Risk factors of residual tumor in single small hepatocellular carcinoma after thermal ablation treatment / 中华内科杂志

Objective:To evaluate the risk factors of residual tumor after thermal ablation in patients with small hepatocellular carcinoma.Methods:This was a retrospective study recruiting 107 patients diagnosed as single hepatocellular carcinoma with maximum diameter ≤3 cm from December 2009 to August 2015 in National Cancer Center. The cohort enrolled 81 males and 26 females, including 83 patients younger than 70 years old. All patients were treated with radiofrequency ablation or microwave ablation, and evaluated by CT or MRI after 4-6 weeks compared with baseline data. Potentially related factors were analyzed such as patients′ characteristics, tumor location and adjacent, ablation pattern, hepatitis B/C infection. A multivariate logistic regression analysis was conducted for the independence of risk factors.Results:Six patients (5.6%) with residual tumor was detected in the whole population of 101 cases. Univariate analysis suggested that tumor adjacent to vascular structure, poor differentiation, AFP≥200 μg/L were the risk factors of residue disease (all P<0.05). Multivariate logistic regression suggested that pathological type of poorly differentiated tumor was the only independent risk factor ( HR=2.26,95% CI 0.25-20.50, P=0.030). Conclusions:Poorly differentiated pathology is an independent predictive factor for residual disease in small hepatocellular carcinoma after thermal ablation. Such patients should be routinely followed up after operation.

Comparative analysis of curative effect of percutaneous radiofrequency ablation and open resection for primary small and medium liver cancer / 中国现代普通外科进展

Objective:To investigate the effects of radiofrequency ablation and hepato-recetion in the treatment of less than 5 cm of primary liver cancer.Methods:A retrospective analysis from January 2009 to December 2014 in Department of hepatobiliary surgery,Chifeng Hospital treated 255 cases of primary liver cancer patients,including 130 cases of tumors less than 5 cm.They were divided into treatment group (percutaneous radiofrequency ablation) and control group (open surgery group),To get evaluation of effects preliminarily,aH patients were followed up with ultrasonography and blood tests,etc.Results:Percutaneous radiofrequency ablation group after 1,3,5 year overall survival rate was 93.7％,69.8％,15.9％,Patients in the control group were 1,3 and 5 years overall survival rate was 92.5％,74.6％,17.9％.Two groups had no significant difference between the survival period,percutaneous radiofrequency ablation group after 1 and 3 and 5 years disease-free survival was 81％,33.3％,1.6％;laparotomy in the control group after 1,3 and 5 years disease-free survival was 88.1％,53.7％,10.4％,the difference was statistically significant between the two groups.Conclusion:Compared with the operation group,the radiofrequency ablation group recovered faster and had less complications,and the difference between the two groups was statistically significant.Compared with open operation group,primary percutaneous radiofrequency ablation for primary small and medium liver cancer has similar long-term therapeutic effect.Percutaneous radiofrequency ablation has less trauma,less complications and shorter hospital stay than that of the control group.

The effect and influencing factors of percutaneous radiofrequency ablation for the treatment of benign thyroid nodules / 中华医学超声杂志（电子版）

Objective To explore the curative effect and influencing factors of percutaneous radiofrequency ablation(PRFA)for benign thyroid nodules in order to improve the effect of thyroid benign nodule ablation treatment.Methods The study included 482 benign thyroid nodules.The largest diameter of benign thyroid nodules ranges from 0.7 to 9.2 cm.Two hundred and fifty-eight nodules were solid nodules,224 nodules were cystic-solid nodules,and 96 thyroid nodules combined with the background of Hashimoto's thyroiditis.The patients of this study included 356 females and 126 males,the ages of the study population ranged from 14 to 82 years old.In order to observe the local pain,swelling,skin infection,hoarseness and other complications of the thyroid nodules with PRFA,we conducted conventional ultrasound and contrast-enhanced ultrasound immediately and followed up in 1,3,6,12,18 and 24 months after the treatment.Besides,the nodule volume reduction ratio was calculated,and the effects of gender,age,nodule size,cystic proportion,and the background of Hashimoto's thyroiditis on the treatment were analyzed.Results The volume of benign thyroid nodules after the PRFA treatment was significantly reduced after 1,3,6,12,18,24 months,and their nodule volume reduction ratio(VRR)was(51.2±5.7)%(1 months),(69.7±4.3)%(3 months),(84.6±3.7)%(6 months),(89.3±2.9)%(12 months),(93.7±1.6)%(18 months)and(94.9±1.4)%(24 months),respectively.The thyroid nodules were divided into 3 groups according to the cystic portion,significant differences were found in the volume reduction rate at 1,3,6,12,18 and 24 months after PRFA(F=66.858,69.101,19.410,49.559,146.653 and 309.950 respectively,all P＜0.001),the more cystic portion was,the faster the lesion shrinked.The nodules with the cystic portion ＜ 20%were grouped according to the maximum diameter(≤3 cm/＞3 cm),and the background of Hashimoto's disease; and significant differences were found in the volume reduction rate at 1,3,6,12,18 and 24 months after PRFA(the t values for different size groups were 9.710,8.925,9.899,12.734,17.226 and 42.580,respectively,the t values for whether there is a background of Hashimoto's disease were 66.858,69.101,19.410,49.559,146.653,309.950,respectively,all P ＜ 0.001).The VRR of nodules of which the maximum diameter ≤ 3 cm,or without Hashimoto's thyroiditis was larger after radiofrequency ablation.The nodules of which the maximum diameter≤3 cm and with the cystic portion ＜20%were grouped according to different genders(male or female)and different ages(≤40 or＞40 years old),and the mean VRR of the nodules between different gender and age groups are not significantly different(P＞0.05).Conclusions Ultrasound guided PRFA is a safe and effective minimally invasive therapy for benign thyroid nodules.

3D printing navigation template-guided percutaneous radiofrequency thermocoagulation for V2 trigeminal neuralgia treatment / 华西口腔医学杂志

OBJECTIVE@#This paper aimed to evaluate the effectiveness of the 3D printing puncture navigation template-guided percutaneous radiofrequency thermocoagulation for V2 trigeminal neuralgia treatment.@*METHODS@#A total of 52 patients with V2 trigeminal neuralgia were treated with radiofrequency thermocoagulation. A total of 32 patients were treated under the guidance of the 3D printing puncture navigation template (guide plate group), while 20 patients underwent puncture via pterygopalatine fossa routinely (routine treatment group). The puncture time, operation time, puncture success rate, and immediate postoperative pain were recorded. The degree of immediate postoperative pain was indicated by visual analogue scale (VAS). Barrow Neurological Institute (BNI) classification criteria were used to evaluate the efficacy, and the postoperative complications were observed. All patients were followed up for 1 year.@*RESULTS@#The two groups showed significant decrease in VAS after the operation (P0.05).@*CONCLUSIONS@#3D printing puncture navigation template-guided radiofrequency thermocoagulation may increase the operation success rate and reduce complication incidence. Therefore, this technique possesses clinical promotional value.

Cost-benefit analysis of different surgical methods in patients with trigeminal neuralgia / 重庆医学

Objective To analyze the cost-benefit ratio of primary trigeminal neuralgia patients with bad drug control and never accepted the surgical treatment through surgery [including microvascular decompression (MVD) ,percutaneous radiofrequency rhizotomy (RFR) ,stereotactic radiotherapy (SRS)] .Methods A total of 89 patients with primary trigeminal neuralgia who under-went surgical treatment for the first time from 2005 to 2013 were enrolled in this study ,including 27 patients with MVD ,23 patients with RFR and 39 patients with SRS .Evaluation criteria (effect factors) include facial pain (excellent :no pain and no drug treat-ment ;good :no pain but medication ;worse:less than 50% of patients with pain ;worse:more than 50% of patients with facial pain or need to undergo secondary surgery ) ,numbness ,cost and .Results The mean age of the patients treated with MVD was (50 .4 ± 14 .3)years old ,RFR was(73 .2 ± 13 .6) years old SRS was (72 .6 ± 11 .8) years old ,MVD group was younger than RFR and SRS group(P<0 .05);The average total cost of each surgical approach as follows :MVD was 50274 yuan ,RFR was 4539 yuan ,SRS was 38512 yuan (P<0 .05);The postoperative facial numbness proportion of MVD was 1 .1% ,RFR was 52 .2% and SRS was 28 .2% (P<0 .05);The ratio of patients who needed recurrent surgery in two years was MVD 26 .0% ,RFR 73 .9% and SRS 30 .7% (P<0 .05);The mean remission rate of MVD was 1 .6 years ,the RFR was 2 .1 years ,and the SRS was 1 .0 year(P<0 .05);The cost-benefit ratio of MVD was 31618 yuan ,RFR was 1982 yuan ,SRS was 39297 yuan(P<0 .05) .Conclusion The cost-ben-efit ratio of the three surgical from low to high were RFR ,MVD ,SRS ,which means the unit cost of RFR gain the highest ,followed by M VD and SRS .

Comparison of nerve combing and percutaneous radiofrequency thermocoagulation in the treatment for idiopathic trigeminal neuralgia / Comparação entre neurólise interna e termocoagulação percutânea por radiofrequência no tratamento da neuralgia idiopática do trigêmeo

ABSTRACT INTRODUCTION: Idiopathic trigeminal neuralgia (ITN) is a common pain disease in elderly people. Many methods have been used to alleviate the pain of patients, but few studies in the literature have compared the effect of nerve combing and percutaneous radiofrequency thermocoagulation. OBJECTIVE: The purpose of this study was to describe and evaluate the clinical outcome of idiopathic trigeminal neuralgia after nerve combing (NC) and compare them with those obtained using percutaneous radiofrequency thermocoagulation (RF). METHODS: The study included 105 idiopathic trigeminal neuralgia patients with similar symptom, age and underlying disease, which were divided into two groups. One group was treated by nerve combing (50 patients), the other by RF (55 cases). All patients were considered medical failures prior to the surgeries. A questionnaire was used to assess the long-term outcomes: pain relief, recurrence, complication and need for additional treatment. RESULTS: The median duration of follow-up in both groups was 90 months. Satisfactory relief was noted in 41 patients (82%), 5 patients (10%) initially experienced pain relief, then recurred, and four patients (8%) were designated poor among the group NC. In the group RF, satisfactory relief was noted in 42 patients (76.4%). There were eight "pain free with recurrence patients (14.5%) and 5 poor cases (9.1%). No statistically significant differences existed in the outcomes between both groups (p > 0.05). Postoperative morbidity included dysesthesia, diplopia, partial facial nerve palsy, hearing loss, tinnitus, cerebrospinal fluid leak, meningitis and mortality. CONCLUSION: Nerve combing and RF are both satisfactory treatment strategies for patients with ITN. Because of the higher risk of sensory morbidity and surgical risk as open surgery, RF is preferred as the recommended procedure for patients with ITN.

Resumo Introdução: A neuralgia idiopática do trigêmeo (NIT) é uma condição dolorosa comum em idosos. Muitos métodos têm sido usados para aliviar a dor dos pacientes, mas poucos estudos na literatura compararam o efeito de neurólise interna e termocoagulação percutânea por radiofrequência. Objetivo: O objetivo desse estudo foi descrever e avaliar o desfecho clínico de pacientes com neuralgia idiopática do trigêmeo após neurólise interna (NI) e compará-los com os obtidos usando termocoagulação percutânea por radiofrequência (RF). Método: O estudo incluiu 105 pacientes com NIT com sintomas, idade e doenças de base semelhantes, que foram divididos em dois grupos. Um grupo foi tratado por neurólise interna (50 pacientes) e o outro por RF (55 casos). Todos os pacientes haviam sido considerados fracassos terapêuticos antes das cirurgias. Um questionário foi utilizado para avaliar os resultados a longo prazo: alívio da dor, recorrência, complicações e necessidade de tratamento adicional. Resultados: A duração média do acompanhamento foi de 90 meses em ambos os grupos. Alívio satisfatório foi observado em 41 pacientes (82%); cinco pacientes (10%) experimentaram alívio inicial da dor, porém seguido de recrudescimento, e quatro pacientes (8%) apresentaram desfecho desfavorável no grupo NI. No grupo de RF, alívio satisfatório foi observado em 42 pacientes (76,4%). Houve oito pacientes livres de dor, com recorrência ''LDR'' (14,5%) e cinco casos com desfecho desfavorável (9,1%). Não houve diferenças significantes nos resultados entre os dois grupos (p > 0,05). Morbidade pós-operatória incluiu disestesia, diplopia, paralisia parcial do nervo facial, perda auditiva, tinnitus, fístula liquórica, meningite e óbito. Conclusão: Neurólise interna e RF são estratégias satisfatórias de tratamento para os pacientes com NIT. Em decorrência da maior morbidade sensorial e maior risco cirúrgico em uma cirurgia aberta, a RF é o procedimento mais indicado para pacientes com NIT.

Observation of the results in the treatment of Sequential hepatic arteria chemoembolization,percuta-neous radiofrequency ablation for hepatocellular carcinoma / 中国医师杂志

Objective To investigate the efficacy and safety of combination of transcatheter arterial chemoembolization (TACE)and percutaneous radiofrequency ablation (RFA)in treatment of hepatocellular carcinoma (PHC).Methods 70 cases of PHC were divided into combined group (TACE +RFA,n =37) and control group (only TACE,n =33).Patients were followed up for1 to 2 years,and the therapeutic effects and side effects were compared between the two groups.Results The patients with tumor completely necrosis and AFP level lower than >50% in combined group were significantly more than those in control group (P <0.05);the half of year,one year and two years survival rate in combined group were greatly higher than those of control group;no severe side effect was observed in two groups.Conclusions TACE+RFA is effective and safe in treatment of PHC of more than 5 cm in diameter.

Temperature variation during percutaneous radiofrequency ablation treatment for vertebral tumor:an in vivo study in experimental rabbits / 介入放射学杂志

Objective To investigate the temperature variation within intra-spinal canal and intra-spinal tumor during percutaneous radiofrequency ablation (RFA) procedure for vertebral tumor in experimental rabbits. Methods Eight New Zealand white rabbits were transplanted with VX2 carcinoma in the lumbar vertebral body by percutaneous puncture inoculation technique under CT guidance in order to set up vertebral tumor models. The eight vertebral tumor models were treated with RFA under CT guidance. The temperature within the spinal canal and vertebral tumor of rabbits was measured and recorded every 30 seconds during the RFA treatment. The results were statistically analyzed by paired sampled t text. Results The intra-tumor temperature rose to 90℃ rapidly and remained stable during the whole RFA procedure, whereas the temperature in the spinal canal exceeded 42℃ when treatment time was over three minutes during the procedure. Statistically significant difference in the temperature level during RFA existed between the spinal canal and the vertebral tumor (P < 0.05). Conclusion The temperature in the vertebral tumor of rabbit can quickly reach to the therapeutic level during RFA. Prolonging operative time of RFA may hurt the nerve due to high temperature.

Clinical study on percutaneous radiofrequency nucleoplasty treatment for cervical disc herniation / 中国基层医药

Objective To explore the clinical outcomes of the percutaneous radiofrequency nucleoplasty in the treatment of cervical disc herniation.Methods 183 patients with cervical disc herniation were treated with percutaneous radiofrequency nucleoplasty.A retrospective analysis of 183 patients was made,and their effects were evaluated using the VAS and the subjective satisfactory degree of the patients.Results All cases were followed up for 3 to 36 months( average 12 months).There were no complications observed such as hemorrhages,infections and nerve root injurys due to the procedure.One week after operation,symptom remission rate was 58.4％ and perfect rate of subjective satisfaction was 95.1％.At final follow up,symptom remission' rate was 66.1％ and perfect rate of subjective satisfaction was 85.8％.Conclusion Percutaneous radiofrequency nucleoplasty was an effective,minimally invasive and safe procedure to treat cervical disc herniation,and the operative treatment had shown better results.

Pressure changes in cervical disc after percutaneous radiofrequency nucleoplasty / 中国医师进修杂志

Objective To study the changes of pressure in cervical disc after percutaneous radiofrequency nucleoplasty,and provide theoretical basis for percutaneous radiofrequency nucleoplasty in the treatment of cervical disc herniation. Methods Forty-two patients with cervical disc herniation (33 cases of nerve root-type cervical spondylopathy and 9 cases of vertebral artery-type cervical spondylopathy) were treated with pereutaneous radiofrequeney nucleoplasty. The pressures of operated cervical disc were measured in the operation, and their clinical effects were evaluated using the JOA values 1 week after operation. The relationship between pressure changes in cervical disc and clinical effect was studied. Results The pressure in the cervical disc in 33 cases of nerve root-type cervical spondylopathy was decreased (1.84 ± 0.96) kPa (P=0.000), and the JOA values increased (3.27 ± 1.35) scares (P=0.000) 1 week after operation. The pressure in the cervical disc in 9 cases of vertebral artery-type cervical spondylopathy was decreased (1.72 ± 0.92) kPa (P= 0.000), and the JOA values increased (2.78 ± 0.67) scores (P= 0.000) 1 week after operation. Correlative analysis showed that there was a positive correlation between the pressure decrease of cervical disc and the JOA values increase (P < 0.05). Conclusion Percutaneous radiofrequency nucleoplasty can help to reduce pressure in the cervical disc and relieve the clinical symptoms.

Analysis of factors affecting intrahepatic infection after percutaneous radiofrequency ablation for liver cancers / 第二军医大学学报

Objective: To investigate the factors affecting the intrahepatic infection after percutaneous radiofrequency ablation (PRFA) for liver cancers. Methods: The clinical data of 1 567 patients with intrahepatic infection after PRFA for liver cancers (from Dec. 1999 to Oct. 2007) were retrospectively summarized. Logistic regression method was used to analyze the possible affecting factors. Results: Twenty-eight person-times of intrahepatic infection occurred in 1 635 patients who received a total of 2 035 times of PRFA, with the infecting rate being 1.38%. The intrahepatic infection-related mortality was 0.13% (2/1 567). Univariate analysis indicated that the intrahepatic infection was significantly correlated with metastatic liver cancer, pattern of past abdominal operation, tumor location, tumor size and tumor numbers (P<0.05). Multivariate analysis showed that the types of liver cancer, tumor number, tumor location and pattern of past abdominal operation were independent risk factors for intrahepatic infection after PRFA for liver cancers(r=3.647, P=0.004; r=1.155, P=0.042; r=1.701, P=0.019; r=2.213, P=0.010, respectively). Conclusion: Our findings suggested that patients with metastatic liver cancer(especially for the patients who have received gastroenterostomy or cholangioenterostomy), multi-liver cancer, and cancers locating near the cavity organs are liable to intrahepatic infection after PRFA.

Needle Tract Implantation after Percutaneous Interventional Procedures in Hepatocellular Carcinomas: Lessons Learned from a 10-year Experience

Percutaneous interventional procedures under image guidance, such as biopsy, ethanol injection therapy, and radiofrequency ablation play important roles in the management of hepatocellular carcinomas. Although uncommon, the procedures may result in tumor implantation along the needle tract, which is a major delayed complication. Implanted tumors usually appear as one or a few, round or oval-shaped, enhancing nodules along the needle tract on CT, from the intraperitoneum through the intercostal or abdominal muscles to the subcutaneous or cutaneous tissues. Radiologists should understand the mechanisms and risk factors of needle tract implantation, minimize this complication, and also pay attention to the presence of implanted tumors along the needle tract during follow-up.

Trigeminal Neuralgia in a Patient with Osteopetrosis: A Case Report

Osteopetrosis is a rare disease by a generalized increase in skeletal density and by abnormalities of bone modeling secondary to defective osteoclastic function with impairment of bone resorption. The various cranial nerve palsies may occur secondary to bony encroachment on the cranial foramina. The authors report a case of osteopetrosis with trigeminal neuralgia. This 30-year-old woman presented with the recurring attacks of severe lancinating paroxysmal pain on her right face(mandibular division>maxillary division>ophthalmic division) for 10 years and anosmia, both blindness for 20 years. Her foramen ovale and optic canal narrowings were caused by osteopetrosis. The neuralgia was refractory to medical treatment. Percutaneous radio-frequency rhizotomy for trigeminal neuralgia was performed and pain relief have been obtained. She was satisfied with the procedure, even if with facial numbness. In the case of trigeminal neuralgia in young patient without abnormal mass lesion on brain radiologic imaging studies, it is important to investigate the bony abnormalities of skull base. The authors believe that radiofrequency rhizotomy is the first choice of treatment for trigeminal neuralgia caused by the bony abnormalities of skull base such as osteopetrosis.

Analysis of factors affecting intrahepatic infection after percutaneous radiofrequency ablation for liver cancers / 第二军医大学学报

Objective:To investigate the factors affecting the intrahepatic infection after percutaneous radiofrequency ablation(PRFA)for liver cancers.Methods:The clinical data of 1567 patients with intrahepatic infection after PRFA for liver cancers(from Dec.1999 to Oct.2007)were retrospectively summarized.Logistic regression method was used to analyze the possible affecting factors.Results:Twenty-eight person-times of intrahepatic infection occurred in 1635 patients who received a total of 2035 times of PRFA.with the infecting rate being 1.38%.The intrahepatic infection-related mortality was 0.13% (2/1567).Univariate analysis indicated that the intrahepatic infection was significantly correlated with metastatic liver cancer, pattern of past abdominal operation,tumor location,tumor size and tumor numbers(P