CT导引下腰_5骶_1脱出型椎间盘的胶原酶溶解术

目的 探讨腰_5骶_1脱出型椎间盘胶原酶溶解术的方法及其疗效。材料与方法 采用CT导引,经棘突旁、黄韧带、硬膜外间隙入路直接穿刺椎间盘髓核脱出部位,用1200单位胶原酶溶解脱出髓核。采用本方法治疗68例经临床确诊的腰_5骶_1脱出型椎间盘病人,取得了良好的治疗效果。结果 68例病人用本方法治疗,治愈率为51.5％(35例),有效率为92.6％(63例),无严重并发症发生。结论 经CT导引硬膜外间隙入路直接穿刺脱出的髓核组织行胶原酶溶解术是一种安全、简便、疗效确切的方法,值得推广应用。

The kinematics modeling based on Spinor theory for CT-guided hybrid robot

This paper focused on a simplified method for solving the hybrid robot kinematics in CT-guided （computerized tomography, CT） surgery. By position constraint introduced, the hybrid robot can be transformed as a redundant serial 7-DOF robot. The forward displacement calculation was developed based on the product-of-exponential formula （POE）. Because of the kinematics complexity of the hybrid and redundant robot, the combination technique of Ulrich two-step iteration method and paul variables detachment method （UTI-PVD） was introduced to fulfill the inverse kinematics of redundant robot, the novelty of which lay in the flexibility of various robots structures and in high calculation efficiency for realtime control. The process of solving the inverse displacement was analyzed. The UTI-PVD method can be applicable to kinematics of many robots, especially for redundant robots with more than 6DOF. The kinematics simulation was provided, and robot dexterity analysis was presented. The results indicated that the hybrid robot could implement the minimally invasive CT-guided surgery.

COMPARISON OF CT-GUIDED LESS INVASIVE SURGERIES WITH WIDE SURGICAL EXCISION IN TREATMENT OF OSTEOID OSTEOMAS

Objective To report the results of treatment of osteoid osteomas with wide surgical excision and CT-guided less invasive surgeries.Methods Forty-two patients were entered into this prospective study between Jan.1998 and Jan.2008.Nineteen patients underwent wide surgical excision.The lesions were in the femur(n=9),tibia(n=7),and humerus(n=3).The mean lesion diameter was(9.2±2.3)mm(range,7-16mm).Twenty-three patients(15 males and 8 females)underwent CT-guided less invasive surgeries procedures.The lesions were in the femur(n=9),tibia(n=6),acetabulum(n=4)and humerus(n=4).The mean lesion diameter was(8.1±2.7)mm(range,6-15mm).Among these 23 patients,20 patients were performed by core drill excision.Three patients were performed by radiofrequency ablation.Follow-up ranged from 16 to 68 months(mean,35 months)to assess pain,neurovascular damage,pathological fracture,movement,and recurrence.Results were categorized as success(persistent complete relief of pain)and failure(absent or incomplete relief of pain,requiring additional treatment).Results The success rates were 89%(17/19)after wide surgical excision and 96%(22/23)after less invasive surgeries,respectively,and the difference was not significant(P>0.05).Patients were hospitalized for average 8.3 d(5-15d)after wide surgical excision and 3.2d(3-5d)after less invasive surgeries(P<0.05).There were no complications such as sepsis,pathological fracture,or neurovascular damage.No further recurrences were observed during follow-up.Conclusion Less invasive surgeries has obvious advantages such as reduced cost,shorter stay in hospital and rapid convalescence.Core-drill excision can obtain sufficient material for pathologic examination.

Percutaneous transgastric computed tomography-guided biopsy of the pancreas using large needles

AIM:To assess the safety,yield and clinical utility of percutaneous transgastric computed tomography(CT)-guided biopsy of pancreatic tumor using large needles, in selected patients. METHODS:We reviewed 34 CT-guided biopsies in patients with pancreas mass,of whom 24(71%)had a direct path to the mass without passing through a major organ.The needle passed through the liver in one case(3%).Nine passes(26%)were made through the stomach.These nine transgastric biopsies which used a coaxial technique(i.e.a 17-gauge coaxial introducer needle and an 18-gauge biopsy needle)were the basis of this study.Immediate and late follow-up CT images to detect complications were obtained. RESULTS:Tumor tissues were obtained in nine pancreatic biopsies,and histologic specimens for diagnosis were obtained in all cases.One patient,who had a rare sarco-matoid carcinoma,received a second biopsy.One patient had a complication of transient pneumoperitoneum but no subjective complaints.An immediate imaging study and clinical follow-up detected neither hemorrhage nor peritonitis.No delayed procedure-related complication was seen during the survival period of our patients.CONCLUSION:Pancreatic biopsy can be obtained by a transgastric route using a large needle as an alternative method,without complications of peritonitis or bleeding.

Clinical Effects of Treatment for Lung Cancer with Double Points Cryoablation through Percutaneous Puncture Guided by Computed Tomography

OBJECTIVE To investigate the clinical effects of the application of double points cryoablation through percutaneous puncture for advanced lung cancer patients. METHODS Forty-one patients diagnosed with stage III-IV pulmonary carcinoma were selected for the study. The patients were found to have from 1 to 3 foci of carcinoma, and in each case the disease was limited to one lung. The study patients were divided randomly into 3 groups. There were 16 cases receiving routine chemotherapy and radiotherapy in group I, 13 cases treated with cryoablation at a single point in group II, and 12 cases treated with cryoablation at 2 points simultaneously in group III. The patients in the 2 cryoablation groups also received the same treatment as the patients did in group I. The clinical effects were evaluated within 6 months after treatment, and the survival rate was followed-up for 3 years. RESULTS The clinical effects were improved significantly after treatment in group II and in group III compared with those in group I （P 〈 0.05）, including an enhanced regressive rate of 21%, postponed tumor progression of 50.58% and a clinical benefit rate of 92%. The effective rate of regression in group III was higher than that in group II, 43.59% （P 〈 0.05）, and the 3-year survival rate was 37.25%. Significant differences in side effects were not found between the 2 cryoablation groups. CONCLUSION Cryosurgery ablation at 2 points, simultaneously, and directed at I foci might improve the effects of treatment and the prognosis of lung cancer patients, when used in combination with routine treatment.

Prognostic value of the ratio between prosthesis area and indexed annulus area measured by MultiSlice-CT for transcatheter aortic valve implantation procedures

Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation （TAVI） procedures remain an is- sue. Benefit of oversizing strategies to prevent them isn＇t well established. We compared different level of oversizing in our cohort of con- secutive patients to address if severe oversizing compared to normal sizing had an impact on post-procedural outcomes. Methods From January 2010 to August 2013, consecutive patients were referred for TAVI with preoperative Multislice-CT （MSCT） and the procedures were achieved using Edwards Sapien~ or Corevalve devices~. Retrospectively, according to pre-procedural MSCT and the valve size, pa- tients were classified into three groups： normal, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and measured on MSCT. Main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium （VARC-2） endpoints. Results Two hundred and sixty eight patients had a MSCT and underwent TAVI procedure, with mainly Corevalve~. While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pacemaker （PM） implantation rate was significantly higher in the severe oversizing group （P = 0.03）, while we observed more in-hospital congestive heart-failure （P = 0.02） in the normal sizing group. There was a trend toward more moderate to severe aortic regurgitation （AR） in the normal sizing group （P = 0.07）. Conclusions Despite a higher rate of PM implantation, oversizing based on this ratio reduces aortic leak with lower rates of post-procedural complications and a similar mid-term survival.

肝癌局部消融治疗规范的专家共识

局部消融治疗是在影像技术的引导下对肿瘤靶向定位,用物理或化学的方法杀死肿瘤细胞;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种.局部消融治疗的特点：一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,可以反复应用.局部消融治疗在过去20年左右发展迅速,已经成为继手术切除、介入治疗后的第三大肝癌治疗手段,而且由于其疗效确切,特别是在小肝癌的治疗方面,射频消融治疗的疗效与手术切除相近,因此,被认为是小肝癌的根治性治疗手段之一.