Objective To investigate the impact of injection of acetic acid hypertonic saline solution (AHS) in dog liver during radiofrequency ablation (RFA) on its destructive zone. Methods RFAs were performed in dog livers by using LDRF-120S mutiple probe ablation system combining 50% acetic acid 5% hypertonic saline solution injection. Thirty healthy adult hybrid dogs were randomly divided into 5 groups (n=6). Group A: RFA was performed immediately after injection of 2 ml AHS; Group B: RFA was performed 5 min after injection of 2 ml AHS; Group C: RFA was performed immediately after injection of 4 ml AHS; Group D: RFA was performed 5 min after injection of 4 ml AHS; Group E: RFA was performed immediately after injection of 6 ml AHS. Results There were no significant differences in the mean initial impedance within 5 groups. The mean ablation times were different significantly among 5 groups (F=83.831, P＜0.001). The mean ablation time was different significantly between any two groups by LSD-t analysis (P＜0.001). The mean coagulation diameters were different significantly among 5 groups （F=53.488, P＜0.001）. The mean coagulation diameter of group E was the largest among 5 groups. Besides mean coagulation diameter was no significant difference between group D and E (Pgt;0.05), the mean coagulation diameter was different significantly between any two groups by LSD-t analysis (P＜0.001). Obviously thrombus were shown in coagulation necrosis zone and nearly normal tissue with gordon amp; sweet. AHS spillage from the injection site occurred in group E. Four dogs died in group E within 14 d but no dog died in the other groups. Conclusion RFA is performed 5 min after injection of 4 ml AHS in dog liver produces the ideal ablation destructive zone.
ObjectiveTo evaluate the clinical application and the efficacy of contrast enhanced ultrasonography (CEUS)guided percutaneous radiofrequency ablation (RFA) in patients with liver metastases. MethodsTotal 136 patients with 219 liver metastatic tumors, which were detected by CEUS before RFA therapy, were analyzed retrospectively. The diamter of tumors was (3.2±1.2) cm. Among them, the largest tumor more than 3 cm in diameter were found in 48.5% (66 patients), and 57.4% (78 patients) were with solitary metastasis. Enhanced CT and (or) MRI, and laboratory tests were applied to evaluate the outcomes after RFA treatment by regular followup. ResultsTumors were not detected by conventional ultrasonography in two cases, and 47.0% (63/134) of the patients with the largest tumor were 0.3 cm larger by CEUS than by conventional ultrasonography. More 40 tumors were detected in 18.4% (25/136) patients by CEUS. Followup ranged from 3 to 68 months (median time of 12 months). Early tumor necrosis rate one month after therapy was 98.2% (215/219 tumors). The incidence of local recurrence, new intrahepatic metastasis, and extrahepatic metastasis was 16.9% (23/136), 38.2% (52/136), and 8.8% (12/136), respectively. Local recurrence and new intrahepatic metastasis happened 2-25 months (median time of 6 months) after treatment. Local recurrence rates of the largest tumors ≥ 3 cm and tumor lt; 3 cm was 22.7% and 11.4%， respectively (P=0.079). The rate of new intrahepatic metastasis for the solitary metastasis cases was significantly lower than that for multiple metastases cases (25.6% versus 55.2%, P=0.000). The 1, 2, 3year survival rates were 82.5%, 64.3%, and 50.1%, and the 1, 2, 3year local recurrence free survival rates were 67.7%, 53.8%, and 38.3%, respetively. Patients with solitary metastasis survived longer than that with multiple metastases (P=0.034). ConclusionPatients with liver metastases treated by CEUSguided percutaneous RFA can get better survival rate, and CEUS is of much value for clinic application.
Objective To evaluate the efficacy and safety of computed tomography (CT)-guided percutaneous and cone beam CT-guided transbronchial ablation in the treatment of early multiple primary lung cancer (MPLC). Methods Retrospective analysis was performed on patients who met inclusion criteria in Shanghai Chest Hospital between May 2020 to June 2022. According to ablation pathway, lesions were divided into two groups: percutaneous ablation group and transbronchial ablation group. Results A total of 13 MPLC patients with 26 lesions were included (14 percutaneous ablation and 12 transbronchial ablation). There were no statistically significant differences in solid component, lesion location, lung field and lesion size between the two groups. The distance from the parietal pleura in the transbronchial ablation group was longer than that in percutaneous ablation group (P=0.03). The median follow-up period time were 13 months and 12 months for group percutaneous ablation and transbronchial ablation. No significant differences were found in 3-month complete ablation rate (100.0% vs. 83.3%), 1-year local control rate (100.0% vs. 91.7%) and severe complication rate (7.1% vs. 16.7%). The minor complication rate in percutaneous ablation group was higher than that in transbronchial ablation group (50.0% vs 0.0%, P=0.02). Conclusions Percutaneous ablation and transbronchial ablation have high efficacy and safety, and the latter involves lower minor complication rate. They complement each other, which provide the individualized treatments for early MPLC patients who are not suitable for or refuse surgery.
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.
The temperature dependence of relative permittivity and conductivity of ex-vivo pig liver, lung and heart at 2 450 MHz was studied. The relative permittivity and conductivity of three kinds of biological tissues were measured by the open-end coaxial line method. The dielectric model was fitted according to the principle of least square method. The results showed that the relative permittivity and conductivity of pig liver, pig lung and pig heart decreased with the increase of tissue temperature from 20 to 80 ℃. The relative permittivity and conductivity models of pig liver, pig lung and pig heart were established to reflect the law of dielectric properties of biological tissue changing with temperature and provide a reference for the parameters setting of thermal ablation temperature field.
Objective To study the short-term outcome and safety of radiofrequency ablation (RFA) combined with recombinant human endostatin (endostar) for non-small cell lung cancer (NSCLC) patients. Methods Between December 2013 and December 2014, 80 consecutive patients (50 males, 30 females) with biopsy-proved NSCLC were divided into two groups: a RFA combined treatment group (RFA combined with endostar, 60 patients, 38 males, 22 females, mean age at 67.77±10.43 years) and a RFA alone group (20 patients, 12 males, 8 females, mean age at 67.35±9.82 years). The RFA combined treatment group was divided into three groups according to vascular normalization window of endostar and 20 patients in each group: a combined treatment group 1 (transfusion of endostar after RFA), a combined treatment group 2 (transfusion of endostar for 1 to 3 d before RFA) and a combined treatment group 3 (transfusion of endostar for 4 to 7 d before RFA). The CT scan of the chest was followed up after the treatment, local recurrence and safety was observed. Results There was a statistical difference in local recurrence time among groups (χ2 = 11.05, P = 0.011). The effect of the combined treatment group is better than that of the radiofrequency ablation therapy alone group. And in the recombinant human endostatin of tumor vascular normalization time best combination therapy was observed in the near future effect compared with the radiofrequency ablation therapy alone. In this study common complications were associated with radiofrequency ablation. No recombinant human endostatin related complication was found. There was no satistical difference in safety between the combined treatment group and the radiofrequency ablation therapy group (χ2= 0.889, P > 0.05). Conclusion RFA combined with endostar is safe and effective for non-small cell lung cancer.
摘要:目的:探讨联合应用激光汽化减压(percutaneous laser disc discompression,PLDD)、射频热凝靶点消融、臭氧注射治疗腰椎间盘突出症的的个体化选择。方法: 自2006年6月,在CT引导下选择性联合应用PLDD、射频和臭氧治疗腰椎间盘突出症患者267例,突出椎间盘的特点个体化选择穿刺路径和治疗方法;其中PLDD联合臭氧治疗92例(A组),射频联合臭氧治疗67例(B组),PLDD、射频和臭氧三者联合治疗108例(C组)。结果:所有患者均顺利完成手术,于术后1周、1个月,3个月及6个月随访记录VAS评分和Macanab优良率。三组患者VAS评分经方差分析,手术前、后有显著性差异(Plt;0.05),术后1周至6个月的VAS评分统计无显著性差异(Pgt;0.05);术后三组间VAS评分、Macanab优良率比较无显著性差异(Pgt;0.05)。结论: 选择性联合应用微创技术进行个体化的立体治疗,具有扩大微创手术适应症、提高手术疗效的优势,值得推广和利用。Abstract: Objective: To investigate the selectivity and individualization of using percutaneous laser disc discompression(PLDD) and ozone injection combined with radiofrequency thermocoagulation and target ablation curing lumbar intervertebral disc protrusion. Methods: From June 2006, 267 lumbar disc herniation cases were operated that guided by CT, the characteristic of the liable disc was confirmed by magnetic resonance imaging and CT before the procedure. 92 cases (A group) were treated by PLDD combined with ozone injection,67 case were treated by radiofrequency thermocoagulation and target ablation combined with ozone injection, 108 cases were treated by PLDD and ozone injection combined with radiofrequency thermocoagulation and target ablation. Results: All case been successfully operated, the theraptic effect was evaluated by comparing the value of VAS and excellent and good rate of therapy at preoperation and at 1 week, 1month,3 months, 6 months after operation. The value of VAS in three groups at postoperation were remarkably lower than preoperation (Plt;0.05). The excellent and good rate of therapy at 6 months was respectively 94.5％ in group A,94.0％ in group B and 95.4％ in group C,no significant difference was observed between the three groups(Pgt;0.05).Conclusion: The selectivity and individualization of using PLDD and ozone injection combined with radiofrequency thermocoagulation and target ablation curing lumbar intervertebral disc protrusion can enlarge the indication and improve the clinical curative effect, it should be spreaded in clinic.
Objective To evaluate the efficacy of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treating primary hepatocellular carcinoma (HCC). Methods From March 2004 to March 2006, 137 patients with primary HCC underwent TACE alone (n=87) and TACE+RFA (n=50), respectively, after the interventional treatment, all patients periodically received CT reexaminations and alpha fetoprotein (AFP) measurement. The therapeutic efficacy, AFP level and survival rate between two groups were compared with each other. Results In TACE group the effective rate (CR+PR) was 34.5%, AFP decreasing amplitude was 54.2%, and 2 years survival rate was 43.7%. While in TACE+RFA group, the effective rate (CR+PR) was 70.0%, AFP decreasing amplitude was 78.0%, and 2 years survival rate was 62.0%, there were significant differences between two groups (P＜0.05). Conclusion Combined application of TACE and RFA is significantly superior to TACE alone in treatment of primary HCC.
Objective To compare short-term clinical outcomes of bipolar/unipolar radiofrequency （RF） ablation for the treatment of permanent atrial fibrillation（AF） of patients with rheumatic valvular heart disease. Methods Clinicaldata of 124 patients with rheumatic valvular heart disease and permanent AF who underwent heart valve replacement and concomitant bipolar/unipolar RF ablation in Wuhan Asia Heart Hospital from February 2011 to December 2011 were retros- pectively analyzed. According to different RF ablation methods，all the 124 patients were divided into bipolar group and unipolar group. There were 62 patients in the bipolar group including 29 males and 33 females with their age of 44.20±8.61 years，and 62 patients in the unipolar group including 33 males and 29 females with their age of 46.40±9.48 years. Electrocardiogram examinations were performed at the time of intraoperative heart re-beating，the very postoperative day，7 days，1 month，3 months and 6 months postoperatively to detect restoration of sinus rhythm. Results There was no in-hospital death or ablation-related complication in either group. Aortic cross-clamp time（70.05±22.02 min vs. 54.47±20.65 min，P=0.025） and RF ablation time（25.12±3.00 min vs. 15.70±3.02 min，P=0.000）of the bipolar group were significantly longer than those of the unipolar group. At the time of intraoperative heart re-beating，the lst and 7th day after operation， sinus rhythm restoration rates were 88.71%，87.10%，80.65% respectively in the bipolar group，85.48%，77.42%，72.58% respectively in the unipolar group，and there was no statistical difference between the two groups （P＞0.05）. In the 1st，3rd and 6th postoperative month，sinus rhythm restoration rates of the bipolar group （79.03%，75.81%，72.58% respectively） were significantly higher than those of the unipolar group （59.68%，50.00%，48.38% respectively，P＜0.05）. Conclusion Clinical outcomes of RF ablation for the treatment of permanent AF of patients with rheumatic valvular heart disease are satisfactory. Unipolar RF ablation has the advantage of being time-saving and easier technique，while short-term sinus rhythm restoration rate of bipolar RF ablation is higher than that of unipolar RF ablation for the treatment of permanent AF.
摘要:目的:探讨三维电解剖标测系统(CARTO)指导下进行房性心动过速射频消融的方法及效果。方法:对40例房性心动过速患者应用CARTO标测心房, 构建三维电解剖图,分析房性心动过速的电生理机制。局灶性房速消融最早激动点,大折返性房速消融折返环的关键性峡部。选择利用常规方法行消融的28 例患者作为对照组。比较两组消融的成功率、X线曝光时间。结果:38例患者CARTO三维标测系统标测提示为局灶性房性心动过速, 最早激动点位于右心房35例,其中冠状静脉窦口8例(20%)、间隔部10例(25%)、侧壁8例(20%)、上腔静脉口附近4例(10%)、后壁4例(10 %),1例患者(2.5%)有3种类型房速(分别为间隔部、上腔静脉口的局灶房速和三尖瓣峡部依赖的大折返房速)。位于左心房的局灶房速3例,分别位于右上肺静脉口(2.5%)、左上肺静脉口(2.5%)及左心耳(2.5%)。2例患者为大折返房速(5%),1例为三尖瓣峡部依赖性,1例为围绕界嵴的大折返房速。均消融成功(100%),随访4~16个月,均无复发。常规消融组成功率为89.3%(Plt;0.05)。CARTO组X线曝光时间比常规组明显缩短,分别为(13.8±5.5 ) min 和( 30.4±12.9 ) min,差异有统计学意义（Plt;0.05）。结论:应用CARTO标测房性心动过速, 对分析房性心动过速的机制准确快速, 能有效指导射频消融。Abstract: Objective: To evaluate the methods and effects of radiofrequency ablation of atrial tachycardia guided by CARTO. Methods: The atria of 40 cases were mapped by three dimensional electroanatomic mapping system. In order to analyse the mechanism of atrial tachycardia and perform the ablation of the earliest excited point in focal atrial tachycardia and isthmus in macroreentry atrial tachycardia. 28 cases ablated by conventional procedure were selected as controlled group. The success rate and fluoroscopic time were compared between the two groups. Results: Focal atrial tachycardia was seen in 38 patients. The sites of origin from right atrium were at the coronary sinus ostium in 8 cases (20%), septal in 10 cases (25%), lateral wall in 8 cases (20%), superior vena cava ostium in 4 cases (10%), posterior wall in 4 cases (10%). One case had 3 types of atrial tachycardia (2.5%). The sites of origin from left atrium were at right pulmonary vein ostium in 1 case (2.5%), left pulmonary vein ostium in 1 case (2.5%), left auricular appendage in 1 case (2.5%). 2 cases were macroreentry atrial tachycardia (5%). Ablation was performed successfully (100%) without any complication. No recurrence was found during a followup of 416 months. Success rate in conventional group was 89.3%(Plt;0.05)。Comparing the CARTO group and conventional group, the fluoroscopic time was shorter, ( 13.8±5.5 ) min vs ( 30.4±12.9 ) min （Plt;0.05).Conclusion: The mechanism of atrial tachycardia can be evaluated quickly and accurately. Ablation can be performed safely and effectively guided by CARTO.