射频及微波消融治疗与单纯化疗治疗中晚期非小细胞肺癌生活质量的对比研究

目的：探讨射频及微波消融治疗与单纯化疗对中晚期非小细胞肺癌患者生活质量（QOL）的影响。方法：从选择2009年8月1日至2011年7月31日在我科治疗的120例中晚期非小细胞肺癌患者,将其分为三组,A组：射频消融组;B组：经皮穿刺微波消融治疗治疗组;C组：单纯化疗。在治疗前、后及治疗结束后1个月,应用欧洲癌症研究与治疗组织（european organization for rese-arch treat-ment of cancer,EORTC）生活质量核心问卷（QLQ-C30）对患者的生存质量进行评估。结果：治疗后1个月,A、B两组所有功能指标评分和治疗前比较均无统计学差异（P〉0.05）,症状指标仅呼吸困难评分较治疗前明显升高（P〈0.05）,C组患者体力功能、情绪功能较治疗前明显下降（P〈0.05）,认知功能、总体状况、角色功能及社会功能和治疗前比较无显着性差异（P〉0.05）,疲乏、恶心呕吐、呼吸困难、食欲丧失、腹泻临床症状较治疗前明显增加（P〈0.05）,其余症状指标评分较治疗前无显着性差异（P〉0.05）。治疗后3个月,三组所有功能指标评分与治疗前比较均无显着性差异（P〉0.05）,C组患者恶心呕吐、呼吸困难、食欲丧失的评分仍较治疗前显著增加（P〈0.05）,A、B组呼吸困难评分仍较治疗前明显升高（P〈0.05）。结论：与单纯化疗相比,射频消融、经皮穿刺微波消融治疗中晚期非小细胞肺癌均对患者的生存质量影响较小。     

氩氦冷冻消融联合放化疗治疗非小细胞肺癌的临床观察

目的:讨论氲氦冷冻消融联合放化疗治疗中晚期非小细胞肺癌的疗效.方法:2006年8月至2007年8月在我院初诊Ⅲa～Ⅳ期非小细胞肺癌患者98例,归为2组:氩氦冷冻消融联合放化疗组和放化疗组.结果:氩氦冷冻消融后肿块冰球覆盖率高,术后CT值明显降低;氢氯冷冻消融联合放化疗组和放化疗组的有效率(CR+PR)分别为59.2%和32.7%(p＜0.05),卡氏评分治疗后改善分别为36.7%和16.3%(p＜0.05),组间有统计学差异;中位生存期分别为19月、14月,1年生存率分别为67.3%和53%(p＞0.05),组间无明显统计学差异.结论:氩氦冷冻消融是一种安全的减瘤术,氩氦冷冻消融联合放化疗的综合治疗能显著提高中晚期非小细胞肺癌近期疗效,改善患者生活质量.     

射频消融联合DC-CIK治疗肝癌40例的临床观察

目的:探讨射频消融联合DC-CIK治疗原发性肝癌的临床效果及其毒副作用.方法:将我院2009年1月-2010年1月收治的80例原发性肝癌患者随机分为观察组和对照组各40例,均给予射频消融治疗,观察组患者在此基础上给予DC-CIK治疗.观察和比较两组患者的治疗效果、生存质量、免疫功能、癌胚抗原(AFP)的变化及患者3年生存率.结果:观察组患者的治疗总有效率为92.5％,显著高于对照组72.5％(P＜0.05);观察组患者治疗后外周血T细胞亚群中CD3+、CD4+,、CD4+/CD8+比值及NK(CD16+CD56+)均较治疗前显著上升(P＜0.01),且显著高于对照组;而T细胞亚群CD8+及甲胎蛋白(AFP)水平均显著下降(P＜0.01),且显著低于对照组(P＜0.01).治疗后,两组患者的自觉症状均减轻、食欲增加、精神状态有所改善,观察组患者的生存质量平均分(167.2±15.8)显著高于对照组(133.5±12.9)(P＜0.01).治疗期间,两组患者均部分出现腹痛、恶心、发热症状,对症处理后24h内均可缓解,不良反应发生率比较无显著差异(P＞0.05);观察组患者6个月内的死亡率为5.0％,显著低于对照组40.0％(P＜0.05),3年生存率为22.5％,显著高于对照组2.5％(P＜0.01).结论:DC-CIK辅助射频消融治疗原发性肝癌可显著提高其治疗效果,增强患者的免疫功能,改善患者的生存质量,并延长患者生存时间.     

脊神经后支射频消融结合椎间孔镜在关节突盘源性腰痛中的应用及临床分析

目的:探讨和分析使用脊神经后支射频消融结合腰椎简孔镜的方法治疗关节突盘源性腰痛作用和临床疗效。方法:回顾性分析2015.01-2017.01经纳入和排除标准筛选,因腰背痛来我院就诊,确诊为关节突盘源性腰痛的腰椎间盘突出症患者共计92人。使用椎间孔镜下射频消融处理组(实验组)为36人,保守治疗组(对照组)为56人。对两组患者在治疗前及治疗后的的疼痛评分(VAS)、治疗评分(JOA)及腰椎功能评分(MacNab)进行记录并统计学比较。前两者在治疗后1月及6月进行记录。功能评分在治疗后1年进行记录。结果:两组患者在治疗后1月的各项评分均较治疗前有显著改善(P0.05)。且两组之间有统计学差异(P0.05)。在治疗后6月及12月的观察指标的比较中,实验组的各项数据与治疗前比仍有显著差异(P0.05)。对照组较治疗前则无显著性差异(P0.05)。且两组间有统计学差异(P0.05)。治疗后1年的实验组功能评分显著高于对照组(P0.05)。两组所有患者均未出现严重并发症。结论:对于关节突盘源性腰痛,使用脊神经后支结合椎间孔镜进行治疗,具有很好的临床疗效和远期效果,且相对安全,具有非常重要的临床推广价值。     

益气活血汤联合化疗灌注治疗中晚期膀胱癌的临床疗效

目的:探讨益气活血汤联合化疗灌注治疗中晚期膀胱癌的临床疗效及其对患者免疫功能及生活质量的影响。方法:选择2011年6月至2016年12月在我院进行手术治疗的中晚期膀胱癌患者86例,随机分为两组。对照组31例患者术后接受化疗灌注治疗,观察组55例患者在对照组基础上服用益气活血汤。比较两组患者治疗后的临床疗效、治疗前后CD4~+含量、CD4~+/CD8~+及NK细胞活性、生活质量评分的变化及治疗期间不良反应的发生情况。结果:治疗后,观察组的总缓解率显著高于对照组(P0.05);两组患者CD4~+含量及NK细胞活性均较治疗前显著升高(P0.05),CD8~+细胞含量均较治疗前显著降低(P0.05),且观察组患者的CD4~+数量、NK细胞活性、CD4~+/CD8~+比例均显著高于对照组(P0.05);两组患者的生活质量评分均较治疗前明显升高,且观察组的生活质量评分显著高于对照组(P0.05);观察组胃肠不适、骨髓抑制的发生率均显著低于对照组(P0.05),两组患者肝损伤、发热的发生率比较差异无统计学意义(P0.05)。结论:益气活血汤辅助灌注化疗可显著提高中晚期膀胱癌术后患者的临床疗效,改善患者的免疫功能及生活质量,并降低化疗所致不良反应的发生率。     

微波消融联合全身化疗治疗晚期非小细胞肺癌的疗效对血清VEGF、id1蛋白浓度的影响

目的:探讨微波消融联合全身化疗治疗晚期非小细胞肺癌(NSCLC)患者的临床疗效及对患者血清中血管内皮生长因子(VEGF)、分化抑制因子-1(id1)蛋白浓度的影响。方法:选取2014年5月到2015年12月在我院接受治疗的晚期NSCLC患者50例,按随机数字表法分为对照组和观察组各25例,对照组给予全身化疗治疗,观察组给予微波消融联合全身化疗治疗。治疗后4周对两组的客观缓解率、临床受益率、并发症发生率进行对比,对比两组患者治疗前和治疗后4周血清中VEGF、id1蛋白浓度,对比两组患者的6个月生存率和1年生存率。结果:治疗后4周观察组客观缓解率高于对照组,但差异无统计学意义(P0.05),观察组临床受益率显著高于对照组,差异有统计学意义(P0.05)。治疗后4周两组患者血清中VEGF、id1蛋白浓度较治疗前均显著降低,差异有统计学意义(P0.05),两组的id1蛋白浓度比较无统计学意义(P0.05),观察组血清中VEGF浓度低于对照组,差异有统计学意义(P0.05)。两组患者治疗后并发症发生率比较差异无统计学意义(P0.05)。观察组1年生存率显著高于对照组,差异有统计学意义(P0.05)。结论:微波消融联合全身化疗治疗晚期NSCLC患者,能有效提高患者临床受益率,更显著的降低血清中VEGF浓度,提升患者1年生存率,较单用全身化疗优势更为明显,值得临床推广应用。     

肝动脉化疗栓塞联合射频消融对中晚期肝癌患者血清肿瘤活性因子、肝功能和预后的影响

目的:探讨肝动脉化疗栓塞(TACE)联合射频消融(RFA)对中晚期肝癌患者血清肿瘤活性因子、肝功能和预后的影响。方法:选取2012年2月～2016年6月期间我院收治的中晚期肝癌患者103例,根据随机数字表法将患者分为对照组(n=51)和研究组(n=52),对照组患者给予RFA治疗,研究组给予TACE联合RFA治疗,比较两组临床总有效率,比较两组治疗前后肝功能、血清肿瘤活性因子水平,统计两组患者并发症情况和预后。结果:治疗后研究组临床总有效率为53.85%(28/52),高于对照组患者的33.33%(17/51)(P0.05)。两组患者治疗后总胆红素(TBIL)、丙氨酸转氨酶(ALT)、氨基酸转氨酶(AST)较治疗前降低(P0.05),但两组治疗后TBIL、ALT、AST比较差异无统计学意义(P0.05)。两组患者治疗后甲胎蛋白(AFP)、糖类抗原199(CA199),基质金属蛋白酶(MMP)均较治疗前降低,且研究组低于对照组(P0.05)。两组患者并发症发生率比较无差异(P0.05)。研究组患者治疗后1年、2年复发率低于对照组,生存率高于对照组(P0.05)。结论:TACE联合RFA治疗中晚期肝癌,疗效确切,可有效降低血清肿瘤活性因子水平,未加重肝功能损伤,且可改善患者的预后。     

一种新型国产内镜射频消融治疗仪对胃食管反流病的疗效

目的:探讨一种新型国产内镜射频消融治疗仪对胃食管反流病(GERD)的疗效。方法:选取2016年6月-2017年6月来我院就诊的难治性GERD患者50例,随机分为内镜射频治疗组(美顿Medi誖射频治疗仪,n=25)与药物治疗组(n=25)。比较两组患者干预前后的酸反流严重程度、胃食管反流病自测量表(GerdQ)评分、质子泵抑制剂(PPI)的药物使用率、简明健康调查量表(SF-36)评分。结果:(1)内镜射频治疗组患者干预后即刻的胃镜提示射频消融治疗区域的消化道黏膜出现收缩、增厚,干预后6、12个月分别有15例(60.0%)、20例(80.0%)的食管下段黏膜的充血带较前减少。(2)两组干预后3、12个月的GerdQ总分均显著低于干预前(P0.05),内镜射频治疗组干预后3、12个月的GerdQ总分均显著低于同期药物治疗组(P0.05)。(3)全部患者干预前均需要药物来缓解症状,内镜射频治疗组干预3、12个月时的PPI药物使用率均显著低于药物治疗组(P0.05)。(4)内镜射频治疗组干预后SF-36的生理职能、生命活力、精神状态、总体健康等维度评分均显著高于同期药物治疗组(P0.05)。结论:美顿Medi?射频治疗仪对GERD患者是一种安全、有效的治疗选择,能显著改善反流症状,减少PPI药物使用,提高患者的生活质量。     

化疗联合放疗治疗非小细胞肺癌疗效观察

目的:研究化疗联合放疗治疗非小细胞肺癌的临床疗效及毒副作用.方法:58例非小细胞肺癌患者随机分为观察组与对照组两组各29例,观察组患者采用化疗联合放疗治疗,对照组患者只采用化疗治疗.观察比较两组患者的临床疗效、1,2,3年生存率及毒副作用.结果:观察组患者的有效率(79.3％)明显高于对照组(41.4％),两组相比差异有统计学意义(P＜0.05).观察组患者1,2,3年生存率均高于对照组,两组相比差异有统计学意义(P＜0.05,P＜0.01).两组患者的Ⅱ-Ⅳ级白细胞减少率,Ⅲ-Ⅳ级血红蛋白减少率,Ⅲ-Ⅳ级消化系统反应无显著差别,两组相比差异均无统计学意义(P＞0.05).结论:相对于单纯化疗,化疗联合放疗治疗非小细胞肺癌临床效果更好,毒副作用并未加重,可以显著提高患者生存率,值得临床推广应用.     

新辅助化疗对局部晚期非小细胞肺癌患者术后生存质量的影响

目的:探讨新辅助化疗对局部晚期非小细胞肺癌患者术后生存质量的影响。方法:选取2011年5月至2012年5月于本院胸腔外科接受治疗的ⅢA~ⅢB期非小细胞肺癌患者240例并将其随机分成2组,即新辅助化疗组(A组)和单纯手术组(B组),每组120例。A组患者在临床确诊后接受2个周期的新辅助化疗,化疗结束2~3周后接受手术治疗;对照组患者临床确诊后直接行手术治疗。术后,两组患者均给予4周期常规放化疗。采用QLQ-C30量表对两组患者术前与术后第1、3、6个月的生存质量进行评估,并比较两组患者生存质量评分的差异。结果:术后1、3、6个月时,两组患者的各项功能分值均较术前显著升高(P0.05);术后第3、6个月,患者的总体健康状况得分较术前显著升高(P0.05);术后1个月时,A组患者的呼吸困难评分较术前明显增加(P0.05),术后第3个月后,该分值与术前比较无显著性差异;术后第1、3个月时,两组患者的疼痛评分均较术前明显升高(P0.05),但第6个月时,该评分与术前无显著性差异;术后第6个月时,两组患者的疲乏得分较术前明显降低(P0.05);术后第1、3、6个月时,两组患者的经济困难评分明显较术前升高(P0.05)。术后1、3、6个月时,A组患者的总体状况得分均显著高于B组(P0.05),呼吸困难评分和疲乏评分明显低于B组(P0.05),经济困难评分均显著高于B组(P0.05)。结论:新辅助化疗可以提高局部晚期非小细胞肺癌患者术后半年内的生存质量。     

Improved Flutter Ablation Outcomes Using a 10mm-tip Ablation Catheter

Introduction

Radiofrequency(RF) ablation has become the first line of therapy for atrial flutter(AFL). Advances in catheter and mapping technologies have led to better understanding and different approaches for treating this arrhythmia. We describe the results of different approaches to ablate this arrhythmia.

Materials and Methods

A cohort of 198 patients with isthmus dependent AFL. The techniques used were: 10mm-tip catheter with power set to 100w, 8mm-tip catheter with power set to 60W and irrigated tip catheter.

Results

212 procedures, including redos were done in 198 consecutive patients. We used irrigated tip catheters in 14 procedures, 8mm-tip in 55 procedures, and 10mm-tip in 143 procedures. Bidirectional block was achieved in 97.6% of cases with all techniques, with no difference among them. Procedure time was shorter in the 10mm-tip versus 8mm-tip(69.6±30.6min vs.105±43min) or irrigated tip(180±90min) (P<0.05). Fluoroscopy time was also shorter in the 10mm-tip versus 8mm-tip (24±18min vs. 37±23min) or irrigated tip (110±25min)(P<0.05). The cumulative incidence of failure during follow-up was 1.2%/year in the 10mm, 10.1%year in the 8mm and 6.9%year in the irrigated tip. The survival free of a new procedure was significantly higher among 10mm patients.

Conclusions

In our series we found a high rate of acute success with the use of different techniques for AFL ablation. Procedure and fluoroscopic times were shorter with the use of 10mm-tip as compared with the others techniques. The long-term risk of recurrence was lower when we used the 10mm-tip catheter and the survival free of a second procedure was higher among patients treated with this catheter.     

Therapeutic Efficacy of Percutaneous Radiofrequency Ablation versus Microwave Ablation for Hepatocellular Carcinoma

The aim of this study was to investigate the therapeutic efficacy of percutaneous radiofrequency (RF) ablation versus microwave (MW) ablation for hepatocellular carcinoma (HCC) measuring ≤5 cm in greatest diameter. From January 2006 to December 2006, 78 patients had undergone RF ablation whereas 77 had undergone MW ablation. Complete ablation (CA), local tumour progression (LTP) and distant recurrence (DR) were compared. The overall survival curves were calculated with the Kaplan-Meier technique and compared with the log-rank test. The CA rate was 83.4% (78/93) for RF ablation and 86.7%(91/105 for MW ablation. The LTP rate was 11.8% (11/93) for RF ablation and 10.5% (11/105) for MW ablation. DR was found in 51 (65.4%) in the RF ablation and 62 (80.5%) in the MW ablation. There was no significant difference in the 1-, 3-, and 5-year overall survival rates (P = 0.780) and the 1-, 3-, and 5-year disease-free survival rates (P = 0.123) between RF and MW ablation. At subgroup analyses, for patients with tumors ≤3.0 cm, there was no significant difference in the 1-, 3-, and 5-year overall survival rates (P = 0.067) and the corresponding disease-free survival rates(P = 0.849). For patients with tumor diameters of 3.1–5.0 cm, the 1-, 3-, and 5-year overall survival rates were 87.1%, 61.3%, and 40.1% for RF ablation and 85.4%, 36.6%, and 22% for MW ablation, with no significant difference (P = 0.068). The corresponding disease-free survival rates were 74.2%, 54.8%, and 45.2% for the RF ablation group and 53.3%, 26.8%, and 17.1% for the MW ablation group. The disease-free survival curve for the RF ablation group was significantly better than that for the MW ablation group (P = 0.018). RF ablation and MW ablation are both effective methods in treating hepatocellular carcinomas, with no significant differences in CA, LTP, DR, and overall survival.     

Epicardial Ablation on the Beating Heart: Limited Efficacy of a Novel, Cooled Radiofrequency Ablation Device

OBJECTIVE: To perform a minimally invasive procedure for atrial fibrillation without cardiopulmonary bypass, it is necessary to create transmural lesions on the beating heart. Although bipolar radiofrequency clamps can isolate the pulmonary veins, they have difficulty in performing any other left atrial lesions, particularly those of the traditional Cox-Maze procedure. This study examined the performance of an internally cooled, bipolar radiofrequency device designed for such an application. METHODS: Eleven domestic pigs underwent median sternotomy. Five animals had eight atrial lesions created with the radiofrequency device at times of 20, 30, 40, and 50 seconds. In six other pigs, the device was compared with another technology that has been used clinically for epicardial, beating heart ablation, the Guidant Flex 4 microwave device. The tissue was stained with 2,3,5-triphenyl-tetrazoluim chloride, and the lesions were sectioned at 5-mm intervals. Lesion width, depth, and transmurality were evaluated. RESULTS: The radiofrequency device had a linear dose-response relationship. Lesions were wider and deeper with increasing ablation times. A total of 40%, 45%, 60%, and 67% of lesions were transmural at times of 20, 30, 40, and 50 seconds, respectively. Ninety-one percent of lesions in tissue up to 4-mm thick were transmural after 50 seconds. However, performance in thicker tissue was poor. Lesions created by the device were deeper and more likely to be transmural than the Flex 4. CONCLUSIONS: This internally cooled, bipolar radiofrequency device can reliably create transmural lesions on tissue up to 4-mm thick and performs better than a microwave device.     

Robotic Ablation of Atrial Fibrillation

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between pulmonary vein (PV) and left atrium (LA) is created. This conduction block prevents AF, which is triggered by irregular electric activity originating from the PV. However, transmural atrial lesions are required which can be challenging. Re-conduction and AF recurrence occur in 20 - 40% of the cases. Robotic catheter systems aim to improve catheter steerability. Here, a procedure with a new remote catheter system (RCS), is presented. Objective of this article is to show feasibility of robotic AF ablation with a novel system. Materials and Methods: After interatrial trans-septal puncture is performed using a long sheath and needle under fluoroscopic guidance. The needle is removed and a guide wire is placed in the left superior PV. Then an ablation catheter is positioned in the LA, using the sheath and wire as guide to the LA. LA angiography is performed over the sheath. A circular mapping catheter is positioned via the long sheath into the LA and a three-dimensional (3-D) anatomical reconstruction of the LA is performed. The handle of the ablation catheter is positioned in the robotic arm of the Amigo system and the ablation procedure begins. During the ablation procedure, the operator manipulates the ablation catheter via the robotic arm with the use of a remote control. The ablation is performed by creating point-by-point lesions around the left and right PV ostia. Contact force is measured at the catheter tip to provide feedback of catheter-tissue contact. Conduction block is confirmed by recording the PV potentials on the circular mapping catheter and by pacing maneuvers. The operator stays out of the radiationfield during ablation. Conclusion: The novel catheter system allows ablation with high stability on low operator fluoroscopy exposure.     

Pituitary Ablation for Diabetic Retinopathy

Pituitary ablation was performed on 26 patients with advanced diabetic retinopathy by pituitary stalk section (nine patients) or transphenoidal hypophysectomy (17 patients). After a latent period varying from six to 12 months, retinal hemorrhages disappeared, vitreous hemorrhages stopped and new vessels regressed. Eight of 10 patients followed up for more than a year had a complete remission, although in one of two patients whose ablation was incomplete the retinopathy remained active. Preoperative visual acuity levels were preserved in 47 of 50 eyes of patients followed up for a mean period of 12 months. Three patients have died, two from causes related to their operation. Twenty of the survivors have continued in their usual occupation. Pituitary ablation is effective in preventing the progressive visual deterioration usually associated with advanced diabetic retinopathy.     

Epicardial Ablation For Ventricular Tachycardia

Epicardial ablation has lately become a necessary tool to approach some ventricular tachycardias in different types of cardiomyopathy. Its diffusion is now limited to a few high volume centers not because of the difficulty of the pericardial puncture but since it requires high competence not only in the VT ablation field but also in knowing and recognizing the possible complications each of which require a careful treatment.This article will review the state of the art of epicardial ablation with special attention to the procedural aspects and to the possible selection criteria of the patients.