Uterine artery embolization combined with percutaneous microwave ablation for the treatment of prolapsed uterine submucosal leiomyoma:A case report

BACKGROUND Vaginal myomectomy is the most common form of radical treatment for prolapsed submucosal leiomyoma and is typically performed under general anesthesia.However,an alternative treatment approach is needed for patients who cannot tolerate general anesthesia.We describe a case with such a patient who was successfully treated via a minimally invasive method under local anesthesia.CASE SUMMARY A 46-year-old female suffered from abnormal uterine bleeding,severe anemia,and a reduced quality of life attributed to a massive prolapsed submucosal leiomyoma.She could not tolerate general anesthesia due to a congenital thoracic malformation and cardiopulmonary insufficiency.A new individualized combined treatment,consisting uterine artery embolization(UAE),percutaneous microwave ablation(PMWA)of the pedicle and the endometrium,and transvaginal removal of the leiomyoma by twisting,was performed.The lesion was completely removed successfully under local anesthesia without any major complications.The postoperative follow-up showed complete symptom relief and a significant improvement in the quality of life.CONCLUSION UAE combined with PMWA can be performed under local anesthesia and is a promising alternative treatment for patients who cannot tolerate general anesthesia.

Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma

Hepatocellular cancer ranks fifth among cancers and is related to chronic viral hepatitis, alcohol abuse,steatohepatitis and liver autoimmunity. Surgical resection and orthotopic liver transplantation have curative potential, but fewer than 20% of patients are suitable candidates. Interventional treatments are offered to the vast majority of patients. Radiofrequency(RFA) and microwave ablation(MWA) are among the therapeutic modalities, with similar indications which include the presence of up to three lesions, smaller than 3 cm in size, and the absence of extrahepatic disease. The therapeutic effect of both methods relies on thermal injury, but MWA uses an electromagnetic field as opposed to electrical current used in RFA. Unlike MWA, the effect of RFA is partially limited by the heat-sink effect and increased impedance of the ablated tissue. Compared with RFA, MWA attains a more predictable ablation zone, permits simultaneous treatment of multiple lesions, and achieves larger coagulation volumes in a shorter procedural time. Major complications of both methods are comparable and infrequent(approximately 2%-3%), and they include haemorrhage, infection/abscess, visceral organ injury, liver failure, and pneumothorax. RFA may incur the additional complication of skin burns. Nevertheless, there is no compelling evidence for differences in clinical outcomes, including local recurrence rates and survival.

Safety and efficacy of microwave ablation for periductal hepatocellular carcinoma with intraductal cooling of the central bile ducts through a percutaneous transhepatic cholangial drainage tube

Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies have demonstrated that intraductal cooling of the biliary tract with chilled saline during thermal ablation can successfully prevent these complications.In this study,we present a novel bile duct cooling technique through a percutaneous transhepatic cholangial drainage(PTCD)tube for preventing biliary thermal injury caused by MWA,and compare the feasibility and safety of the intraductal cooling technique when performed with a PTCD tube and with an endoscopic nasobiliary drainage(ENBD)tube.Methods:Participants were randomly assigned to undergo MWA of HCC with intraductal chilled saline perfusion through a PTCD tube or an ENBD tube.The main study outcomes were bile duct complications related to MWA and local tumor recurrence,p value<0.05 was considered to indicate a statistically significant difference.Results:A total of 23 patients with an HCC(23 nodules)close to a central bile duct were enrolled in this study.Of these patients,12 had a PTCD tube and 11 had an ENBD tube placed into the hepatic duct close to the lesions.There were no PTCD-and ENBD-related mortality cases.There was no complication related to the PTCD procedure;however,3 patients(27.27%)developed acute pancreatitis and 1 patient(9.09%)had hemorrhage in the ENBD group(p=0.037).One patient(8.33%)in the PTCD group had bile leakage and 2 patients(18.18%)in the ENBD group developed a biloma.Within 5 years,1 patient in the PTCD group and 2 patients in the ENBD group had local recurrence.There was no significant difference in local recurrence,nonlocal hepatic recurrence,mortality rate,or median cumulative overall survival between the 2 groups.Conclusions:The intraductal cooling technique using a PTCD tube is a feasible and effective method for preventing bile duct thermal injury caused by MWA for an HCC close to the central bile ducts.It does not increase local recurrence and may be safer than intraductal cooling through an ENBD tube.

Ultrasound-guided percutaneous microwave ablationfor small liver cancers adjacent to large vessels：long-term outcomes and strategies

Objective The aim of the study was to evaluate the long-term efficacy and safety of percutaneous microwave ablation(MWA) for small hepatic cancers adjacent to large vessels and to investigate the treatment strategies.Methods From March 2009 to July 2015,a total of 86 patients with 94 tumors underwent ultrasound(US)-guided percutaneous MWA,with pathologically proven or clinically diagnosed liver cancers measuring ≤ 3 cm in diameter and located ≤ 10 mm from a major vessel(n = 94).Regular follow-up after MWA was performed to assess treatment efficacy and perioperative complications.Results The complete ablation rate at 1 month after MWA was 93.3%(84/90).The 6-,9-,12-,24-,36-,48-,60-,72-,and 84-month local recurrence rates were 2.4%,2.4%,3.7%,6.6%,8.4%,8.4%,8.4%,8.4%,and 8.4%,respectively.There were no major complications.The perioperative special complication rate was 5.32%(5/94),including 3 cases of moderate liver function damage and 2 cases of limited sub-capsular hematoma.Conclusion Percutaneous MWA for small hepatic cancers adjacent to large vessels is feasible,effective,and safe with an acceptable rate of complications.The key point is to strictly follow operative indications and adopt proper treatment strategies.

Past,present,and future perspectives of ultrasound-guided ablation of liver tumors:Where could artificial intelligence lead interventional oncology?

The first ablation procedures for small hepatocellular carcinomas were percutaneous ethanol injection under ultrasound(US)guidance.Later,radiofrequency ablation was shown to achieve larger coagulation areas than percutaneous ethanol injection and became the most used ablation technique worldwide.In the past decade,microwave ablation systems have achieved larger ablation areas than radiofrequency ablation,suggesting that the 3-cm barrier could be broken in the treatment of liver tumors.Likewise,US techniques to guide percutaneous ablation have seen important progress.Contrast-enhanced US(CEUS)can define and target the tumor better than US and can assess the size of the ablation area after the procedure,which allows immediate retreatment of the residual tumor foci.Furthermore,fusion imaging fuses real-time US images with computed tomography or magnetic resonance imaging with significant improvements in detecting and targeting lesions with low conspicuity on CEUS.Recently,software powered by artificial intelligence has been developed to allow three-dimensional segmentation and reconstruction of the anatomical structures,aiding in procedure planning,assessing ablation completeness,and targeting the residual viable foci with greater precision than CEUS.Hopefully,this could lead to the ablation of tumors up to 5-7 cm in size.

Microwave ablation of hepatocellular carcinoma

Although surgical resection is still the optimal treatment option for early-stage hepatocellular carcinoma(HCC) in patients with well compensated cirrhosis,thermal ablation techniques provide a valid nonsurgical treatment alternative,thanks to their minimal invasiveness,excellent tolerability and safety profile,proven efficacy in local disease control,virtually unlimited repeatability and cost-effectiveness.Different energy sources are currently employed in clinics as physical agents for percutaneous or intra-surgical thermal ablation of HCC nodules.Among them,radiofrequency(RF) currents are the most used,while microwave ablations(MWA) are becoming increasingly popular.Starting from the 90s',RF ablation(RFA) rapidly became the standard of care in ablation,especially in the treatment of small HCC nodules;however,RFA exhibits substantial performance limitations in the treatment of large lesions and/or tumors located near major heat sinks.MWA,first introduced in the Far Eastern clinical practice in the 80s',showing promising results but also severe limitations in the controllability of the emitted field and in the high amount of power employed for the ablation of large tumors,resulting in a poor coagulative performance and a relatively high complication rate,nowadays shows better results both in terms of treatment controllability and of overall coagulative performance,thanks to the improvement of technology.In this review we provide an extensive and detailed overview of the key physical and technical aspects of MWA and of the currently available systems,and we want to discuss the most relevant published data on MWA treatments of HCC nodules in regard to clinical results and to the type and rate of complications,both in absolute terms and in comparison with RFA.

Percutaneous ablation of pancreatic cancer

Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of nonresectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques(radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review.

Evaluation of short-and medium-term efficacy and complications of ultrasound-guided ablation for small liver cancer

BACKGROUND To ensure clinical efficacy and prolong patient survival,treatments such as surgery and microwave ablation(MWA)are used for early liver cancer.MWA is preferred because it effectively preserves the normal liver tissue and causes transient coagulation necrosis of local liver tumor cells.However,due to technical limitations,the cancerous liver tissue cannot be completely ablated;therefore,the probability of local tumor recurrence is high.AIM To investigate the clinical efficacy and safety of ultrasound-guided percutaneous MWA in the treatment of small liver cancer.METHODS A total of 118 patients treated for small liver cancer in The Central Hospital of Yongzhou from January 2018 to April 2019 were selected.Sixty-six patients received ultrasound-guided percutaneous MWA(MWA group)and 52 received laparoscopic surgery(laparoscope group).The operation time,blood loss,hospital stay,and medical expenses of both groups were statistically analyzed.Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin(ALB),alpha fetal protein(AFP),carcinoembryonic antigen(CEA),and peripheral blood regulatory T lymphocytes(Treg)levels were evaluated pre-and post-operatively.The cross-sectional area of tumors measured before and after ablation was analyzed statistically;the therapeutic effect was compared between both groups in terms of surgical complications,2-year progression-free survival rate,and overall survival rate.RESULTS The operation time,blood loss,hospital stay,and medical expenses in the MWA group were lower than those of the laparoscope group,and the differences were significant(P<0.05);these parameters,and ALT,AST,TBIL,and ALB levels were compared preoperatively between both groups,and there was no significance(P>0.05).The operation time,blood loss,hospital stay,and medical expenses for 2 d and 1 wk after surgery,the ALT and AST of the MWA group were lower than those of the laparoscope group,and the difference was significant(P<0.05).The operation time,blood loss,hospital stay,and medical expenses,and serum AFP,CEA,and Treg levels were measured preoperatively and 4 and 8 wk postoperatively,and there were no significant differences between the two groups(P>0.05).Compared with preoperative levels,serum AFP,CEA,and Treg levels in both groups were decreased(P<0.05).The lesion in the MWA group had a maximum area of 4.86±0.90 cm2,1.24±0.57 cm2,and 0.31±0.11 cm2 preoperatively,1 and 3 mo postoperatively,respectively.Fifty-eight of them achieved complete response and eight achieved a partial response.After 2 years of followup,the progression-free and overall survival rates in the MWA group were 37.88%and 66.67%,respectively,compared with 44.23%and 76.92%in the laparoscope group,with no significant difference(P>0.05).CONCLUSION The effects of ultrasound-guided percutaneous MWA in the treatment of small liver cancer are similar to those of laparoscopic surgery.However,ablation causes less trauma and liver dysfunction.

Ⅰ期非小细胞肺癌微波消融术与胸腔镜下肺段切除术疗效分析

目的:探讨CT引导下微波消融术(MWA)与胸腔镜下肺段切除术对治疗Ⅰ期非小细胞肺癌(NSCLC)的效果比较。方法:选取2020年1月—2021年1月青岛市第八人民医院就诊的62例Ⅰ期NSCLC患者作为研究对象,根据治疗方案的不同将患者分为消融组(CT引导下经皮MWA)30例和胸腔镜组(胸腔镜下肺段切除术)32例,比较两组患者的短期疗效、手术时间、术中出血量、住院时间、住院费用,术后并发症发生率以及随访术后1年的肿瘤复发数,进行病例对照研究。结果:两组患者均顺利完成手术,消融组手术时间、术中出血量、住院时间、住院花费低于胸腔镜组,差异有统计学意义(t=9.305、10.843、11.843、21.065,P<0.05);消融组有1例出现了肺肿瘤复发,胸腔镜组未见肺肿瘤复发病例。结论:在严格筛选手术适应证的前提下,Ⅰ期NSCLC MWA与胸腔镜下肺段切除术相比,具有创伤小、恢复快、费用低、住院时间短等优点,综合治疗效果明显优于胸腔镜下肺段切除术。

超声引导下微波介入治疗Ⅲ~Ⅳ期原发性肝癌疗效及病灶无进展生存时间分析

目的:分析超声引导下微波介入治疗Ⅲ~Ⅳ期原发性肝癌(PLC)疗效及病灶无进展生存时间。方法:随机选择医院2020年8月至2021年8月诊治的122例Ⅲ~Ⅳ期PLC患者,根据入院顺序不同分为对照组60例和观察组62例。对照组接受经肝动脉的化疗栓塞相关治疗,观察组实施超声引导下微波介入治疗。比较两组血清肿瘤标志物水平、临床疗效、病灶无进展生存时间、生活质量、并发症及不良反应。结果:治疗后,两组癌胚抗原(CEA)、甲胎蛋白(AFP)水平较治疗前下降,且观察组低于对照组(P<0.05);两组治疗后天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)、碱性磷酸酯酶(ALP)和总胆红素(TBil)均低于治疗前,直接胆红素(DBil)高于治疗前,差异有统计学意义(P<0.05),但两组治疗后数据对比,差异无统计学意义(P>0.05);两组治疗后视觉模拟法评分(VAS)较治疗前下降,且观察组低于对照组(P<0.05);观察组完全缓解率高于对照组(P<0.05),局部残留率和转移复发率低于对照组(P<0.05);观察组病灶无进展生存时间长于对照组(P<0.05);两组治疗后生活质量评分上升,且观察组高于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05),不良反应发生率低于对照组(P<0.05)。结论:超声引导下微波介入治疗Ⅲ~Ⅳ期PLC能明显提升疗效,延长病灶无进展生存时间,改善其日常的生活质量。

超声引导经皮微波消融对不同性质乳腺结节的疗效观察

目的探讨超声引导下经皮微波消融(percutaneous microwave coagulation therapy,PMCT)治疗不同性质乳腺多发良性结节的疗效。方法回顾性研究2018年4月至2020年4月收治的294例乳腺多发良性结节患者的临床资料。记录经治结节,包括1278个(74.60%)实性结节、340个(19.85%)囊性结节、95个(5.55%)混合性结节的灭活情况、体积变化、消融时间、消融功率、美观效果、并发症及患者满意度。评估超声引导下PMCT治疗不同性质乳腺多发良性结节的安全性、有效性及满意度。结果3种不同类型结节在PMCT术后1、3、6、12、18、24个月的VVR差异均有统计学意义(P<0.05),囊性结节的VVR均高于混合性结节和实性结节(P<0.05)。患者整体满意度为100%。结论PMCT治疗乳腺多发良性结节具有安全有效、精准微创、美观的特点,对囊性结节临床效果更佳,患者满意度高,值得临床推广应用。

肝动脉化疗栓塞术联合CT引导下经皮微波消融术对特殊部位原发性肝癌患者的疗效分析

目的:研究肝动脉化疗栓塞术联合CT引导下经皮微波消融术对特殊部位原发性肝癌患者的疗效。方法:选取2018年1月—2020年4月蚌埠医学院第一附属医院收治的60例特殊部位原发性肝癌患者,依据抽签法将其随机分为对照组及研究组,各30例。对照组行肝动脉栓塞化疗,研究组在对照组的基础行CT引导下经皮微波消融术。观察两组的临床有效率及2年生存率、血清指标、肝功能。结果:研究组的临床有效率、2年生存率均高于对照组,差异有统计学意义(P<0.05)。治疗后,研究组的甲胎蛋白(AFP)、癌胚抗原(CEA)、血管内皮生长因子(VEGF)、谷丙转氨酶(ALT)、结合胆红素(DBIL)、总胆红素(TBIL)水平均低于对照组,差异有统计学意义(P<0.05)。结论:肝动脉化疗栓塞术联合CT引导下经皮微波消融术疗效较好,可改善特殊部位原发性肝癌患者的血清指标,促进肝功能恢复,提高其生存率。

微波消融联合骨成形术治疗扁骨骨转移瘤的临床疗效

目的评估微波消融联合骨成形术治疗扁骨骨转移瘤的安全性、有效性。方法收集2017年1月至2021年1月中山市人民医院采用微波消融联合骨成形术治疗顽固性疼痛的扁骨骨转移瘤16例,治疗前后定期评价疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数问卷表(ODI)、生活质量评价表(QOL)的变化及观察术后并发症。结果16例患者均手术成功,无严重术后并发症发生。术前、术后1 d、1周、1个月、3个月VAS评分分别为(7.4±0.9)、(7.3±0.9)、(2.0±0.9)、(1.3±0.8)、(1.6±0.5)分,ODI评分分别为(44.1±3.1)、(43.4±2.9)、(17.8±6.1)、(15.8±4.9)、(17.6±5.0)分;术前、术后1周、1个月、3个月QOL评分分别为(25.4±3.5)、(37.1±3.4)、(38.3±4.4)、(37.8±5.3)分。术后1周、1个月、3个月患者VAS评分(F=188.33,P<0.01)、ODI评分(F=114.86,P<0.01)均有下降,QOL评分在术后1周、1个月、3个月上升(F=31.51,P<0.01)。6例患者在术后3个月随访中术区局部出现肿瘤进展。结论微波消融联合骨成形术治疗扁骨骨转移瘤安全有效,可显著缓解患者疼痛,提高生活质量。

经皮微波消融术和腹腔镜肝癌切除术治疗小肝癌的临床效果

目的:探析经皮微波消融术和腹腔镜肝癌切除术治疗小肝癌的临床效果。方法:采用回顾性分析,将龙岩市第二医院肝胆外科2021年3月-2023年1月医治的84例小肝癌患者作为研究对象,按治疗方法分对照组和试验组,每组42例。对照组采用腹腔镜肝癌切除术,试验组采用经皮微波消融术。对比两组肝功能指标水平变化、手术指标、术后住院时间及术后并发症总发生率。结果:术后1个月,试验组丙氨酸氨基转移酶、血清总胆红素、天门冬氨酸氨基转移酶均低于对照组,白蛋白高于对照组,差异均有统计学意义(P<0.05);试验组的术中出血量少于对照组,手术时间短于对照组,差异均有统计学意义(P<0.05);试验组术后住院时间(4.89±1.67)d,短于对照组(8.79±3.45)d,差异有统计学意义(P<0.05);试验组术后并发症总发生率(2.38%)低于对照组(21.43%),差异有统计学意义(P<0.05)。结论:经皮微波消融术治疗小肝癌有较好的临床效果,可以有效降低并发症的发生率,缩短手术时间及住院时间,促进患者康复。

超声引导微波消融治疗慢性肾脏病继发甲状旁腺功能亢进的临床效果

目的探讨超声引导下经皮微波消融治疗慢性肾脏病(chronic kidney disease,CKD)继发甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的临床效果。方法将2019年1月—2022年8月在梅州市人民医院治疗的90例CKD患者SHPT根据不同治疗方法进行分组,观察组(n=62)使用超声引导下经皮微波消融术,对照组(n=28)使用甲状旁腺切除术。对比两组的临床疗效、血全段甲状旁腺激素(intact parathyroid hormone,iPTH)及钙磷指标、症状评分、并发症。结果两组手术成功率均为100%,观察组复发3例(4.84%),对照组复发1例(3.57%),差异无统计学意义(P>0.05);两组术后1 d、1周、1、3、6个月的iPTH、钙、磷均低于术前,术后1、3、6个月的碱性磷酸酶(alkaline phosphatase,ALP)低于术前(P<0.05),观察组iPTH高于对照组,ALP低于对照组,术后3、6个月钙水平高于对照组,术后1个周、1个月、3个月磷水平低于对照组(P<0.05);观察组术后1、3、6个月的皮肤瘙痒、乏力、骨痛等症状评分均低于对照组(P<0.05);观察组感染、声音嘶哑、甲状旁腺损伤、严重低血钙等并发症总发生率明显低于对照组(P<0.05)。结论超声引导下经皮微波消融在治疗CKD患者SHPT的应用效果显著,创伤小,手术成功率高,并发症及复发率低,能有效降低iPTH,改善钙磷代谢,缓解临床症状。

超声引导下经皮穿刺微波消融、经导管动脉化疗栓塞治疗原发性肝癌的临床疗效比较

目的比较超声引导下经皮穿刺微波消融、经导管动脉化疗栓塞治疗原发性肝癌的临床疗效。方法根据治疗方法的不同将92例原发性肝癌患者分为对照组(n=45,经导管动脉化疗栓塞)和观察组(n=47,超声引导下经皮穿刺微波消融)。比较两组患者的临床疗效、肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)]、并发症发生情况及生存情况。结果观察组患者的总有效率为76.60%,高于对照组患者的55.56%,差异有统计学意义(P<0.05)。治疗后,两组患者的ALT、AST水平均高于本组治疗前,观察组患者的ALT、AST水平均低于对照组,差异均有统计学意义(P<0.05)。两组患者的并发症总发生率比较,差异无统计学意义(P﹥0.05)。治疗后6个月、1年,观察组患者的生存率均高于对照组,差异均有统计学意义(P<0.05)。结论与经导管动脉化疗栓塞相比,超声引导下经皮穿刺微波消融治疗原发性肝癌患者能够提高治疗效果和生存率,减轻肝功能损伤,且未增加并发症发生率。

冰敷减轻甲状腺结节经皮微波消融术后疼痛的临床研究

目的 探析冰敷减轻甲状腺结节经皮微波消融术后疼痛的效果。方法 择取经皮微波消融术治疗的60例甲状腺结节患者作为观察对象,分为普通组和研究组,各30例。2组分别采用不同干预方法,对比2组的疼痛干预效果、疼痛评分及住院时长。结果 研究组的疼痛干预效果要优于普通组,且疼痛消失时间及住院时长要短于普通组,差异有统计学意义(P<0.05)。2组治疗前的疼痛评分差异不大(P>0.05),治疗后,普通组的疼痛评分要高于研究组,差异有统计学意义(P<0.05)。结论 冰敷减轻甲状腺结节经皮微波消融术后疼痛的效果较佳,可降低患者疼痛感,减短患者术后疼痛时间,缩短住院时长,具有较高的应用价值。

超声引导下经皮微波消融术治疗小肝癌的疗效及安全性

目的 探讨超声引导下经皮微波消融术治疗小肝癌的疗效及安全性。方法 根据治疗方式的不同将60例小肝癌患者分为对照组和观察组,每组30例,对照组患者予以手术切除治疗,观察组患者予以超声引导下经皮微波消融术治疗。比较两组患者的手术相关指标、免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)水平及CD4^(+)/CD8^(+))、肝功能指标[白蛋白(ALB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)]、并发症发生情况及生存情况。结果观察组患者的手术时间明显短于对照组,术中出血量明显少于对照组,差异均有统计学意义(P﹤0.01)。术后,两组患者CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)均低于本组术前,CD8^(+)水平均高于本组术前,观察组患者CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)均高于对照组,CD8^(+)水平低于对照组,差异均有统计学意义(P﹤0.05)。术后,两组患者ALB水平均高于本组术前,ALT、AST水平均低于本组术前,观察组患者ALB水平高于对照组,ALT、AST水平均低于对照组,差异均有统计学意义(P﹤0.05)。观察组患者的术后并发症总发生率低于对照组(P﹤0.05)。术后6、12个月,两组患者的生存率比较,差异均无统计学意义(P﹥0.05)。结论 超声引导下经皮微波消融术治疗小肝癌可缩短手术时间,减少术中出血量,降低免疫抑制,促进肝功能恢复,安全性较高,且与手术切除治疗的远期疗效相当,临床应用价值较高。

超声引导下经皮微波消融治疗对原发性肝癌患者肝功能、血管内皮功能和免疫功能的影响

目的 探讨超声引导下经皮微波消融治疗对原发性肝癌患者肝功能、血管内皮功能和免疫功能的影响。方法 依据治疗方式的不同将80例原发性肝癌患者分为微波消融组和射频消融组,每组40例,微波消融组患者给予超声引导下经皮微波消融治疗,射频消融组患者给予超声引导下射频消融治疗。比较两组患者肝功能指标[总胆红素(TBIL)、天冬氨酸转氨酶(AST)和丙氨酸转氨酶(ALT)]、血管内皮功能指标[血管内皮生长因子(VEGF)、甲胎蛋白(AFP)]、T淋巴细胞亚群(CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+))水平及并发症发生情况。结果 手术后,两组患者血清TBIL、AST、ALT、VEGF、AFP水平均低于本组手术前,微波消融组患者血清TBIL、AST、ALT、VEGF、AFP水平均低于射频消融组,差异均有统计学意义(P﹤0.05)。手术后,两组患者CD3^(+)、CD4^(+)水平和CD4^(+)/CD8^(+)均高于本组手术前,且微波消融组患者CD3^(+)、CD4^(+)水平和CD4^(+)/CD8^(+)均高于射频消融组,差异均有统计学意义(P﹤0.05)。微波消融组患者并发症总发生率为10.00%,与射频消融组患者的22.50%比较,差异无统计学意义(P﹥0.05)。结论 超声引导下经皮微波消融治疗对原发性肝癌患者的疗效显著,可显著改善患者的肝功能和血管内皮功能,提高机体免疫力。

微波消融联合经皮骨成形术在椎外溶骨性转移瘤中的应用

目的观察CT引导下微波消融(MWA)联合经皮骨成形术(POP)治疗椎体外溶骨性转移瘤的疗效与安全性。方法回顾性分析接受MWA联合POP治疗18例椎体外溶骨性转移瘤患者的临床资料。采用疼痛视觉模拟量表(visual analogue scale,VAS)、国际肌肉骨骼肿瘤学会(musculo-skeletal tumor society system,MSTS)评分、骨转移患者生活质量特异性量表(QLQ-BM22)评估患者手术前后疼痛程度、肢体功能状态和生活质量;记录手术成功率和术中、术后并发症情况,并对随访期间患者局部肿瘤控制状况和生存期进行统计分析。结果18例患者的MWA联合POP手术均成功。术中4例患者出现少量骨水泥渗漏,均无明显症状。手术前后VAS评分总体差异有统计学意义(F=41.74,P<0.01);术后各时间点VAS评分均低于术前(均P<0.01),而术后各时间点间差异均无统计学意义(均P>0.05)。手术前后MSTS评分总体差异有统计学意义(F=12.40,P<0.01);术后各时间点MSTS评分均高于术前(均P<0.01),而术后各时间点间差异均无统计学意义(均P>0.05)。手术前后QLQ-BM22评分总体差异有统计学意义(F=16.26,P<0.01);术后各时间点QLQ-BM22评分均低于术前(均P<0.01),而术后各时间点间差异均无统计学意义(均P>0.05)。术后随访3~28个月,生存时间为(9.14±7.94)个月。随访期间死亡7例,6例术后1年内死亡,1例术后26个月死亡。3例患者分别于术后8、15、16个月肿瘤复发,平均复发时间为13个月。结论CT引导下MWA联合经皮骨成形术治疗椎体外溶骨性转移瘤并发症少,安全可行,能有效缓解疼痛,改善患者肢体功能,提高患者运动能力和生活质量,术后局部肿瘤复发率低且复发周期较长。