Ultrasound-guided percutaneous microwave ablation assisted by a three-dimensional visualization preoperative treatment planning system for larger adrenal metastasis (D ≥ 4 cm): Preliminary results

Objective: The objective of this study is to assess the clinical effect and safety of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by three-dimensional (3D) visualization operative treatment planning system in larger adrenal metastasis (LAM) (D ≥ 4 cm). Materials and Methods: From Dec 2011 to Dec 2017, 12 consecutive LAM patients with pathologically proven with a mean diameter of 5.2±1.3cm (range 4.1-7.6) were treated. Artificial ascites and thermal monitoring system as ancillary technique were used. The patients were followed up with imagings and complications were recorded. Results: The median follow-up period was 31 months (ranged 6–52 m). All LAM achieved completely ablation according to the 3D planning preoperation. Complete ablation was achieved in 10 (10/12, 83.3%) patients by one session and 2 patients (2/12, 16.7%) by two sessions. Recurrence was detected at the treated site in 3 patients (3/12, 25.0%) at 5, 9, and 13 months after ablation and received another ablation. Progression of metastasis disease at extra-adrenal sites occurred in 9 patients (9/12, 75%). Seven (7/12, 58.3%) patients died during the follow-up period. Therefore, the 1-, 2-, and 3-year local tumor control rates were 83.3%, 75.0%, and 75.0%, and 1-, 2-, 3- and 4-year overall survival rates were 91.7%, 75.0%, 50.0%, and 41.7%, respectively. No severe complications related to ablation occurred, except 3 (3/12, 25%) patients developed hypertension during ablation. Conclusions: US-PMWA assisted by 3D visualization preoperative treatment planning system maybe a safe and efficient therapy for LAM, which could promote ablation precision, improve the clinical outcomes

Artificial ascites-assisted ultrasound guided percutaneous radiofrequency ablation of liver tumors adjacent to the gastrointestinal tract / 中华肝胆外科杂志

Objective To study the safety and efficacy of artificial ascites-assisted ultrasound guided percutaneous radiofrequency ablation (RFA) of liver tumors adjacent to the gastrointestinal tract.Metbods After ultrasound-guided percutaneous placement of a central venous tube,saline was injected into the abdominal cavity.The presence of fluid between the liver tumor and its adjacent gastrointestinal organs forms a zone of isolation.Radiofrequency ablation (RFA) was then carried out.This is a retrospective study on 32 patients whose lesions were adjacent to the gastrointestinal tract treated from January 2015 to December 2016 with RFA after establishment of artificial ascites.One month after ablation,CT/MR was performed to evaluate whether the lesions were completely ablated.Results All the 39 lesions in the 32 patients were successfully treated with RFA after establishment of artificial ascites.The complete ablation rate was 92.3 ％ (30/32) after one ablation session.One patient developed a high fever after surgery,another patient had nausea and vomiting during surgery,and two more patients complained of right shoulder and back pain.There were no severe complications such as hemorrhage or gastrointestinal perforation.There was no treatment related deaths.Conclusions For liver tumors which were adjacent to the gastrointestinal tract,establishment of artificial ascites significantly improved the visual field under ultrasound,and reduced the chance of collateral gastrointestinal thermal injury.The treatment of ascites-assisted ultrasound guided percutaneous radiofrequency ablation of liver cancer was safe and efficacious.

Study on the methods and effect of creating artificial ascites in thermal ablation of liver or kidney tumors under ultrasonic guidance / 中华超声影像学杂志

Objective To evaluate the effect of artificial ascites under ultrasonic guidance in the thermal ablation of liver or kidney tumors ,so as to provide basis for successfully creating artificial ascites , increasing the complete ablation rate of the tumors and reducing the damage of important organs . Methods Seven hundred and thirty-six patients with artificial ascites were performed under ultrasonic guidance during the thermal ablation of liver or kidney tumors and six hundred and seventy-nine patients were successfully performed . The success rate of creating artificial ascites at different sites ,time requirement ,the effect of ascites , puncture times were analyzed , while curative effect and complications were evaluated and summarized . Results The success rate of creating artificial ascites was 92 .3％ ;the average time of creating artificial ascites was( 9 .1 ± 1 .3) minutes ;the average puncture times was( 1 .1 ± 0 .2) times ;complete ablation was 98 .7％ ;the complication of ascites creation was 0 .44％ ,minor complications after ablation was 6 .20％ , severe complications was 0 .59％ . The required fluid volume and success rates for the creation of artificial ascites in different sites were different . The volume of fluid needed was relatively high in the liver-gastric space ,and the success rate was relatively low ;the success rate of liver septum and liver -kidney crypts was the highest . Heat injury complications of the important organs such as gastrointestinal tract ,esophagus , diaphragm near the liver or kidney tumors were 0 . Conclusions The establishment of artificial ascites improves the local curative effect and reduces the complication of tumors ablation in difficult locations . The methods and effect of artificial ascites in different parts of liver or kidney are different .

Value of artificial ascites assisted thermal ablation for hepatic tumors adjacent to the gastrointestinal tract on patients with a history of abdominal surgery / 中华超声影像学杂志

Objective To assess the safety and effectiveness of artificial ascites assisted thermal ablation for hepatic tumors adjacent to the gastrointestinal tract in patients with a history of abdominal surgery . Methods Thirty‐two patients (33 lesions located adjacent to the gastrointestinal tract) with a history of abdominal surgery were included in the study . Method ① :normal saline was injected into abdominal cavity to form water insulation band between liver and gastrointestinal tract . Method② :normal saline was injected with appropriate pressure to form local water insulation band between the liver and gastrointestinal tract . Method③ :normal saline was injected continuously at the interval between liver and gastrointestinal tract to flush away heat energy caused by ablation . All the patients were checked for gastrointestinal tract injury after ablation . During one month after ablation ,CT /MR was performed to evaluate whether the lesions were completely ablated . Results Respectively ,the numbers of lesion received method ① ,② and ③ were 27(81 .8% ) ,4(12 .1% ) and 2(6 .1% ) ,while the usage of normal saline were 400~2 000 ml ,600~800 ml and 1 000~1 500 ml . No gastrointestinal tract injury occurred . CT/MR scan during one month after ablation showed that all the 33 lesions had been completely ablated . Conclusions In patients with a history of abdominal surgery ,artificial ascites is a safe and effective method in assistance of thermal ablation for hepatic tumors adjacent to the gastrointestinal tract .