CT引导下瘤体内注射Ad-P53治疗女性盆腔复发转移肿瘤的疗效观察

目的观察P53瘤体内注射的治疗效果及毒副反应,为临床治疗提供更为安全有效的方法。方法纳入2012年10月―2014年7月西安交通大学第一附属医院肿瘤放疗科妇瘤病区收治的28例盆腔复发转移患者,给予行CT引导下的腺病毒介导P53基因(Ad-P53)瘤体内注射治疗。每次(1～2)×1012 VP(病毒颗粒),加入生理盐水稀释至4～8mL,每周1次,共1～6次。28例患者共完成41次瘤体内注射Ad-P53治疗,平均每例患者用药(3±1)支。治疗期间无再次放疗及化疗。以肿瘤消退或者患者不能耐受或不愿继续接受治疗为治疗终点。疗效评价分为客观疗效评价和主观疗效评价:(1)客观疗效评价是在治疗前和停止治疗后1月,以盆腔MRI为依据,测量肿瘤最大径,计算出肿瘤缩小率(%),评定疗效;(2)主观疗效评价以患者主诉疼痛或减轻程度以及阴道排液等进行评价。结果 28例患者每2～4周随访1次,至2014年12月,随访时间6～27个月,中位随访17个月。治疗结束1月进行主观及客观疗效评价,疼痛程度明显减轻者24例(24/28,85.7%);客观临床获益率82.1%(23/28),中位生存时间11个月;病情再度进展者21例,占91.3%(21/23),中位无疾病进展时间为5个月;2例因疼痛减轻后进食及睡眠改善,再次接受姑息性化疗;死亡13例,占46.4%(13/28)。结论 CT引导下Ad-P53局部注射作为女性盆腔复发转移肿瘤的姑息性治疗手段,可改善患者症状,提高生活质量。

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.

Sub-acute disseminated pulmonary tuberculosis in a girl diagnosed by CT guided transthoracic needle biopsy: case report and literature review

Primary tuberculosis often occurs in children with the main types of hilar lymphonode tuberculosis or Ghon complex. When pulmonary tuberculosis aggravates and tubercule bacillus invades pulmonary veins, a disseminated disease may occur clinically. One 8-year-old girl presented with hypodynamia and emaciation. CT indicated the disseminated disease and extensive mediastinal and hilar lymphadenopathy. But she had negative sputum smears and negative PPD test. The bronchi showed inflammatory change in fiberoptic bronchoscopy. Percutaneous transthoracic needle biopsy (PTNB) guided by CT was used as a means for the diagnosis of pulmonary tuberculosis. The case was rapidly diagnosed as sub-acute disseminated pulmonary tuberculosis with the help of combined CT imagine and histology.

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.