Hemodynamic changes in hepatic cancer before and after cluster electrode radio-frequency ablation

Objective: To evaluate the hemodynamic changes of hepatic artery (HA), portal vein (PV) and tumors in hepatic cancer patients treated by cluster electrode radio-frequency ablation with the aid of color Doppler flow imaging (CDFI). Methods: The hemodynamic changes of HA, PV and 42 tumors in 30 cases of hepatic cancer were investi- gated by CDFI one week before and after cluster e- lectrode radio-frequency ablation. Results: One week after radio-frequency ablation, the velocity of HA decreased (P<0.05), but the dia- meter and velocity of PV unchanged. Before radio- frequency ablation, blood signals were observed in 35 cancer nodes (83.0 % of all 42 nodes). After radio- frequency ablation, blood signals were reduced in 15 nodes and disappeared in 14 nodes. Early investiga- tion implied that the decrease of blood supply was parallel with the reduction of node size. However, the outcome in case of huge nodes with double blood supply was not as promising as those small nodes. Conclusion: CDFI is useful to assess blood supply in ablation of hepatic cancer by using cluster electrode radio-frequency therapy.

Combination of percutaneous radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: observation of clinical effects

Objective： To observe the clinical effect of radiofrequency ablation （RFA） combined with transcatheter arterial chemoembolization （TACE） for advanced hepatocellnlar carcinoma （HCC）. Methods： A total of 92 eases of advanced primary liver cancer underwent TACE and RFA treatment from June 2005 to 2011 at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College. A total of 88 cases with complete clinical treatment and follow-up data were divided into two groups： 43 patients treated with TACE （TACE group） and 45 patients that received TACE combined with RFA treatment （TACE ＋ RFA group）. After clinical data assessment, tumor size and survival status were not significantly different between the groups as determined by stratified analysis. Results： Before and after surgery, spiral CT radiography and color comparison observed ablation conditions. The tumor necrosis rates after treatment （CR ＋ PR） were 67.4% （29/43） and 91.1% （41/45） for the TACE and combined treatment groups, respectively, and the difference was statistically significant （P〈0.05）. The quality of life was significantly improved for patients undergoing TACE ~ RFA compared with the control group. Survival duration was not significantly different in patients undergoing TACE ~ RFA compared with the control group. Conclusions： In this study, the effect of RFA combined with TACE treatment was better than TACE alone in treating advanced HCC.

Radiofrequency ablation or microwave ablation combined with transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma by comparing with radiofrequency ablation alone

Objective：To compare radiofrequency ablation （RFA） or microwave ablation （MWA） and transcatheter arterial chemoembolization （TACE） with RFA or MWA monotherapy in hepatocellular carcinoma （HCC）.Methods：A prospective,randomized,controlled trial was conducted on 94 patients with HCC ≤7 cm at a single tertiary referral center from June 2008 to June 2010 at the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Southeast University.The patients were randomly assigned into the TACERFA or TACE-MWA （combined treatment group） and the RFA-alone or MWA-alone groups （control group）.The primary end point was overall survival.The secondary end point was recurrence-free survival,and the tertiary end point was adverse effects.Results：Until the time of censor,17 patients in the TACE-RFA or TACE-MWA group had died.The median follow-up time of the patients who were still alive for the TACE-RFA or TACE-MWA group was 47.5±11.3 months （range,29 to 62 months）.The 1-,3-and 5-year overall survival for the TACE-RFA or TACE-MWA group was 93.6％,68.1％ and 61.7％,respectively.Twenty-five patients in the RFA or MWA group had died.The median follow-up time of the patients who were still alive for the RFA or MWA group was 47.0±12.9 months （range,28 to 62 months）.The 1-,3-and 5-year overall survival for the RFA or MWA group was 85.1％,59.6％ and 44.7％,respectively.The patients in the TACE-RFA or TACE-MWA group had better overall survival than the RFA or MWA group [hazard ratio （HR）,0.526; 95％ confidence interval （95％ CO,0.334-0.823; P=0.002],and showed better recurrence-free survival than the RFA or MWA group （HR,0.582; 95％ CI,0.368-0.895; P=0.008）.Conclusions：RFA or MWA combined with TACE in the treatment of HCC ≤7 cm was superior to RFA or MWA alone in improving survival by reducing arterial and portal blood flow due to TACE with iodized oil before RFA.

Role of Contrast Enhanced Ultrasound in Radiofrequency Ablation of Metastatic Liver Carcinoma

Objective： To investigate the application of contrast enhanced ultrasound （CEUS） in planning and guiding for radiofrequency ablation （RFA） for metastatic liver carcinoma （MLC）. Methods： One hundred and thirty-five patients with clinically and pathologically diagnosed MLC （from gastrointestinal tumors） were included in the present study, and 104 of them had received CEUS prior to RFA to assess the number, size, shape, infiltration, location and enhancing features of the lesions. Among the 204 patients, 21 （20.1%） were excluded from RFA treatment due to too many lesions or large infiltrative range based on CEUS. The remaining 83 patients with 147 lesions underwent RFA （group A）. During the same period, other 32 patients with 202 lesions serving as control group were treated based on findings of conventional ultrasound without contrast （group B）. The patients underwent follow-up enhanced CT at the 1st month, and then every 3-6 months after RFA. The tumor was considered as early necrosis if no contrast enhancement was detected in the treated area on the CT scan at the 2st month. Results： In group A, 72 of 147 MLC lesions （48.9%） showed increased sizes on CEUS. Among them, 48 lesions （66.6%） appeared enlarged in arterial phase, and 24 （33.3%） showed enlarged hypoechoic area in parenchymal phase. CEUS showed total 61 additional lesions in 35 patients （42.2%） （ranged from 8 to 15 mm） compared with conventional ultrasound （US）, and 42 （68.8%） of them were visualized in parenchymal phase only. There were total 208 lesions in group A underwent RFA with CEUS planning, and the tumor necrosis rate was 94.2% （196/208）. In this group, local recurrence was found in 26 lesions （7.7%） during 3-42 months＇ following up, and new metastases were seen in 30 cases （36.2%）. For group B, the tumor necrosis rate was 86.3% （88/202）, local recurrence in 27 lesions （16.7%）, and new metastases in 13 cases （41.9%）. Tumor early necrosis and recurrence rates were significantly different between the two groups （P=0.018, P=0.016, respectively）. Conclusion： CEUS played an important role in RFA for liver metastases by candidate selecting and therapy planning, which helped to improve the outcome of the treatment.

Computed tomography-guided transpulmonary radiofrequency ablation for hepatocellular carcinoma located in hepatic dome

AIM： To determine the feasibility of performing computed tomography （CT）-guided transpulmonary radiofrequency ablation （RFA） for hepatocellular carcinoma （HCC） located in the hepatic dome. METHODS： A total of seven patients with HCC comprising seven nodules located in the hepatic dome were treated from April 2004 to December 2004. CTguided transpulmonary RFA was performed using a cool-tip type electrode （Radionics Company） based on a standardized energy protocol. All tumors located in the hepatic dome were not detectable by the usual ultrasound （US） methods. The lesion diameters ranged from 15 to 27 mm. RESULTS： RFA was technically feasible in all the patients. The puncture procedure was performed twice or less and the total average performance time was 40.6 min. Local tumor control was achieved in all the patients. The necrosis diameter ranged from 25 to 35 mm. The mean follow-up period was 9.6 （7-14 mo） mo. There was no local recurrenceat the follow-up points. Pneumothorax requiring pleural drainage was the main complication, which was observed in two of the seven patients （28.6%）. However, it improved with chest drainage tube, and the tube could be removed within 2-3 d. No other major complications were observed.CONCLUSION： CT-guided puncture is useful for the treatment of tumors located in the hepatic dome which are hardly detectable by US, even though pneumothorax sometimes may occur as a complication. In the cases with adhesion in the pleura for which artificial pleural effusion methods are not appropriate, CT-guided RFA is thus considered to be an alternative treatment for HCC located in the hepatic dome.

Heat shock protein inhibitor, quercetin, as a novel adjuvant agent to improve radiofrequency ablation-induced tumor destruction and its molecular mechanism

Background： We investigated the effect of a small molecular inhibitor of heat shock protein （HSP）, qnercetin, on tumor radiofrequency （RF） ablation, and explored the underlying molecular mechanisms. Methods： In in vivo study, rats with R3230 breast adenocarcinoma were sacrificed 24 h post-treatment and gross coagulation areas were compared, and next, randomized into four treatment arms （control, quercetin alone, RF alone, and combination） for Kaplan-Meier analysis of defined endpoint survival. Then the distribution and expression levels of heat shock protein 70 （HSP70）, cleaved caspase-3 and heat shock factor 1 （HSF1） were analyzed after different treatments. In in vitro study, we used quercetin to promote SK- HEP-I （hepatic） and MCF-7 （breast） cancer cell apoptosis in heat shock cell model, and siRNA was used to block c-Jun and to explore the role of activating protein-1 （AP-1） signaling pathways. Results： We found the effects of quercetin plus RFA resulted in increase on the tumor destruction/ endpoint survival （26.5±3.4 d） in vivo, compared with RF alone （17.6±2.5 d） and quercetin alone （15.7±3.1 d）. Most importantly, quercetin-induced cancer cell death required the presence of HSF1 in animal model. Furthermore, quercetin directly down-regulated expression of HSF1 in vitro, which our findings have revealed, required the activation of AP-1 signaling pathways by loss-of-function analysis using siRNA mediated targeting of c-Jun. Conclusions： These results indicated a protective role of quercetin in tumor ablation and highlighted a novel mechanism involving HSP70 with HSF1 pathway in thermal ablation of solid tumors.

Successful initial ablation therapy contributes to survival in patients with hepatocellular carcinoma

AIM： To evaluate the outcome predictors of percutaneous ablation therapy in patients with unresectable hepatocellular carcinoma （HCC）, especially to identify whether the initial treatment response contributes to the survival of the patients. METHODS： The study cohort included 153 patients with single （102） and two or three （51） HCC nodules 5 cm or less in maximum diameter. As an initial treatment, 110 patients received radiofrequency ablation and 43 patients received percutaneous ethanol injection. RESULTS： The Kaplan-Meier estimates of overall 3- and S-year survival rates were 75% and 59%, respectively. The log-rank test revealed statistically significant differences in the overall survivals according to ChildPugh class （P = 0.0275）, tumor size （P = 0.0130）, serum albumin level （P = 0.0060）, serum protein induced by vitamin K absence or antagonist Ⅱ level （P = 0.0486）, and initial treatment response （P = 0.0130）. The independent predictors of survival were serum albumin level （dsk ratio, 3.216; 950 CI, 1.407-7.353; P = 0.0056） and initial treatment response （risk ratio, 2.474; 95% CI, 1.076-5.692; P = 0.0330） based on the Cox proportional hazards regression models. The patients had a serum albumin level 3.5 g/dL and the 3- and 5-year survival rates of 86% and 82%. CONCLUSION： In HCC patients treated with percutaneous ablation therapy, serum albumin level and initial treatment response are the independent outcome predictors.

Radiofrequency ablation as a treatment for hilar cholangiocarcinoma

AIM: To explore the role of radio-frequency ablation (RFA) as a treatment for hilar cholangiocarcinoma. METHODS: Eleven patients with obstructive cholestasis underwent Computed Tomography (CT) examination, occupying lesions were observed in the hepatic hilar region in each patient. All lesions were confirmed as cholangioadenocarcinoma by biopsy and were classified as type or by percutaneous transhepatic cholangiography. Patients were treated with multiple electrodes RFA combined with other adjuvant therapy. The survival rate, change of CT attenuation coefficient of the tumor and tumor size were studied in these patients after RFA. RESULTS: In a follow-up CT scan one month after RFA, a size reduction of about 30% was observed in six masses, and two masses were reduced by about 20% in size, three of the eleven masses remained unchanged. In a follow-up CT scan 6 mo after RFA, all the masses were reduced in size (overall 35%), in which the most significant size reduction was 60%. The survival follow-up among these eleven cases was 18 mo in average. Ongoing follow-up showed that the longest survival case was 30 mo and the shortest case was 10 mo. CONCLUSION: RFA is a microinvasive and effective treatment for hilar cholangiocarcinoma.

The current role of radiofrequency ablation in the treatment of hepatocellular carcinoma

Local ablative therapy is used in treating liver tumors by either injection of cytotoxic agents（chemicals,radioactive isotopes,hyperthermic agents or chemotherapeutic agents）or application of an energy source to achieve thermal ablation,cryoablation or conformal external beam radiation（Table 1）.

Effectiveness of Radiofrequency Ablation of Initial Recurrent Hepatocellular Carcinoma after Hepatectomy: Long-Term Results and Prognostic Factors

Background: Intrahepatic recurrence of hepatocellular carcinoma (HCC) is frequently noted in patients after hepatectomy of HCC. Recurrence HCC is usually diagnosed as small nodule ≤ 2 cm in diameter due to the frequent postoperative check up with US, dynamic CT, or dynamic EOB-MRI. Radiofrequency ablation (RFA) is recommended for these small HCCs, because RFA is minimally invasive, effective, and repeatedly performed. Purpose: To investigate the long-term outcome and prognostic factors of RFA in recurrent HCC after heaptectomy. Material and Methods: Between February 2002 and October 2011, 75 patients with initial intrahepatic recurrence of HCC after hepatectomy underwent RFA. The 57 patients were men and 18 women, whose age ranged from 44 years to 83 years (median, 69 years). Sixty-nine patients had a single nodule and 6 patients had two nodules. The size of the 81 nodules ranged 5 - 30 mm (median, 15 mm). Regular follow-up after RFA was performed to evaluate rates of local tumor progression, overall survival rates, and disease-free survival rates. Prognostic factors related to overall survivals and disease-free survivals were evaluated, too. Results: During follow-up periods after RFA (3 to 151 months, median, 55 months), local recurrence was noted in 10 nodules of 10 patients (10/81 nodules = 12.3%). The rates of local recurrence of 1-yr, 3-yr, 5-yr, and 8-yr were 7.6%, 12.0%, 12.0%, and 12.0%, respectively. During the follow-up periods, 36 patients were alive and 39 died. The cumulative overall survival rates of 1-yr, 3-yr, 5-yr, and 10-yr were 97.3%, 79.1%, 56.6%, and 32.2%, respectively. The cumulative disease-free survival rates of 1-yr, 3-yr, and 5-yr were 42.7%, 18.8%, and 12.6%, respectively. Child-Pugh Class (A or B) before RFA for a recurrent HCC was a significant prognostic predictor of overall survival rates (p = 0.007), and Child-Pugh class (A or B) before hepatectomy was that of disease-free survival rates (p = 0.004). Conclusion: RFA was an effective, useful therapeutic option for treatment of recurrent HCC after hepatectomy. Child-Pugh Class (A or B) before RFA was a significant prognostic predictor of long-term survival, and Child-Pugh class (A or B) before hepatectomy was a significant prognostic predictor of disease-free survival.

Role of catheter ablation of ventricular tachycardia associated with structural heart disease

In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the shortand long-term prognosis. Several therapeutic options can be considered for the management of this arrhythmia. Among others, catheter ablation, a closed-chest therapy, can prevent arrhythmia recurrences by abolishing the arrhythmogenic substrate. Over the last two decades, different techniques have been developed for an effective approach to both tolerated and untolerated VTs. The clinical outcome of patients undergoing ablation has been evaluated in multiple studies. This editorial gives an overview of the role, methodology, clinical outcome and innovative approaches in catheter ablation of VT.

Propensity score analyses of long-term outcomes of perivascular hepatocellular carcinoma: Radiofrequency ablation vs. surgery

To the Editor:WereadwithgreatinterestthearticlebyDr.Leeetal.[1],which compared the long-term outcomes of patients with perivascular hepatocellular carcinoma (HCC) after radiofrequency ablation(RFA) and surgical resection (SR) as first-line treatment. By using propensity score matching (PSM) analyses, the authors concluded that SR provided better long-term tumor control and overall survival than RFA for patients with small periportal tumors. Herein,

Prospective comparative study of cool-tip radiofrequency ablation and surgical resection for hepatocellular carcinoma

Objective: The aim of this study was to compare the therapeutic efficacy of radiofrequency ablation (RFA) and surgical resection for the patients with hepatocellular carcinoma (HCC). Methods: From January 2002 to June 2009, 87 HCC patients with 3 or fewer nodules, no more than 3 cm in diameter, and liver function of Child-Pugh class A or B were enrolled. Forty-seven underwent RFA while 40 underwent surgical resection. Follow-up ranged from 6 to 69 months. We compared the overall and disease-free survival rate, recurrence patterns, and the complications between the two groups. Survival prob-abilities were estimated using the Kaplan-Meier method. Results: At the end of the study, 67 patients were alive. The 1-, 2- and 3-year overall cumulative survival rates after RFA and surgical resection were 91.0%, 76.7%, 69.7% and 90.0%, 82.9%, 75.4%, respectively. The difference between the two survival curves was not statistically significant (χ2 = 0.99, P = 0.32). Forty-three patients suffered intrahepatic recurrence, including 25 cases after RFA and 18 cases after surgical resection. The 1-, 2-, and 3-year disease-free survival rates after radiofrequency ablation and surgical resection were 57.3% vs 71.1%, 40.3% vs 45.7%, and 35.3% vs 30.9%. The difference between the two groups was not statistically significant (χ2 = 0.06, P = 0.80). Cox hazard model indicated tumor size and Child-Pugh scoring were significant risk factors for local tumor progression, while tumor numbers was risk factor for intrahepatic distant recurrence. Conclusion: RFA is as effective as surgical resection for the treatment of patients with HCC (≤ 5 cm), especially for those who are not suitable for curative resection.

A clinical study on salvage hepatectomy for treating recurrent liver cancer after radiofrequency ablation

Objective We studied the efficacy of salvage hepatectomy for treating recurrent hepatic cancer after radiofrequency ablation （RFA）. Methods A retrospective analysis of 67 patients who had recurrent liver cancer after RFA treatment and received salvage hepatectomy in the Department of Hepatobiliary Surgery, Southwest Hospital, Third Mili- tary Medical University （China）, from January 2006 to January 2014, was performed. The analysis included patient gender, age, hepatitis type, alpha-fetoprotein （AFP）, and TNM stage prior to RFA and salvage hepatectomy, overall survival rates, and tumor-free survival rates after salvage hepatectomy. Results Among the 67 patients, there were 57 cases of hepatitis B, two cases of hepatitis C, and eight cases did not have hepatitis. AFP levels in patients ranged from 3 to 4521 ng/mL （median 33 ng/mL）. Before RFA, 54 cases were stage I tumors, and 13 were stage II tumors. Tumor sizes varied from 0.82 to 4.83 cm （median 3.0 cm）. In 20 cases, one RFA was performed, and for 47 cases, RFA was repeated. RFA- ablated region diameters ranged from 3.8 to 5.2 cm （median 4.5 cm）. The interval between the salvage surgical resection and RFA was 3-37 months. Before salvage hepatectomy, 23 stage I tumors, 12 stage II tumors, and 32 stage III tumors were present （size ranged 4.83-11.84 cm; median 6.3 cm）. For salvage hepatectomy, laparotomy was performed for 56 cases, and laparoscopy was performed for 28 cases. Inflow clamping was performed for 39 cases （15-45 rain）. Surgery was 219-370 rain and intraoperative blood loss was 100-2100 mL. For 13 cases, intraoperative blood transfusion was required. Tumor pathological data revealed 31,35, and 1 poorly, moderately, and well differentiated tumors, respectively. No patients died due to operative complications, and hospital stays were 8-10 days. Overall and tumor-free survival rates were 85% and 79% for 1 year, 50% and 20% for 3 years, and 39% and 19% for 5 years, respectively. Kaplan- Meier analysis and Cox regression confirmed that tumor number and size prior to salvage liver cancer were risk factors affecting survival. Conclusion Patients who received RFA to treat early-stage liver cancer with postoperative recurrent stage I tumors have satisfactory outcomes with salvage hepatectomy.

经导管肝动脉化疗栓塞(TACE)联合经皮射频消融术(RFA)治疗中晚期肝癌的疗效及预后影响因素分析

目的探讨经导管肝动脉化疗栓塞(TACE)联合经皮射频消融术(RFA)治疗中晚期肝癌的临床疗效及安全性并分析影响预后因素。方法将中晚期原发性肝癌患者128例分为肝动脉化疗栓塞组(TACE组)与肝动脉化疗栓塞联合经皮射频消融术(RFA)组(TACE+RFA组),各64例。TACE组患者行一次或多次单一肝动脉化疗治疗;TACE+RFA组在肝动脉化疗治疗结束后1~2周再行经皮射频消融术治疗。结果 TACE组与TACE+RFA组总有效率分别为68.75%(44/64)、95.31%(61/64);中位生存时间分别为13与18个月;TACE+RFA组1年生存率为73.4%(47/64),2年生存率为20.3%(13/64),而TACE组分别为56.25%(36/64)和7.81%(5/64);预后影响因素分析结果显示肿瘤数量、分期、直径、血清甲胎蛋白水平等与患者预后有相关性。结论经导管肝动脉化疗栓塞(TACE)联合经皮射频消融术(RFA)治疗原发性中晚期肝癌可以有效提高患者生存率,延长患者的生存期,其肿瘤数量、分期、直径等4项指标是影响患者预后的危险因素。

静脉腔内热消融术治疗下肢静脉曲张研究进展

下肢静脉曲张在静脉系统疾病中的发病率较高,手术治疗是下肢静脉曲张的主要治疗方式。随着医学技术的进步和微创理念的发展,静脉腔内热消融术(EVTA)以其创伤小、术后恢复快、并发症发生率低、闭合率高等特点,成为下肢静脉曲张治疗指南中的首选推荐术式。EVTA主要包括腔内射频消融术(RFA)、腔内激光消融术(EVLA)和腔内微波消融术(EMA),通过不同的热消融设备施加热量于目标血管,以热能破坏血管内皮细胞和管壁胶原纤维,使管腔收缩形成纤维条索,从而达到闭合目标血管的目的。不同的EVTA术式作用机制、治疗效果以及并发症发生率不同,在应用范围上也有所区别。综述EVTA常见术式及近5年的临床应用,为合理选择热消融术式及设备提供参考,为预防热损伤并发症提供帮助。

Radiofrequency ablation versus microwave ablation for colorectal liver metastases:long-term results of a retrospective cohort surgical experience

Background:Ablation is an alternative treatment modality for selected patients with colorectal liver metastases(CRLMs).Although initially widely performed via radiofrequency ablation(RFA),more recently,microwave ablation(MWA)is being preferred due to its perceived superiority in creating the ablation zones.The aim of this study is to compare the long-term efficacy of these two modalities performed surgically.Methods:Patients undergoing surgical liver ablation from 2005-2023 at a tertiary center by a single surgeon for CRLM were included in a retrospective institutional review board-approved study.Outcomes were compared using Wilcoxon,Chi-square,Kaplan-Meier,and Cox multivariate regression analyses.Continuous data are presented as median(interquartile range).Results:There were a total of 242 patients.Laparoscopic RFA was done in 121 patients with 303 lesions and laparoscopic MWA in 121 patients with 300 lesions.There was no difference between the groups regarding operative time(161 vs.147 minutes,respectively,P=0.4),perioperative morbidity(3%vs.8%,respectively,P=0.2)or hospital stay(1 vs.1 day,P=0.05).Local recurrence(LR)per lesion with at least 1 year of imaging follow-up was 29%in the RFA and 13%in the MWA group(P<0.001).Based on univariate survival analysis,tumor size,blood vessel proximity,ablation margin,and ablation modality were independent predictors of LR.To control these variables,direct matching was performed.Each cohort included 189 lesions.Kaplan-Meier analysis of these cohorts showed increased LR-free survival in the MWA group vs.the RFA group(P=0.005).Conclusions:This large study confirms our initial observation that local tumor control rate is better after MWA vs.RFA.

TACE联合射频消融对复发性肝癌患者生存期的影响

目的探究经导管动脉化疗栓塞(TACE)和射频消融(RFA)对复发性肝癌患者生存期的影响。方法本研究选取2018年5月至2021年5月间,本院收治的复发性肝癌患者80例作为研究对象。所有患者均经病理学确诊为肝癌,且至少接受过一次手术治疗后复发。根据治疗方法的不同,将患者分为对照组和观察组两组。对照组35例患者仅予RFA治疗,而观察组45例患者则接受TACE联合RFA治疗。通过对比分析两组患者术后3年内的无瘤生存率、总生存率和并发症发生率。结果比较术后1年内患者的无瘤生存率和总生存率观察组与对照组差异不显著。术后2、3年内患者的无瘤生存率和总生存率观察组显著高于对照组(P<0.05)。多因素logistic多元回归分析结果发现,复发至手术时间短、TACE联合RFA治疗是影响复发性肝癌患者3年内总生存率的重要因素。结论TACE联合RFA治疗对复发性肝癌患者的生存期具有显著的影响,该方法能够提高患者的无瘤生存率和总生存率,值得在临床上进一步推广和应用。

射频消融术(RFA)治疗继发性甲状旁腺功能亢进(SHPT)的安全性及有效性分析

目的探讨超声引导下射频消融术治疗慢性肾脏病(chronic kidney disease,CKD)继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的安全性及有效性。方法选取复旦大学附属中山医院2017年10月至2018年9月确诊为SHPT并进行超声引导下射频消融术(radiofrequency ablatio,RFA)的患者15例,共15枚甲状旁腺增生结节,以超声造影作为测量消融术前后甲状旁腺结节大小的标准方法。对比消融术前后甲状旁腺结节大小、甲状旁腺激素(parathyroid hormone,PTH)、血钙(Ca)、血磷(P)、碱性磷酸酶(alkaline phosphatase,ALP)、活性维生素D[1,25-(OH)2D]、临床症状(骨痛、皮肤瘙痒、失眠、手抖)及并发症情况。结果与消融术前比较,患者术后1、3和6个月甲状旁腺结节明显变小(P<0.05),结节缩小率分别为66%、93%和98%,术后1天、1、3和6个月血清PTH、Ca、P、ALP水平明显下降(P<0.05),活性维生素D水平无明显改变,患者的临床症状明显好转。并发症声音嘶哑的发生率为6.7%,低钙血症的发生率6.7%,治疗后均恢复,且未再复发,无其他并发症。结论超声引导下经皮RFA治疗SHPT安全有效,能明显改善患者症状,且并发症较少。

CT引导下射频消融(RFA)治疗晚期胰腺癌

目的评价CT引导下Habib EUS射频消融(radiofrequency ablation,RFA)治疗晚期胰腺癌的可行性和安全性。方法纳入2016年5月至2019年1月于复旦大学附属中山医院介入治疗科接受CT引导下RFA治疗的晚期胰腺癌患者。本次治疗中使用直径1Fr的Habib EUS RFA针。主要观察指标是Habib EUS RFA针治疗晚期胰腺癌的技术成功率及相关并发症,次要观察指标是Habib EUS RFA的治疗效果。结果所有入组的6例患者均在CT引导下成功实施了RFA。所有患者接受治疗期间及术后均无严重的治疗相关不良事件(如急性胰腺炎、出血,胰瘘等)发生。2例患者出现RFA后轻度自限性腹痛;1例患者出现消融术后淀粉酶水平一过性升高。术后1个月影像学随访,Habib EUS RFA在晚期胰腺癌病灶中形成低密度坏死区。结论CT引导的Habib EUS RFA可用于晚期胰腺癌的治疗。