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直視雙極射頻消融術治療心瓣膜病合并慢性心房顫動

目的 介紹直視雙極射頻消融術治療心瓣膜病合并慢性心房顫動（AF）的初步體會，探討控制慢性AF的有效方法。 方法 2005年5月至2007年11月，對23例心瓣膜病合并慢性AF患者采用直視雙極射頻消融術治療，在常溫體外循環心臟跳動下進行右心房的消融，然后在中度低溫心臟停搏下做左、右肺靜脈口和左心耳的消融隔離，最后行心瓣膜置換術。 結果 射頻消融時間18～26 min。術后因特發性血小板減少致消化道大出血住院死亡1例，生存的22例患者隨訪3～30個月，出院時、3個月、1年和2年竇性心律轉復率分別是81.8%、86.4%、82.4%和77.8%，無Ⅲ度房室傳導阻滯、病竇綜合征和栓塞等并發癥發生。 結論 直視雙極射頻消融術治療心瓣膜病合并慢性AF操作簡單、效果滿意、并發癥較少。

Clinical Efficacy and Status of Image-Guided Ablation of Liver Cancer

無射線射頻消融妊娠合并室性早搏一例

開腹術中射頻消融治療肝右葉外傷18例臨床分析

目的 探討術中射頻消融止血法在肝右葉外傷中的應用。 方法 回顧性分析術中射頻消融治療 18例肝右葉外傷患者的臨床資料。 結果 所有患者均痊愈出院，無死亡病例。術后出現膈下膿腫 1 例，肝周積液 2 例，低流量膽瘺 1 例，經術后外科引流、抗感染治療后治愈。 結論 處理較為困難的肝右葉肝外傷，術中射頻消融止血法是一種有效的可供選擇的手術方式。

Recovery rule of atrial contractility after Maze Ⅳ in patients with valvular atrial fibrillation

ObjectiveTo analyze the recovery rule of atrial contractility (AC) function after Maze Ⅳ procedure of valvular atrial fibrillation (AF).MethodsIn our hospital from March 2016 to April 2018, 103 patients who underwent cryoablation Maze Ⅳ procedure due to mitral valve lesions associated with persistent or long-term persistent AF were enrolled. There were 42 males and 61 females, with an average age of 58.5±9.1 years. Electrocardiogram and echocardiography were followed up at discharge and 1, 3, 6, 12 months after procedure. A multivariate Cox analysis of predictive factors for AC recovery was applied.ResultsAll the 103 patients were followed up for 1 year. The recovery rate of AC increased gradually after operation. It was not until 3 months after procedure that most of the right atrial contractility (RAC) was accompanied by synchronous recovery of the corresponding left atrial contractility (LAC, Kappa coefficient≥0.40, P<0.05). However, the coexistence of sinus rhythm (SR) and bilateral AC was not consistent well until 1 year after operation (Kappa coefficient≥0.40, P<0.05). One year after procedure, the recovery rates of SR and bilateral AC were 86.4% (89/103) and 66.0% (68/103) respectively. By Cox multivariate regression analysis, longer preoperative AF duration (P=0.040), larger preoperative left atrial diameter (LAD, P=0.003), and AC deletion 3 months after surgery (P=0.037) were predictive factors for AF recurrence in the middle and advanced stages (>3 months) after Maze surgery. At the same time, longer preoperative AF duration and larger preoperative LAD were also negative predictors of middle and late recovery of LAC and bilateral AC (All P<0.05). Receiver operating characteristic curve analysis showed that the best critical value of preoperative AF time and preoperative LAD for prediction of AC recovery was 37 months (sensitivity 99.6%, specificity 76.3%) and 60.5 mm (sensitivity 98.5%, specificity 78.9%), respectively.ConclusionThe recovery of AC after Maze procedure is a dynamic improvement process. Early recovery of AC is beneficial to the stable maintenance of SR in the future. Prolonged duration of AF and enlarged LAD have adverse effects on the outcome of Maze Ⅳ procedure.

Influence of Radiofrequency Ablation on Hepatic Function and Nursing Measures

摘要:目的： 探討肝癌患者行射頻消融術圍手術期的肝功能變化情況,以及相應的護理措施。方法:對2006～2009年6月在我院接受射頻消融術治療的91例肝癌患者,監測其圍手術期的肝功能指標,如丙氨酸氨基轉移酶及總膽紅素等變化情況,分析射頻消融術對肝功能的影響,總結相應的護理措施。 結果:全組無死亡病例。射頻消融術后早期丙氨酸氨基轉移酶及總膽紅素與術前有顯著差異（P＜005）。結論: 肝癌患者行射頻消融術后早期肝功能減退,應加強護理措施,促進患者恢復。 Abstract: Objective: To explore the influence of radiofrequency ablation (RFA) on hepatic function of patients suffering hepatocelluler carcinoma and to summarize corresponding nursing measures.Methods: Ninetyone patients suffering hepatocelluler carcinoma received RFA were studied with their hepatic function preoperation and postoperation. Alanine aminotransferase (ALT) and total bilirubin (TB) were selected as the liver functional parameters,and perioperative changes of the two parameters were measured. Influence of RFA on hepatic function was analyzed and corresponding nursing measures were summarized. Results: Significant changes of ALT and TB were observed early after RFA,and there were statistical difference between preoperation and postoperation (P＜005). Conclusion: Proper nursing measures should be applied to improve hypohepatia and promote recovery of patients.

Clinical analysis of CT-guided percutaneous microwave ablation therapy for 39 patients with primary lung cancer

目的 探索無法行手術及化放療等治療措施的原發性周圍性肺癌患者行微波消融治療的安全性及效果。 方法 我院 2013 年 12 月至 2015 年 11 月 39 例原發性肺癌患者（其中男 24 例、女 15 例，年齡 44～83 歲，中位年齡 67 歲）行微波消融治療，腫瘤平均直徑 3.5 cm。評價腫瘤局部療效，隨訪時間 0.5～2.0 年。 結果 全組 39 例患者進行病灶消融后，病灶立即均質化，CT 值下降，供血終止，6 個月后病灶開始逐步縮小，瘢痕化。隨訪 39 例患者中有 3 例手術后生存 1.0～1.5 年因腫瘤全身廣泛轉移死亡；2 例患者手術后 6 個月復查增強 CT 見局部有少許血供予以再次消融；全組患者無 1 例嚴重并發癥發生。 結論 微波消融對原發性小細胞肺癌患者的治療效果佳、創傷小、手術風險小、安全性高。

Efficacy of Treatment on Liver Metastases by Contrast Enhanced Ultrasonography-Guided Percutaneous Radiofrequency Ablation

ObjectiveTo evaluate the clinical application and the efficacy of contrast enhanced ultrasonography (CEUS)guided percutaneous radiofrequency ablation (RFA) in patients with liver metastases. MethodsTotal 136 patients with 219 liver metastatic tumors, which were detected by CEUS before RFA therapy, were analyzed retrospectively. The diamter of tumors was (3.2±1.2) cm. Among them, the largest tumor more than 3 cm in diameter were found in 48.5% (66 patients), and 57.4% (78 patients) were with solitary metastasis. Enhanced CT and (or) MRI, and laboratory tests were applied to evaluate the outcomes after RFA treatment by regular followup. ResultsTumors were not detected by conventional ultrasonography in two cases, and 47.0% (63/134) of the patients with the largest tumor were 0.3 cm larger by CEUS than by conventional ultrasonography. More 40 tumors were detected in 18.4% (25/136) patients by CEUS. Followup ranged from 3 to 68 months (median time of 12 months). Early tumor necrosis rate one month after therapy was 98.2% (215/219 tumors). The incidence of local recurrence, new intrahepatic metastasis, and extrahepatic metastasis was 16.9% (23/136), 38.2% (52/136), and 8.8% (12/136), respectively. Local recurrence and new intrahepatic metastasis happened 2-25 months (median time of 6 months) after treatment. Local recurrence rates of the largest tumors ≥ 3 cm and tumor lt; 3 cm was 22.7% and 11.4%， respectively (P=0.079). The rate of new intrahepatic metastasis for the solitary metastasis cases was significantly lower than that for multiple metastases cases (25.6% versus 55.2%, P=0.000). The 1, 2, 3year survival rates were 82.5%, 64.3%, and 50.1%, and the 1, 2, 3year local recurrence free survival rates were 67.7%, 53.8%, and 38.3%, respetively. Patients with solitary metastasis survived longer than that with multiple metastases (P=0.034). ConclusionPatients with liver metastases treated by CEUSguided percutaneous RFA can get better survival rate, and CEUS is of much value for clinic application.

射頻消融治療復發性肝癌的護理

【摘要】　目的　總結89例復發性肝癌患者行經皮或開腹射頻消融術圍手術期的護理。　方法　2005年9月-2009年9月收治的89例復發性肝癌患者行經皮或開腹射頻消融術，做好術前心理護理，術前指導及各項準備；術后嚴密觀察病情及并發癥預防，做好出院指導。　結果　81例順利出院，經皮組出現發熱2例、傷口感染2例、腹水1例，開腹組出現腹水、發熱、房顫、胸水各1例，經治療后出院。　結論　良好的圍術期護理能有效地降低術后并發癥的發生，減輕患者的痛苦，提高患者的生活質量，延長患者的生命。

CT引導射頻消融治療非小細胞肺癌的臨床分析

目的　評價CT引導射頻消融治療非小細胞肺癌（NSCLC）的緩解率、中位生存時間及生存率。方法　2005年12月至2007年12月復旦大學附屬中山醫院分部收治高齡、心肺功能差或有嚴重并發癥無法耐受手術的NSCLC患者56例，其中男32例，女24例；平均年齡63.7歲。腫瘤直徑平均2.6 （0.8～4.0） cm。組織病理學分型為：鱗狀細胞癌20例，腺癌30例，肺泡細胞癌5例，神經內分泌癌1例。有11例患者臨床分期為Ⅰ期。56例NSCLC患者均進行CT引導射頻消融術。 結果　56例患者射頻消融治療均順利完成，無與手術相關的死亡發生。并發癥包括氣胸6例、胸痛15例、發熱13例、肺內出血5例、胸膜滲出1例。平均住院時間3 （2～12） d。隨訪至射頻消融治療后1年，腫瘤達到完全緩解共48例 （86%），中位生存時間為28.33個月；隨訪至3年結束時，共死亡36例，因腫瘤進展死亡32例。1年、2年總體生存率分別為84%和56%，其中Ⅰ期NSCLC患者的1年、2年總體生存率為100%和82%。 結論　射頻消融為無法耐受手術或不適合手術的肺癌患者提供了一種新的治療手段，短期療效明顯。但因其開展時間較短，能否提高患者5年生存率，其遠期效果有待今后更長時間的隨訪和觀察。