Efficacy and safety of computed tomography-guided microwave ablation with fine needle-assisted puncture positioning technique for hepatocellular carcinoma

BACKGROUND In microwave ablation(MWA), although computed tomography(CT) scanning can overcome gas interference, it cannot achieve real-time localization. Therefore, the puncture technique is more important in CT-guided ablation.AIM To compare the fine needle-assisted puncture(FNP) positioning technique and the conventional puncture(CP) technique for the safety and efficacy of CT-guided MWA in treating hepatocellular carcinoma(HCC).METHODS This retrospective study included 124 patients with 166 tumor nodules from February 2018 and June 2021. Seventy patients received CT-guided MWA under the FNP technique(FNP group), and 54 patients received MWA under the CP technique(CP group). Intergroup comparisons were made regarding local tumor progression(LTP), recurrence-free survival(RFS), overall survival(OS), and complications. The influencing variables of LTP and RFS were analyzed through univariate and multivariate regressions.RESULTS The 1-, 2-, and 3-year cumulative incidences of LTP in the FNP group were significantly lower than those in the CP group(7.4%, 12.7%, 21.3% vs 13.7%, 32.9%, 36.4%;P = 0.038). The 1-, 2-, and 3-year RFS rates in the FNP group were significantly higher than those in the CP group(80.6%, 73.3%, 64.0% vs 83.3%,39.4%, and 32.5%, respectively;P = 0.008). The FNP technique independently predicted LTP and RFS. Minor complications in the FNP group were lower than those in the CP group(P < 0.001). The difference in median OS was insignificant between the FNP and CP groups(P = 0.229).CONCLUSION The FNP technique used in CT-guided MWA may improve outcomes in terms of LTP, RFS, and procedure-related complications for HCC.

Ischemic Apoplexy-Induced Sequelae Treated by Penetrating Puncture with Long Needles

In recent years, the author have treated 47 cases of ischemic apoplexy-induced sequelae with long needles to perform penetrating puncture, and achieved satisfactory results as reported in the following.

Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum

The factors influencing the incidence of common complications（pneumothorax and pulmonary hemorrhage） of CT-guided percutaneous needle biopsy of lumps near pulmonary hilum were investigated. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum was performed on 48 patients. The complications of pneumothorax and pneumorrhagia as well as the contributing factors were analyzed statistically. The major complications associated with CT-guided needle biopsy included pneumothorax（13 cases, 27.1%） and pulmonary hemorrhage（14 cases, 20.24%）. ？2 test revealed that pneumothorax was associated with the lesion size and depth of needle penetration, and pulmonary hemorrhage with the depth of needle penetration and needle retention time with a significant P value. Pneumothorax was observed in 7 cases（17.5%） out of 40 cases with diameter of mass greater than 3 cm, and in 6 cases（60%） out of 10 cases with depth of needle penetration greater than 4 cm. Additionally, pulmonary hemorrhage was identified in 12 cases（41.4%） out of 29 cases with needle retention time longer than 15 min, and pulmonary hemorrhage in 7 cases（70%） out of 10 cases with depth of needle penetration greater than 4 cm. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum is safe and effective. The key factors to prevent the complications include correct evaluation of lesion size, depth of needle penetration and the needle retention time before the operation. Key words： biopsy, CT-guided; hilum; pneumothorax; pulmonary hemorrhage

Treatment for Injury of Superior Clunial Nerves by Triple Puncture Needling with Massage

Superior clunial nerve injury occupies a high percentage in lumbocluneal tissue injuries. It is commonly seen in winter and in athletic competition and training. The authors have treated 67 cases of pain of the superior clunial nerves by triple puncture needling combined with massage and obtained satisfactory therapeutic result. A report follows.

Novel Visualization Tool for Percutaneous Renal Puncture Training Using Augmented Reality Technology

We aim to develop a novel visualization tool for percutaneous renal puncture training based on augmented reality(AR)and compare the needle placement performance of this AR system with ultrasound-guidedfreehand navigation in phantoms.A head-mounted display-based AR navigation system was developed usingthe Unity3D software and Visual Studio to enable the overlay of the preoperative needle path and the complexanatomical structures onto a phantom in real time.The spatial location of the stationary phantom and the percutaneous instrument motion were traced by a Qualisys motion capture system.To evaluate the tracking accuracy,15 participants(7 males and 8 females)performed a single needle insertion using AR navigation(the number ofpunctures n=75)and ultrasound-guided freehand navigation(n=75).The needle placement error was measuredas the Euclidean distance between the actual needle tip and the virtual target by MicronTracker.All participantsdemonstrated a superior needle insertion efficiency when using the AR-assisted puncture method compared withthe ultrasound-guided freehand method.The needle insertion error of the ultrasound-guided method showed anincreased error compared with the AR method(5.54 mm±2.59 mm,4.34 mm±2.10 mm,respectively,p<0.05).The ultrasound-guided needle placements showed an increased time compared with the AR method(19.08 s±3.59 s,15.14 s±2.72 s,respectively,p<0.0001).Our AR training system facilitates the needle placement performance and solves hand-eye coordination problems.The system has the potential to increase efficiency andeffectiveness of percutaneous renal puncture training.