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....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.展开更多
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...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.展开更多
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 percu...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.展开更多
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 po...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.展开更多
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...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.展开更多
Adenomyosis is a common gynecological disease in reproductive women,which causes serious dysmenorrhea,menorrhagia,anemia,and infertility,and has a serious impact on the physical and mental health of women.Considering ...Adenomyosis is a common gynecological disease in reproductive women,which causes serious dysmenorrhea,menorrhagia,anemia,and infertility,and has a serious impact on the physical and mental health of women.Considering that the efficacy of the traditional medication and surgical treatment is not ideal,an increasing number of patients are searching for more effective and less invasive therapies.Ultrasound(US)-guided microwave ablation(MWA)has emerged as a new effective and minimally invasive alternative treatment for symptomatic adenomyosis,and it is widely being used in clinical settings.Several studies have proven that it is an efficient and safe treatment modality for symptomatic adenomyosis,but a significant variance in clinical outcomes reported in previous studies was also observed.Herein,we have analyzed the potential causes of this problem from the aspects of the diagnosis of adenomyosis,symptom evaluation before ablation,steps of USguided ablation treatment,and outcome evaluation after ablation.Simultaneously,the clinical problems existing in the ablation treatment of adenomyosis are discussed,and the directions of future research are pointed out.展开更多
Objective To investigate the therapeutic efficacy and its influencing factors of ultrasoundguided percutaneous radiofrequency ablation (PRFA) in the treatment of liver carcinoma. Methods With a temperature-controlled ...Objective To investigate the therapeutic efficacy and its influencing factors of ultrasoundguided percutaneous radiofrequency ablation (PRFA) in the treatment of liver carcinoma. Methods With a temperature-controlled multi-electrode needle, ultrasound-guided PRFA was employed to treat forty-seven patients with 67 tumor nodules, with a diameterof 2.6 ± 1.1 cm (1.0 - 5.5 cm). Results A complete ablation (CA) rate of 80. 6% was achieved in the present series, with a CA rate of 91.7 % in the tumors ≤3 cm in diameter,75. 0% in tumors from 3.1 to 4. 0 cm,and 14. 3% in tumors 】4 cm. The CA rate was significantly greater in tumors with a temperature rising up to 70℃ within the initial 2 minutes at ablation as compared with that longer than 2 minutes (P 【 0.05). A markedly higher CA rate was obtained in tumors with an ablation-maintaining temperature of over 80℃ than that between 70℃ and 80℃ ( P 【 0. 01). All patients were followed up with a mean time of 11. 3 months. The local recurrence rate was 9.3% (5/展开更多
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 treat...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.展开更多
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...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.展开更多
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 li...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.展开更多
文摘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.
基金Supported by Science and Technology Commission of Shanghai Municipality,China,No.19DZ2251100Shanghai Municipal Health Commission,China,No.SHSLCZDZK 03502National Natural Science Foundation of China,No.81725008.
文摘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.
文摘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.
文摘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.
基金Financial support from the Municipal Hospital Joint Research Project of Emerging Frontier Technology(Project SHDC12014112)Shanghai City,Shen Kang Group,and medical guided technology project of Shanghai Committee of Science and Technology,China(project 14411967500).
文摘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.
基金supported in part by the Science and Technology Commission of Shanghai Municipality(Grants 21Y11910800 and 19DZ2251100)Shanghai Municipal Health Commission(Grants 2019LJ21 and SHSLCZDZK 03502)the National Natural Science Foundation of China(Grant 81725008)。
文摘Adenomyosis is a common gynecological disease in reproductive women,which causes serious dysmenorrhea,menorrhagia,anemia,and infertility,and has a serious impact on the physical and mental health of women.Considering that the efficacy of the traditional medication and surgical treatment is not ideal,an increasing number of patients are searching for more effective and less invasive therapies.Ultrasound(US)-guided microwave ablation(MWA)has emerged as a new effective and minimally invasive alternative treatment for symptomatic adenomyosis,and it is widely being used in clinical settings.Several studies have proven that it is an efficient and safe treatment modality for symptomatic adenomyosis,but a significant variance in clinical outcomes reported in previous studies was also observed.Herein,we have analyzed the potential causes of this problem from the aspects of the diagnosis of adenomyosis,symptom evaluation before ablation,steps of USguided ablation treatment,and outcome evaluation after ablation.Simultaneously,the clinical problems existing in the ablation treatment of adenomyosis are discussed,and the directions of future research are pointed out.
文摘Objective To investigate the therapeutic efficacy and its influencing factors of ultrasoundguided percutaneous radiofrequency ablation (PRFA) in the treatment of liver carcinoma. Methods With a temperature-controlled multi-electrode needle, ultrasound-guided PRFA was employed to treat forty-seven patients with 67 tumor nodules, with a diameterof 2.6 ± 1.1 cm (1.0 - 5.5 cm). Results A complete ablation (CA) rate of 80. 6% was achieved in the present series, with a CA rate of 91.7 % in the tumors ≤3 cm in diameter,75. 0% in tumors from 3.1 to 4. 0 cm,and 14. 3% in tumors 】4 cm. The CA rate was significantly greater in tumors with a temperature rising up to 70℃ within the initial 2 minutes at ablation as compared with that longer than 2 minutes (P 【 0.05). A markedly higher CA rate was obtained in tumors with an ablation-maintaining temperature of over 80℃ than that between 70℃ and 80℃ ( P 【 0. 01). All patients were followed up with a mean time of 11. 3 months. The local recurrence rate was 9.3% (5/
文摘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.
文摘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.
文摘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.
