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Objective:To study the precision of 3D printing coplanar template (3D-PCT) assisted CT-guided radioactive particle implantation using two types of phantoms, and compare the differences between the phantoms, in order to provide reference for radioactive particle implantation.Methods:The needle inserting path was designed in the brachytherapy treatment planning system (BTPS) and the needle tip coordinates were obtained. Following the needle inserting path, the implant needles were inserted into the custom and the liver phantoms, respectively. Then gold markers were implanted through the needles. Subsequently, the needles were withdrawn by 10 mm, and the cold sources were implanted. The coordinates of needle tips, gold markers, and cold sources were recorded. The precision of implanted needles, first particles, and particles after needle withdrawal were obtained by calculating the distance between two points in the space. Finally, the differences between the two phantoms were compared through independent samples t-test. Results:In the 3D-PCT-assisted CT-guided radioactive particle implantation, the precision of implanted needles, first particles, and particles after needle withdrawal in the custom and the liver phantoms was (1.89±0.72) and (2.14±0.88 ) mm ( P>0.05), (2.03±1.14) and (2.42±1.12) mm ( P>0.05), and (-1.96±1.29) and (-2.82±0.91) mm ( t=2.09, P=0.046), respectively. Conclusions:The 3D-PCT-assisted CT-guided radioactive particle implantation is efficient, stable, and precise, showing slight precision differences between the two phantoms.
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Objective To discuss the safety and curative effect of CT -guided percutaneous argon -helium cryoablation in treating leiomyosarcoma. Methods A total of 25 patients with leiomyosarcoma, who were treated at authors' hospital during the period from January 2012 to January 2016, were included in this study. CT-guided percutaneous argon-helium cryoablation was performed in all patients. The local changes of target lesions, the progression - free survival (PFS) and the survival rate were dynamically checked, and the complications were recorded. Results CT examination performed immediately after argon- helium cryoablation indicated that radical frozen ablation was achieved in 13 patients (52％), significant tumor -reductive frozen ablation in 11 patients (44％), effective tumor-reductive frozen ablation in one patient (4％), and invalid tumor-reductive frozen ablation in 0 patient. Follow - up CT examination performed at 3 months after argon - helium cryoablation showed that, based on solid tumor evaluation criteria, complete remission (CR) was obtained in 14 patients, partial remission (PR) in 8 patients and stable disease (SD) in one patient, the total remission rate (CR+PR) was 88％. The local PFS time was (9. 4±6. 2) months. The one-, 2-and 3-year survival rates were 64％, 48％ and 32％ respectively. In this group of cases, neither serious complications such as haemorrhage or tumor lysis syndrome nor procedure-related death occurred. Postoperative mild and moderate complications included fever, skin frostbite, immediate postoperative local pain exacerbation, nerve damage, etc., all of which disappeared or became relived after symptomatic treatment. Conclusion For the treatment of leiomyosarcoma, CT-guided percutaneous targeted argon-helium cryoablation has certain and definite short-term curative effect. CT-guided argon-helium cryoablation is a safe, reliable and minimally-invasive treatment, this technique is worth popularizing in clinical practice. (J Intervent Radiol, 2018, 27:228-232)
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Objective To evaluate the effect of CT-guided percutaneous coaxial needle biopsy combined with microwave ablation (MWA) for the treatment of lung tumors, and to discuss its technique, safety, curative effect and clinical application value. Methods A total of 20 patients with lung tumor, who were admitted to the Department of Interventional Radiology, Shanghai Ruijin Hospital, China, during the period from August 2014 to June 2016, were collected. Among the 20 patients, primary pulmonary cancer was diagnosed in 9 and metastatic tumor in 11. A total of 23 tumor lesions were detected, and CT-guided percutaneous coaxial needle biopsy combined with MWA was performed for all lesions. Based on the size and shape of the tumor, the corresponding ablation power and time of duration were set up. After the treatment, the patients were followed up for 4-26 months, and chest enhanced CT examination was regularly reexamined to assess the curative effect. Results Percutaneous coaxial needle biopsy was carried out for 23 lesions, the tumor diameters ranged from 0.80 cm to 2.40 cm, with a mean of 1.39 cm. MWA was employed for 23 lesions. CT scan performed immediately after MWA showed that the density of tumor lesion became decreased, the diagnostic positive rate of needle biopsy was 83.3％. After the treatment, complete remission was obtained in 15 patients, partial remission in 2 patients, stable disease in one patient, and progression.
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Objective To compare the dose distribution of postoperative plans with preoperative plans of 3D-printing template (coplanar and non-coplanar) assisted and CT-guided 125I seed implantation for the treatment of soft tissue sarcoma,and to explore the accuracy of treatment at dosimetry level.Methods From December 2015 to July 2017,19 patients with soft tissue sarcoma (a total of 25 lesions)were treated with 3D printing template assisted and CT-guided 125I seed implantation in Peking University Third Hospital.All patients underwent preoperative assessment,CT simulation orientation,preoperative planning,3D-template printing,3D-template reduction,needle and seed implantation,postoperative dosimetry assessment,postoperative care and follow-up.The preoperative and postoperative dosimetric parameters were conpared.Ten cases of soft tissue sarcoma in superficial trunk or limbs were screened.Preoperative planning of coplanar template and non-coplanar template were designed respectively.The dosimetric parameters of preoperative planning guided of two templates were compared.Results Twentyfive 3D-printing templates were designed and constructed,and 25 lesions were totalled.There was no statistical difference between preoperative and postoperative dosimetric parameters.There was no statistical difference of the preoperative plan's dosimetric parameters between coplanar and non-coplanar in soft tissue sarcoma of superficial trunk/limbs.Conclusions The validation of actual dose distribution in postoperative plans assisted by 3D-printing template in 125I seed implantation showed that most of parameters could meet the expectation of preoperative plans,which indicated the improvement in accuracy for this new modality.For soft tissue sarcoma located in the superficial trunk/limbs,it was recommended to select the 3D-printing coplanar template firstly.
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Objective To compare the accuracy of 125I seeds longitudinal distance between groups by degradable catheters and hand.Methods The study was divided into two groups (implantation by degradable catheters and that by hand).There were 12 simulated lesions in each group.Seed needle and 125I seeds were implanted by three physicians according to the set longitudinal distance (0.5 and 1.0 cm).Postoperative CT was conducted and the longitudinal distance between seeds was measured,and then the data was analyzed between the actual distance and the designed distance in each group.Results The degree of deviation from the set distance were (0.184 ±0.047) and (0.127 ±0.051) cm in the group by hand,and (0.007 ± 0.006) and (-0.003 ± 0.006) cm in degradable catheters group.The degree of deviation of the seeds in the catheter group was significantly lower than the group by hand (t =3.804,2.499,P ＜0.05).Conclusions The accuracy of the longitudinal distance of the group by catheter is much better than that by hand.
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Objective To evaluate the clinical value of CT-guided 125I particle implantation combined with iliac artery infusion chemotherapy in treating refractory and recurrent pelvic malignant tumors.Methods A total of 35 patients with refractory and recurrent pelvic malignant tumor,who were admitted to authors' hospital during the period from January 2013 to January 2016 to receive CT-guided 125I particle implantation combined with iliac artery infusion chemotherapy,were selected and used as the study group,while other 39 patients with refractory and recurrent pelvic malignant tumor received simple 125I particle implantation and were used as the control group.The short-term and long-term curative effect,as well as the improvement of clinical symptoms,were compared between the two groups.Results The objective effective rate and the benefit rate in the study group were 60.0％ (21/35) and 85.7％ (30/35) respectively,while those in the control group were 53.8％ (21/39) and 84.6％ (33/39) respectively,the differences between the two groups were not statistically significant (P=0.594 and P=0.894 respectively).In the study group the mean disease progressionfree period was 12.2 months,which was 3.6 months longer than that of 8.6 months in the control group,the difference between the two groups was statistically significant (P=0.002).The recurrence rates in the study group and the control group were 40.0％(12/30) and 57.6％ (19/33) respectively,the difference between the two groups was statistically significant (P=0.018).The mean preoperative and postoperative KPS values in the study group were 72.4 points and 82.7 points respectively,which in the control group were 68.9 points and 79.1 points respectively;in each group statistically significant difference existed between the preoperative KPS value and the postoperative one (P=0.043 and P=0.039 respectively),however,no statistically significant difference in postoperative KPS value existed between the study group and the control group (P=0.745).Conclusion For the treatment of refractory and recurrent pelvic malignant tumors,CT-guided 125I particle implantation is an effective therapy,however,combination use of iliac artery infusion chemotherapy can reduce the incidence of tumor recurrence and prolong the disease progression-free period.
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Objective:To explore the clinical efficacy of microwave ablation under CT-guidance for patients with liver cancer of the first hepatic hilar region at advanced period.Methods: 56 patients with liver cancer of the first hepatic hilar region at advanced period, who had lost the chance of operative treatment, were divided into observation group (28cases) and control group (28cases) as the random number table. The patients of observation group received CT-guidance microwave ablation and other targeted combining therapy while patients of control group underwent routine chemotherapy of arterial embolism. The therapeutic effect and survival situation of the two groups were compared and analyzed.Results: The total effective rate of patients with liver cancer of the observation group(82.14%) was significantly higher than that of control group (46.43%)(x2=7.778,P<0.05). The AFP of both of the two group was obviously reduced, and the improvement degree of observation group was significantly better than that of control group (t=14.662,P<0.05). The survival rate of post-operative 1-2 y of observation group was slightly higher than that of control group, but it was no significant (x2=4.156,x2=0.080,P>0.05).During the process of treatment and post the process of treatment, the occurrence rate of adverse reaction of observation group was significantly lower than that of control group (x2=6.842,P<0.05).Conclusion: The microwave ablation under CT-guidance and other targeted combining therapy has outstanding advantages including simple operation, curative precision and so on. And it has better curative effect for patients with liver cancer of the first hepatic hilar region at advanced period who had lost optimum opportunity of operative treatment. Besides, its adverse reaction is lower and it has obviously preponderance to compare with routine arterial embolism.
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Objective:To explore the clinical efficacy of microwave ablation under CT-guidance for patients with liver cancer of the first hepatic hilar region at advanced period.Methods: 56 patients with liver cancer of the first hepatic hilar region at advanced period, who had lost the chance of operative treatment, were divided into observation group (28cases) and control group (28cases) as the random number table. The patients of observation group received CT-guidance microwave ablation and other targeted combining therapy while patients of control group underwent routine chemotherapy of arterial embolism. The therapeutic effect and survival situation of the two groups were compared and analyzed.Results: The total effective rate of patients with liver cancer of the observation group(82.14%) was significantly higher than that of control group (46.43%)(x2=7.778,P<0.05). The AFP of both of the two group was obviously reduced, and the improvement degree of observation group was significantly better than that of control group (t=14.662,P<0.05). The survival rate of post-operative 1-2 y of observation group was slightly higher than that of control group, but it was no significant (x2=4.156,x2=0.080,P>0.05).During the process of treatment and post the process of treatment, the occurrence rate of adverse reaction of observation group was significantly lower than that of control group (x2=6.842,P<0.05).Conclusion: The microwave ablation under CT-guidance and other targeted combining therapy has outstanding advantages including simple operation, curative precision and so on. And it has better curative effect for patients with liver cancer of the first hepatic hilar region at advanced period who had lost optimum opportunity of operative treatment. Besides, its adverse reaction is lower and it has obviously preponderance to compare with routine arterial embolism.
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As an interstitial brachytherapy,radioactive seed implantation could provide high doses in the local site and minimal doses at surrounding normal tissues.It has become one of the best choice for early stage prostate carcinoma.Radioactive seeds were implanted under the guidance by ultrasound,CT and MRI,featured with surgical and interventional treatment.Based on dosimetry for target and organs at risk,radioactive seed implantation is multiple disciplinary.In order to acquire the accurate and high quality seed implantation,it is necessary to set up a team including surgeons,radiation oncologists,interventional doctors and nuclear medicine doctors.The content of the consensus is as follows:radiation physics and dosimetry,indications,side-effects and 3 D-printing template work-follow.Despite the benefit of radioactive seed implantation for solid carcinoma,there still a compelling need for prospective randomized and stage Ⅲ clinical trials from multiple centers,so as to upgrade the evidencebased level,above all confirm the role of radioactive seed implantation in the comprehensive treatment of tumors.
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Objective To discuss the optimalselection of the puncture path in performing CT-guided pericardial drainage,and to evaluate its clinical feasibility and safety.Methods A total of 114 patients with pericardial effusion,who were admitted to authors' hospital during the period from May 2013 to March 2016,were enrolledin this study.The appropriate body position and suitable needle-puncturing route were selected,and CT-guided pericardial drainage with Seldinger'stechnique was performed.Results Successful puncturing and catheter drainage was obtained in all 114 patients,no any serious complication occurred.The time used for manipulation was 18-30 min.Conclusion The use of right puncture path is of great importance for the performance of CT-guided pericardial drainage for pericardial effusion,this technique is highly feasible and safe for relieving the clinical symptoms of pericardial tamponade.
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Objective:To investigate the effect of enteral nutrition support by CT-guided percutaneous gastrostomyon the nutritional status of patients with esophageal cancer complicated with dysphagia during radiotherapy.Methods:Therewere46 cases of esophageal cancer patients with dysphagia treated with CT-guided percutaneousgastrostomy.Others 43 cases of esophageal cancer by oral feeding in patients with dysphagia as control groupduringthe sametimein our hospital radiotherapy center.Patients in the observation group were ingested daily through the gastrostomy,and the nutritional intake of the control group included oral ingestion and intravenous infusion.All patients were measuredthe body height,body weight (BW).body mass index (BMI),Serum levels of serum albumin (ALB),pre-albumin (PA) and hemoglobin (HB) before and after radiotherapy.We also observed the incidence of acute radiation esophagitis and the completion of the treatment plan during radiotherapy in both groups,and to observe the two groups of patients the incidence rate of radiotherapy and treatment plan during the completion of acute radiation esophagitis.Results:There was no significant difference in BW,BMI,ALB,PA,HB before radiotherapy between the two groups (t =0.84,0.63,-1.07,-0.81,1.48,P ＞ 0.05).The BW,BMI,ALB,PA and HB of the observation group were significantly higher than those of the control group at the end of radiotherapy,which werestatistically significant (t=3.30,4.65,6.82,43.56,31.91,P ＜ 0.01).During the radiotherapy,the total incidence of acute radiation esophagitis in the observation group was significantly lower than that in the control group,(x2=3.971,P＜ 0.05).In addition,the completion rate of the observationgroup was significantly higher than that of the control group (x2 =6.811,P ＜ 0.01).Conclusion:To the Patients with dysphagia of esophageal cancer,enteral nutrition byCT guided percutaneous gastrostomy,can improve the malnutrition,the immune function of the patients and reduce the acute radiation esophagitis during radiotherapy and ensure the successful completion of the treatment plan.
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Objective To investigate the risk factors of pneumorrhagia and pneumothorax occurring after CT-guided cutting needle biopsy for pulmonary solid nodules.Methods The clinical data and imaging materials of 320 patients with pulmonary solid nodule (≤3 cm),who received 16 G semi-automatic cutting needle biopsy,were retrospectively analyzed.Both univariate and multivariate logistic regression analysis methods were used to evaluate the risk factors of pneumorrhagia and pneumothorax.Results The incidence of needle track hemorrhage was 33.1％ and the incidence of pneumothorax was 18.1％,the diagnostic accuracy for benign and malignant nodules was 99.6％.Needle track length was an independent risk factor for pneumorrhagia;every increase of 3 cm in needle track length,the risk of pneumorrhagia would increase 3.881 times,besides,the risk of pneumorrhagia had a parallel relationship with the time used for puncturing (P=0.061) as well as with the number of pleural puncturing (P=0.062).The age,lesion's location and needle-pleural angle were independent risk factors for pneumothorax.Each increase of 10 years in age,the risk of pneumothorax would increase 2.102 times.The pneumothorax risk of pulmonary lesion located at upper lung lobe was strikingly lower than that of pulmonary lesion located at lower lung lobe.Each increase of 20 degrees in needle-pleural angle,the risk of pneumothorax would increase 2.413 times.Emphysema was excluded from the equation because it had only a minute difference (P=0.086).Based on the pneumorrhagia and pneumothorax probability values,ROC curves of pneumorrhagia and pneumothorax were drawn,and AUC values of pneumorrhagia and pneumothorax were 0.753 and 0.725 respectively.Conclusion The occurrences of pneumorrhagia and pneumothorax after CT-guided cutting needle biopsy for pulmonary solid nodules are affected by many factors.Careful preoperative evaluation and skilled intraoperative manipulation can effectively reduce the incidence of pneumorrhagia and pneumothorax.
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Objective To evaluate the clinical effect of CT-guided radiofrequency thermal coagulation in treating primary trigeminal neuralgia.Methods A total of 165 patients with primary trigeminal neuralgia were selected as research objects.The patients were randomly divided into radiofrequency thermal coagulation group (study group,n=83) and drug damage group (control group,n=82).For the treatment of trigeminal neuralgia,CT-guided radiofrequency thermal coagulation was carried out in the patients of the study group,and CT-guided percutaneous puncturing of oval foramen with epirubicin injection as chemical damage therapy was employed in the patients of the control group.Follow-up check-up was conducted at 3,6,12 and 36 months after the treatment.Visual analog score (VAS),total effective rate and incidence of complications were calculated and the results were compared between the two groups.Results The excellent therapeutic rate of the study group was significantly better than that of the control group,the difference between the two groups was statistically significant (P＜0.05).The incidence of complications in the study group was remarkably lower than that in the control group,the difference between the two groups was statistically significant (P＜0.05).The VAS pain score of the study group was much lower than that of the control group.The total therapeutic effect in the study group was more prominent.Conclusion In treating primary trigeminal neuralgia,CT-guided radiofrequency thermal coagulation has excellent clinical effect.Therefore,this technique is worthy of popularization and application in clinical practice.
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Objective To compare the puncturing hit rate,positive rate of pathological diagnosis and the incidence of complications between color Doppler ultrasound-guided and CT-guided percutaneous biopsy for the qualitative diagnosis of ultrasonic-visual chest lesions.Methods A total of 112 patients,who were encountered from January 2015 to June 2016 in authors' hospital and whose imaging materials suggested the presence of ultrasonic-visual chest lesions,were enrolled in this study.There were no bones or lung air between the thoracic skin and chest lesion to hinder imaging observation.Ultrasound-guided puncturing was employed in 52 patients (ultrasound-guided group) and CT-guided puncturing was adopted in 60 patients (CT-guided group).The puncturing hit rate,positive rate of pathological diagnosis and the incidence of complications were compared between the two groups.Results The puncturing hit rate in ultrasound-guided group was 100％ (52/52),which was higher than 91.7％ (55/60) in CT-guided group.The positive rate of pathological diagnosis in ultrasound-guided group was 96.2％ (50/52),which was higher than 80.0％ (48/60)in CT-guided group.The incidence of complications in ultrasound-guided group was 3.8％ (2/52),which was lower than 18.3％(11/60) in CT-guided group.Conclusion For the qualitative diagnosis of ultrasonic-visual chest lesions,ultrasound-guided percutaneous biopsy is more reliable than CT-guided percutaneous biopsy.
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Objective To compare the pre-and post-operative tumor target volume and to examine the consistency in physical dosimetric parameters of organs at risk (OAR) following 3D-printed coplanar template (3D-PCT)-assisted and CT-guided radioactive seed implantation.Methods The 3D-printed coplanar template was designed using a computer software, and the coordinate system was established where the center was used as the basis for setting the x axis and y axis.Crosses defining the center of treatment were drawn on the patient''s body and matched with the corresponding central point, x axis, and y axis of the coplanar template.3D-PCT-assisted and CT-guided radioactive seed implantation was performed based on the pre-operative plan, and the pre-operative, operative, and post-operative plans were designed to evaluate the target tumor volume and the normal dose received by the tissues.In addition, dosimetric parameters, including D90(minimum dose received by 90% of the gross target volume), V100, V150, V200(percentage of GTV that received 100%, 150%, and 200% of the prescribed dose, respectively), minimum peripheral dose (MPD), conformal index (CI), external index (EI), and homogeneity index (HI) in the pre-operative and post-operative plans were also assessed and compared using the Wilcoxon test. Results Fourteen patients treated in our institution from August to October, 2016 were included in this study. The median age of the patients was 61.5 years, and the median Karnofsky Performance Scale score was 80. A total of 14 lesions from the 14 patients were treated by seed implantation in the neck (n=4), chest (n=3), abdomen (n=5), and pelvis (n=2). Of the 14 patients that underwent implantation, 8 had previously received radiation therapy, and 6 had not received radiation therapy. Dosage optimization was performed for all patients during the operation. The median activity of the implanted seeds was 0.625 mCi (0.55-0.75 mCi,1 Ci=3.7×1010 Bq), and the preoperatively planned median number of needling and implanted seeds were 9(4-34) and 45.5(10-162), respectively. However, the actual median number of needling and implanted seeds were 9.5(4-34) and 45.5(10-162), respectively. Dosimetric analysis showed that there were no significant changes in tumor volume (P=0.135), D90(P=0.208), MPD (P=0.104), V100(P=0.542), V150(P=0.754), V200(P=0.583), CI (P=0.426), EI (P=0.326), and HI (P=0.952) after implantation. Conclusions 3D-PCT guidance and dosage optimization can result in good consistency between pre-and post-operative plans for radioactive seed implantation. 3D-PCT is a convenient and cheap technique suitable for large-scale clinical application.
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Objective To study the guided interstitial implantation of125I seeds combined with S-1 in the treatment of elderly patients with pancreatic cancer treatment in CT, to evaluate the clinical value of the actual.Methods60 cases of elderly patients with pancreatic cancer in Pujiang People's Hospital from January 2013 to December 2016 were selected as the research object in this study.They were randomly divided into two groups, the control group and the experimental group, each with a total of 30 cases.The control group of patients with S-1 in the treatment.The experimental group with,125I implantation combined with S-1 treatment.Comparative analysis of the control group and the experimental group of patients with treatment effect and toxicity.ResultsAfter different treatment, 30 patients in the experimental group, 9 patients were invalid, the total effective number of cases was 21 cases, the effective rate was 70%.The control group of 30 patients, 19 patients were invalid, the total effective number of cases was 11 cases, the effective rate was 36.7%.Therefore, the effective rate of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05).The disease control rate of the experimental group was 90%, the clinical benefit rate was 50%, the control rate of the patients in the control group was 60%, and the clinical benefit rate was about 23.3%,.The control rate of patientsand the clinical benefit rate of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05).There was no significant difference between the experimental group and the control group.ConclusionCT guided interstitial implantation of125I seeds combined with S-1 in the treatment of elderly patients with pancreatic cancer can improve the treatment efficiency to a great extent, to help alleviate the suffering of patients, with further clinical promotion and application significance.
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Objective To analyze the factors related to the occurrence of complications in performing CT-guided percutaneous lung biopsy with 18 G-Bard Magnum needle. Methods CT-guided percutaneous lung biopsy with 18 G-Bard Magnum needle was carried out in a total of 58 patients. The postoperative complications were recorded, and the related factors causing complication were analyzed. Results Successful puncturing was achieved in all patients with a technical success rate of 100%. Postoperative complications included pulmonary hemorrhage (n=11,19.0%), a little amount of bleeding in needle tract (n=7,12.1%), hemoptysis (n=3,5.2%), hemothorax (n=1,1.7%), and pneumothorax (n=10,17.2%). Chi-square test showed that the occurrence of pulmonary hemorrhage bore a close relationship to the lesion’s diameter, the distance between the lesion and the chest wall, the lesion’s location and times of puncturing (P<0.05). The occurrence of pneumothorax was closely correlated with the age, the distance between the lesion and the chest wall, the presence of perifocal emphysema, the lesion’s location and times of puncturing (P<0.05). Univariate analysis indicated that the postoperative complications were liable to occur in the patients whose imaging examination showed perifocal emphysema and lung hilar lesion, and who had more than two independent risk factors (P<0.05). Conclusion CT-guided percutaneous lung biopsy with 18 G-Bard Magnum needle is an accurate and safe technique with relatively higher positive diagnosis rate, but this technique should be carefully used in patients who has perifocal emphysema, or lung hilar lesion, or more than two independent risk factors.(J Intervent Radiol, 2015, 24:792-796)
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Objective To discuss the clinical application of percutaneous transhepatic cholangiopancreatic drainage (PTCD) combined with CT-guided microwave ablation in treating hepatic hilar cholangiocarcinoma. Methods The clinical data of 29 patients with inoperable Ⅲ and Ⅳ type hilar cholangiocarcinoma complicated by obstructive jaundice, who were admitted to authors’ hospital during the period from December 2012 to August 2014, were retrospectively analyzed. The diagnosis of bile duct adenocarcinoma was confirmed by pathology in all patients. Of the 29 patients, both internal and external biliary tract drainage was employed in 19, external biliary tract drainage in 4, and bilateral (both left and right side) bile duct drainage in 6. CT-guided microwave ablation was carried out when the liver function became improved. A total of 46 procedures of microwave ablation were completed in the 29 patients with a mean of 1.5 times per patient. Hepatic function tests, enhanced CT or MR scan were performed 4-8 weeks after treatment. According to mRECIST criteria the therapeutic results were evaluated; the serum bilirubin levels were recorded; the disease progress and the patient’s survival time were followed up. Results One month after the treatment, complete response (CR) was obtained in 15 patients (15/29, 51.7%), and partial remission (PR) in 17 patients (17/29, 58.6%), with the overall efficacy (CR﹢PR) being 82%. After the treatment, one patient developed hepatic metastasis and another one had pulmonary metastasis. Postoperative serum bilirubin levels showed an obvious decrease in all 29 patients. The 6-month, one-year and two-year survival rates were 68.9% (20/29), 31.0% (9/29) and 6.8% (2/29) respectively; the median survival time was 8.9 months and the overall survival time was 11.7 months. Conclusion For the treatment of hepatic hilar cholangiocarcinoma, PTCD combined with CT-guided microwave ablation is minimally invasive, clinically safe and effective.
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Objective To summarize the nursing points for patients with primary hepatocellular carcinoma (HCC) who are receiving CT-guided percutaneous microwave ablation treatment. Methods A total of 77 HCC patients were enrolled in this study. CT-guided percutaneous microwave ablation treatment was carried out in all patients. High quality perioperative nursing care was implemented, and the adverse reactions were analyzed and summarized. Results CT-guided percutaneous microwave ablation was successfully accomplished in all the 77 cases. After the treatment, different degrees of pain occurred in 29 cases, liver function damage was detected in 6 cases, and pneumothorax was seen in one case. After active treatment and nursing, the clinical conditions were effectively controlled in all patients. No death occurred in perioperative period. Conclusion With the help of sufficient preoperative preparation, close intraoperative cooperation and postoperative effective treatment and nursing, the clinical condition is significantly improved, the complications have been effectively prevented and reduced, and the patient’s quality of life is also improved.
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Objective To evaluate the safety, efficacy and local control effect of CT- guided radiofrequency ablation (RFA) in treating non-small-cell lung cancer (NSCLC) that is inoperable or the surgical treatment is refused by the patient. Methods Between March 2007 and March 2010 at authors’ hospital, a total of 68 procedures of CT-guided RFA were carried out in 60 patients with early stage NSCLC. The patients included 37 males and 23 females with a mean age of 68.5 years. Pathologically, the lesions included squamous cell carcinoma (n=23, 38.3%), adenocarcinoma (n=31, 51.7%), large cell carcinoma (n=2, 3.3%) and adeno-squamous carcinoma (n=4, 6.7%). The mean diameter of the lesions was 3.8 cm (1.8-6.8 cm). The overall survival rate, cancer-specific survival rate and local progression-free survival rate were evaluated. Results RFA procedure was well tolerated by all patients with an average ablation time of 35 min (18-63 min). The main intraprocedural complication was pneumothorax (n=17, 28.3%). No death occurred during perioperative period. The median local progression-free survival time was 28 months, the median survival time was 32 months, and the one-, 2- and 3-year local progression-free survival rate were 94.6%, 83.1%and 73.6%, respectively. Conclusion For patients with inoperable NSCLC and patients with NSCLC who refuse to receive surgery, CT-guided RFA is a safe and effective treatment. This therapy can significantly improve the local progression-free survival rate.