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Objective To investigate the CT-guided percutaneous irreversible electroporation (IRE) in treating locally advanced pancreatic cancer (LAPC) and providing guidance for its prevention and treatment. Methods We retrospectively analyzed the clinical and imaging data of 17 patients (17 lesions) of LAPC treated with CT-guided IRE in our hospital from July 2015 to June 2016. Complications were documented and reviewed at day 7,30 and 90 follow up as well as during the procedure. The Clavien?Dindo was used for classification. The reasons that induced complications were summarized and to further discuss the prevention and treatment approaches. Results Of 17 patients, 2 patients suffered a transient tachycardia during the procedure. Eleven patients (65%) showed complications at day 7, of which gradeⅠcomplications occurred in 6 cases, including abdominal pain, nausea, vomiting, or a few of inflammatory exudations around the pancreas; four patients have grade Ⅱ complications, along with portal vein thrombosis;one patient showed grade Ⅲ a complications for retroperitoneal infection. With 30 days follow up, the grade Ⅰ complications disappeared, gradeⅡcomplications have not getting better, while grade Ⅲ a complications have been improved. With 90 days follow up,patients with grade Ⅲ a complications getting better; two patients with grade Ⅱ complications didn't show any changes;2 cases progressed to grade Ⅴ, and died of digestive tract bleeding at 82 days and 98 days after procedure. Conclusion CT-guided irreversible electroporation for treating LAPC is a safe ablation approach. Strict patient selection before procedure and make a reasonable prevention and treatment measures can reduce the complications.
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Objective To investigate the preparation of biodegradable vena cava filter(BVCF) with poly-l-lactic acid (PLLA),and to evaluate its mechanical properties,delivery performance,the ability of capturing thrombus and the degradation property.Methods Three-dimensional design software was used to design the shape of BVCF.The BVCF was prepared by using PLLA with molecular weight of 100 000 unit.Twelve minipigs were used to test the feasibility of this BVCF.They were randomly divided into four groups.At first the BVCFs were placed into the inferior vena cava of pigs in three experimental groups.The fourth group was used as a blank control group.The thrombi were injected into all pigs after 1 week,and CT examinations were performed at different time points to observe the filter locations and pulmonary artery.The animals were sacrificed according to a fixed time table for histopathological assessment.Results The BVCF was successfully designed and produced,which could expand by stretching the center-thread.In vitro test results showed the radial force of BVCF was approximately 1.6 N and could capture the thrombus more than 5 mm in diameter,and it was easy to release.Through the animal experiment confirmed that the filter could capture the lethal thrombus and all 9 pigs of experimental groups were survived,two of those had the symptoms of respiratory frequency and heartbeat accelerated slightly in the operation.In control group,the symptoms such as accelerate of respiratory rate,shortness of breath were observed in varying degree.The pig which was injected with 8 strips of thrombus died in the same day after surgery.Postoperative CT and pathological examinations showed that 2 pigs in the experimental group developed peripheral pulmonary embolism,while the dead pig in the control group developed central pulmona-y embolism.Histological findings showed that the intima covered the BVCF lateral branch partly after one week,and thoroughly after six weeks.The vessel wall structure remained normal and no signs of the obvious inflammatory cells infiltration were detected.Twelve weeks after the implantation,the vessel wall structure was normal,and the lumen was unobstructed,and the collateral of the filter was partly degradated.Conclusions The BVCF has the advantage of good mechanical strength and good biocompatibility.It is easy to release and can capture the lethal thrombus,but its degradation performance remains to be studied.
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ObjectiveTo investigate the technique,safety and clinical value of CT-guided percutaneous interstitial brachytherapy for metastatic carcinoma of lymph nodes in mediastinum.Methods Eight patients with metastatic carcinoma of lymph nodes in mediastinum were treated by CT-guided interstitial implant of radioactive seeds in our department.Anterior approach were performed on all cases,125I radioactive seeds were implanted by setting CT Gantry at an oblique angle,three-dimensional reconstruction with SCT and separation the narrow gap between aortic arch and superior vena cava with fiatscalp core.Dose distributions were checked by TPS after operation.The improvement in clinical symptoms and lymph node sizes were documented in order to investigate the therapeutic effects.ResultsThe particle coverage rate was 93.5％ ± 1.5％.According to the CT scans two months later,3 patients ( 37.5％ ) had complete ablation,4 (50％) partial ablation,and 1 ( 12.5％ ) stable disease.Overall response rate (CR + PR) for this group of patients was 87.5％.The symptoms of all patients including shortness of breath (5 patients),cough (4 patients),dysphagia (4 patients) showed varying degree of improvement.No edema of head-and-neck and upper extremity was observed.There was no major vascular,tracheal and esophageal injury.A small amount of pneumothorax was observed in one patient.ConclusionsCT-guided percutaneous interstitial brachytherapy,a minimally invasive procedure associated with favorable therapeutic results,is a promising technique for treatment of metastatic carcinoma of lymph nodes with local pressure symptoms which may not respond to conventional therapy.
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Objective To evaluate the safety and efficacy of the CT-guided percutaneous cryoablation of osteoid osteoma in children.Methods Nine children with osteoid osteoma proved by histopathology were treated with CT-guided cryoablation from January 2007 to January 2010.There were 6 boys and 3 girls.Their mean age was ( 13.0 + 1.6 ) years ( ranging from 10.0-15.0 years ).The procedures were performed under local anesthesia.Eight G bone biopsy needles for biopsy and 17 G freezing needles were used in the procedure.CT guidance was used for procedural planning,instrument guidance,and monitoring.Each cryoablation included two freezing-thawing cycles.Follow-up was performed to assess technical and clinical outcome.A visual analog scale (VAS) was used to assess severity of pain pre- and post-procedure,and mean VAS for the group was compared pre- and post-procedure with Kruskal-Wallis rank sum test.Results Biopsy and cryoablation were successfully performed in all children.No major immediate or postponed complications were observed.Significant pain relief ( P ＜ 0.01 ) was observed in all patients after procedure.The VAS of preoperation(8 points 1 case,7 points 3 cases,6 points 4 cases,5 points 1 case) compared with that of one month after operation ( 1 point 4 cases,0 point 5 cases),the difference was statistically significant( H =32.838,P ＜ 0.01 ).These patients were allowed to fully weight-bear and function without limitation 3 days after the procedure.Pain was obviously released.Pain recurrence was not observed in all patients.Moderate fever (37.8 ℃ ) was observed in a patient one day after operation and fully recovered 2 days later.Conclusion CT-guided percutaneous cryoablation is a safe and effective minimally invasive method for the treatment of osteoid osteoma in children.
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Objective To investigate the clinical value of CT-guided percutaneous bone biopsy in skeletal lesions.Methods Totally 857 patients with skeletal lesions who underwent CT-guided percutaneous bone biopsy were analyzed retrospectively.The position and path of puncture were selected according to the adjacent and safety principle after CT localization.Lesions were penetrated with 8-13G bone puncture needles or 16-18G trigger-type biopsy needles for obtaining specimens.Results The whole procedures were generally finished within 20-40 min,and adequate samples were obtained for pathologic examinations in all patients.The pathological findings of biopsy for 766 patients were consistent with that of surgeries (89.38%) .No false positive patient was found.Postoperative complications occurred in 27 patients (3.15%) ,including local hematomas in 22 patients,nerve injury in 1 patient and infection in 4 patients.Conclusion CT-guided percutaneous bone biopsy is safe and with high diagnostic accuracy.It can be used to diagnose metastases,primary bone tumors,tumor-like lesions and inflammatory lesions.The reasonable selection of the path of puncture,puncture needles and biopsy methods can improve the success rate of biopsy.