目的:探讨TCR(低温等离子射频)序贯治疗在治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)临床疗效。方法:我院2003年8月至2007年2月收治153例轻中度OSAHS患者,采用TCR序贯治疗,初次手术后追踪患者情况,必要时分阶段分部位反复消融,并在术后半年,1年进行PSG检查等,对其疗效、并发症进行分析。结果:153例患者半年有效率86.27%。1年有效率73.20 %,无严重并发症发生。结论:TCR序贯治疗疗效确切,组织反应轻,可作为治疗轻中度OSAHS的有效方案。
ObjectiveTo investigate the research progress of residual nodules after thermal ablation for benign thyroid nodules.MethodsThe domestic and foreign guidelines and consensus on the treatment of benign thyroid nodules were collected, and the indications for thermal ablation were summarized. The causes of residual nodules after ablation were analyzed, the characteristics of residual nodules were evaluated through multiple approaches, and the follow-up treatment measures were summarized.ResultsThe indications of thermal ablation of benign thyroid nodules were different at home and abroad. The causes of residual nodules included slow absorption after ablation and incomplete ablation. Among the evaluation methods of residual nodules, the nodules volume reduction rate was the evaluation standard of short-term efficacy, contrast-enhanced ultrasound was the best method, color Doppler blood color distributionwas the most commonly used method, elastic imaging was a valuable method, and puncture pathology biopsy was an important standard. Reablation and surgical resection were the follow-up treatments for residual nodules.ConclusionsAs a new technique, thermal ablation of benign thyroid nodules has some advantages, but it is flooding at present. In the future, it is necessary to standardize indications, improve the efficiency of first ablation, attach importance to pathological complete ablation, and reasonably evaluate the treatment of residual nodules, so that thermal ablation of benign thyroid nodules could reflect rationality, safety, and efficiency, and give full play to its advantages, so as to serve patients better and have better application prospects.
【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 evaluate the effect and experience of monopolar or bipolar radiofrequency ablation for organic heart disease with atrial fibrillation under the open heart surgery. MethodsWe retrospectively analyzed the clinical data of 305 patients with organic heart disease such as atrial fibrillation underwent the open heart surgery in Changle People's Hospital and Shanghai Renji Hospital between December 2004 year and December 2013 year. There were 188 male and 117 female patients at age of 38 to 81 years. The patients were divided into three groups according to monopolar or bipolar radiofrequency ablation used. There were 128 patients in a monopolar group, 165 patients in a bipolar group, and 12 patients in a combined group with monopolar radiofrequency ablation plus bipolar radiofrequency ablation. ResultTwo patients died after operation. There were 249 patients (81.6%) with sinus rhythm after operation. Sinus rhythm was restored 78.9% in the monopolar group compared with 83.6% in the bipolar group with a statistical difference (P>0.05). We followed up the patients for 3 to 85 (38.2±15.4) months after operation. There were no statistical differences in sinus rhythm rates after following-up 0.5 year (80.5% vs. 83.9%, P>0.05), 1 year (78.4% vs. 83.3%, P>0.05), 2 years (76.5% vs. 81.1%, P>0.05), and 5 years(73.8% vs. 77.1%, P>0.05). ConclusionMonopolar or bipolar radiofrequency ablation for atrial fibrillation with open heart surgery is an effective method, especially in long-term effect. There was no significant difference between the monopolar group and the bipolar group in effect. Bipolar radiofrequency ablation can reduce the ablation time.
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.
ObjectiveTo summarize the research progress in the treatment of papillary thyroid microcarcinoma (PTMC) , and provide rationalized treatment strategies for patients with PTMC. MethodsRetrieved and reviewed relevant literatures about the treatment of PTMC in recent years both at home and abroad. ResultsLow-risk and high-risk PTMC differ markedly in biological characteristics and prognosis and should be treated differently. For high-risk PTMC, surgery is the primary treatment, supplemented by endocrine and radioiodine therapy. Various options are available for low-risk PTMC, including surgery, active surveillance, and ablative therapy. Surgery is the preferred option with clear efficacy and diversified surgical options. However, there are surgical risks and postoperative complications. Active surveillance avoids surgical and/or postoperative complications. Thermal ablation is minimally invasive with a low impact on thyroid function. Still, both active surveillance and thermal ablation lack the results of large samples with long-term follow-up to validate effectiveness and safety. ConclusionsStratified management should be applied to PTMC. High-risk PTMC should be treated surgically. All three treatment options of low-risk PTMC have advantages and disadvantages, which should be considered in conjunction with the patients’ wishes. After careful assessments and fully informed communications with patients, doctors and patients work together to develop a rationalized and individualized PTMC treatment strategy.
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.
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.
ObjectiveTo evaluate the survival results of surgical resection (SR) and CT-guided percutaneous ablation (PA) for stageⅠnon-small cell lung cancer (NSCLC).MethodsThe PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, VIP, Wanfang databases from inception to June 2021 were searched to collect comparative studies on the survival results between SR and CT-guided PA treatment for stageⅠNSCLC. RevMan 5.3 software was used for statistical analysis of data.ResultsA total of 3 114 patients were included in 11 studies. The results of meta-analysis showed that compared with the PA group, the SR group had a higher 2-year postoperative overall survival (OS) rate (OR=1.44, 95%CI 1.00-2.06, P=0.05), 3-year postoperative OS rate (OR=2.37, 95%CI 1.47-3.81, P<0.001), 5-year OS rate (OR=1.64, 95%CI 1.19-2.28, P<0.01), 5-year progression-free survival rate after operation (OR=2.43, 95%CI 1.54-3.82, P<0.001) and lower local recurrence rate (OR=0.26, 95%CI 0.13-0.54, P<0.001). There were no statistical differences between the two groups in terms of 1-year postoperative OS rate, 1-year, 2-year, and 3-year tumor-related survival rates, 1-year, 2-year tumor-free survival rates, or distant postoperative recurrence rate (P>0.05).ConclusionFor patients with stageⅠNSCLC with optimal basic conditions, surgery is a more appropriate treatment. For patients who cannot withstand surgical injuries or refuse surgery, CT-guided PA is also a potential alternative treatment. However, this conclusion needs to be verified by prospective controlled trials with larger sample sizes and a more rigorous design.