilateral multiple primary lung cancer during the same period are discussed, and its feasibility and safety are confirmed. For the lesions that cannot be completely resected, active surgical local treatment is recommended. The diagnosis and treatment of multiple primary lung cancer is still a clinical difficulty, and we hope that our research can provide theoretical and practical guidance for clinicians.

An in vivo study of ultrasonic monitoring imaging of microwave ablation based on Nakagami statistic parameter

This paper explored the feasibility of using ultrasonic Nakagami statistic parameter imaging to evaluate the thermal lesion induced by microwave ablation (MWA) in porcine models. In this paper, thermal lesions were induced in livers and kidneys in 5 swines using a clinical MWA system. During this treatment progress, ultrasonic radiofrequency (RF) data were collected. The dynamic changes of Nakagami parameter in the thermal lesion were calculated, and the ultrasonic B-mode images and Nakagami images were reconstructed simultaneously. The contrast-to-noise ratio (CNR) between the thermal lesion and the surrounding normal tissue was calculated over the MWA procedure. After MWA, a bright hyperechoic region appeared in the ultrasonic Nakagami image as an indicator of the thermal lesion and this bright spot enlarged with lesion development during MWA exposure. The mean value of Nakagami parameter in the liver and kidney increased from 0.78 and 0.79 before treatment to 0.91 and 0.92 after treatment, respectively. During MWA exposure, the mean values of CNR calculated from the Nakagami parameter increased from 0.49 to 1.13 in the porcine liver and increased from 0.51 to 0.85 in the kidney, which were both higher than those calculated from the B-mode images. This in vivo study on porcine models suggested that the ultrasonic Nakagami imaging may provide an alternative modality for monitoring MWA treatment.

Large Hepatocarcinoma: Treatment with RadioFrequency Ablation

Objective To explore efficacy and safety of radiofrequency ablation (RFA) in the treatment of large hepatocarcinoma. MethodsFortythree cases of large hepatocarcinoma underwent RFA with the expandable cluster electrode,eight of all cases had undergone transcatheter artery chemoembolization (TAE) for 1-2 sessions within 2 months before RFA; the tumors were 5-10 cm in diameter, mean 7.5 cm. Hepatic function examination, alphafetoprotein, enhanced CT scans,color ultrasonography and needle biopsy were performed,pre and posttreatment. Complete necrosis was evaluated by dynamic enhanced CT scans and biopsy. Therapeutic time and sessions of RFA,length of stay in hospital and complications of RFA were observed; and thirtynine of 43 cases after RFA were followed up for 12-18 months.ResultsFortythree cases of large hepatocarcinoma received RFA for 67 sessions， 1-3 sessions per case，mean 1.6 sessions; therapeutic time 55-150 min,mean 75 min; length of stay in hospital 3-15 day， mean 8.7 day; major complications of RFA included local skin burn of electrode board in 2 cases （4.6%） and moderatetolarge right pleural effusion in 3 cases （7.0%），overall complications rate was 11.6%; complete necrosis was achieved in 41.0% of cases which were evaluated by dynamic enhanced CT scans at least 6 months followed RFA; of thirtyone cases of positive AFP, AFP level became negative in 3,decreased obviously in 5 within 6-12 months after RFA; in 12-18 months followup,oneyear survival rate was 69.2%.Conclusion RFA appears to be safe, effective and minor invasive for the treatment of large hepatocarcinoma.

射频消融在脾脏外伤后保脾手术中的临床应用

目的 探讨射频消融在保脾手术治疗脾脏外伤中的临床应用效果。 方法 回顾性分析笔者所在医院科室于 2010 年 7 月至 2015 年 3 月期间行保脾手术治疗的 23 例脾脏外伤患者的临床资料，术中均利用了射频消融技术。 结果 23 例患者均保脾成功，其中 11 例行射频消融止血修补术，12 例行射频消融联合部分脾脏切除术。手术时间为 75～150 min，平均 117 min；术中出血量为 40～500 mL，平均 223 mL；术中见腹腔出血量 800～2 000 mL，平均 1 452 mL，均行自体血回输；术中见脾脏裂伤程度：Ⅰ 度 10 例，Ⅱ 度 11 例，Ⅲ 度 2 例；拔除引流管时间为术后 2～5 d，平均 2.8 d；术后住院时间为 6～15 d，平均 8.5 d。术后出现发热 3 例，腹腔再次出血 1 例，血小板计数升高 7 例。术后获访 16 例，随访时间 8～26 个月，中位数为 11 个月。随访期间患者健康情况良好，未见血小板计数异常、脾脓肿等情况。 结论 射频消融在保脾手术治疗脾脏外伤中的应用是可行的。

应用 Cool Flex 冷盐水射频消融导管行阵发性心房颤动消融一例

Short-term efficacy of CT-guided microwave ablation for solitary pulmonary nodules

ObjectiveTo evaluate the clinical feasibility and safety of CT-guided percutaneous microwave ablation for peripheral solitary pulmonary nodules.MethodsThe imaging and clinical data of 33 patients with pulmonary nodule less than 3 cm in diameter treated by CT-guided microwave ablation treatment (PMAT) in our hospital from July 2018 to December 2019 were retrospectively analyzed. There were 21 males and 12 females aged 38-90 (67.6±13.4) years. Among them, 26 patients were confirmed with lung cancer by biopsy and 7 patients were clinically considered as partial malignant lesions. The average diameter of 33 nodules was 0.6-3.0 (1.8±0.6) cm. The 3- and 6-month follow-up CT was performed to evaluate the therapy method by comparing the diameter and enhancement degree of lesions with 1-month CT manifestation. Short-term treatment analysis including complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) was calculated according to the WHO modified response evaluation criteria in solid tumor (mRECIST) for short-term efficacy evaluation. Eventually the result of response rate (RR) was calculated. Progression-free survival was obtained by Kaplan–Meier analysis.ResultsCT-guided percutaneous microwave ablation was successfully conducted in all patients. Three patients suffered slight pneumothorax. There were 18 (54.5%) patients who achieved CR, 9 (27.3%) patients PR, 4 (12.1%) patients SD and 2 (6.1%) patients PD. The short-term follow-up effective rate was 81.8%. Logistic analysis demonstrated that primary and metastatic pulmonary nodules had no difference in progression-free time (log-rank P=0.624).ConclusionPMAT is of high success rate for the treatment of solitary pulmonary nodules without severe complications, which can be used as an effective alternative treatment for nonsurgical candidates.

The advances of ultrasound-guided thermal ablation for the treatment of papillary thyroid microcarcinoma

Objective To summarize the progress of the application of ultrasound-guided thermal ablation for treatment of papillary thyroid microcarcinoma (PTMC). Methods The relevant literatures of thyroid nodules treated by ultrasound-guided thermal ablation were reviewed by adopting the methods of literature review. Results In conditions of grasping the therapeutic indication strictly and evaluating preoperative various aspects sufficiently, it reveals a certain feasibility and validity applying ultrasound-guided thermal ablation in the treatment of PTMC classified in the low-risk group. Conclutions Possessing the advantages of minimal invasive techniques, low-risks, beauty and rapidness, ultrasound-guided thermal ablation might be recommended as an alternative to a low-risk PTMC patient who is at high risk in general anaesthesia operation or intolerant to open operation.

Efficacy of Radiofrequency Modified Maze Procedure Combined with Open-heart Surgery for Atrial Fibrillation

Objective To evaluate the efficacy of Radiofrequency （RF） modified maze procedure combined with open-heart surgery for atrial fibrillation （AF）. Methods From January 2003 to October 2004, 66 patients underwent the RF modified maze Ⅲ procedure for AF combined with open-heart surgery. The preoperative and postoperative indexes of electrocardiogram and echoeardiogram were compared through retrospective analysis and follow-up. Postoperative cardiac function and thromboembolie events were evaluated through telephone and mail. Results The time needed for RF modified maze Ⅲ was 18.61±3.56 min. There were no hospital deaths and the complications was 15.15%（10/66）. Follow-up duration was 14.25±6.47 months with 95.45%（63/66） completion. At the lastest follow-up, the rate of freedom from AF was 80.95% （51/63）and the rate of restoration to sinus rhythm was 74.60%（47/63）. No thromboembolic events was seen. 77.78%（49/63） of patients were in NYHA class Ⅰ. Significant decrease was seen in both left atrial dimension （LAD） and left ventricular dimension （LVD）（P〈0.01） more than 6 months after operation. Conclusion RF modified maze Ⅲ procedure as an adjunctive procedure is safe, time-sparing and effective in eliminating AF.

Clinical analysis of CT-guided percutaneous microwave ablation therapy for 39 patients with primary lung cancer

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。