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<p><b>OBJECTIVE</b>To evaluate the long-term efficacy of microwave ablation in the treatment of small renal cell carcinoma (RCC).</p><p><b>METHODS</b>We retrospectively analyzed 140 cases of small cell renal carcinoma (151 lesions with a mean diameter of 2.8±0.8 cm) treated between April, 2006 and October, 2015 with ultrasound-guided microwave ablation with cooled-shaft needle antenna. One microwave ablation antenna was used for tumors less than 2 cm in diameter and 2 antennas were used for larger tumors. The patients received enhanced ultrasound and CT/MRI examinations at 1, 3, and 6 months after the operation and every 6 months thereafter. The overall survival, disease-free survival, and local tumor progression rate of the patients were evaluated.</p><p><b>RESULTS</b>The response rate of treatment (complete ablation at one month on enhanced images) was 100% in these patients. The local tumor progression rates at 1, 3, and 5 years were 0.9%, 2.0%, and 7.1%, respectively, and the 1-, 3-, and 5-year distant metastasis rates were 1.6%, 2.5%, and 7.9%, respectively. The overall survival rates of the patients at 1, 3, and 5 years were 98.4%, 94.8%, 89.5%, respectively, with disease-free survival rates of 98.4%, 93.0%, and 83.1%, respectively. No major complications occurred in these cases, and multivariate analysis showed that the tumor number (P=0.015) and tumor growth patterns (P=0.049) were independent risk factors that adversely affected the long-term outcome after surgery.</p><p><b>CONCLUSION</b>Our data show that microwave ablation is a safe and effective modality for treatment of renal cell carcinoma.</p>
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Humanos , Carcinoma de Células Renales , Cirugía General , Carcinoma de Células Pequeñas , Cirugía General , Ablación por Catéter , Supervivencia sin Enfermedad , Neoplasias Renales , Cirugía General , Microondas , Análisis Multivariante , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
<p><b>OBJECTIVE</b>To analyze the major complications of percutaneous cooled-tip microwave ablation for the treatment of primary liver cancer and the possible risk factors of severe complications in a series of 693 patients.</p><p><b>METHODS</b>The clinicopathological data of 693 patients with primary liver cancer who underwent ultrasound-guided percutaneous cooled-tip microwave (MW) ablation in our hospital over the past 5 years were retrospectively analyzed, and the risk factors of severe complications were explored.</p><p><b>RESULTS</b>In a total of 693 patients with 898 primary liver tumors were treated and 1111 MW ablation sessions were performed. The mean diameter of tumors was (2.5 ± 1.2) cm and the range was 0.4 - 10.0 cm. Three deaths occurred in the peri-ablation period, including one case died of multiorgan failure, one case died of pulmonary embolism and one case died of hepatorenal syndrome. Major complications occurred in 27 (3.9%) patients, including 12 pleural effusion requiring thoracentesis (1.7%), 10 tumor seeding (1.4%), 3 liver abscess and empyema (0.4%), 1 hemorrhage requiring arterial embolization (0.1%), and 1 bile duct injury (0.1%). The Chi-square test results showed that the diameter of tumors, number of MW ablation sessions and histological type of tumor were significantly associated with the major complications rate (P < 0.05). The multiple variables 1ogistic regression analysis showed that only type of tumors was associated with the major complication rate (P < 0.05).</p><p><b>CONCLUSIONS</b>Results of this study confirm that cooled-tip MW ablation is a relatively low-risk and effective minimally invasive procedure for the treatment of primary liver cancer. Proper direction for the treatment of cholangiocarcinoma (ICC) patients as well as fewer ablated tumor numbers during one hospital stay may help minimize the major complication rate in patients with primary liver cancer treated by ultrasound-guided percutaneous cooled-tip microwave ablation.</p>
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de los Conductos Biliares , Diagnóstico por Imagen , Cirugía General , Conductos Biliares Intrahepáticos , Carcinoma Hepatocelular , Diagnóstico por Imagen , Cirugía General , Ablación por Catéter , Métodos , Colangiocarcinoma , Diagnóstico por Imagen , Cirugía General , Estudios de Seguimiento , Absceso Hepático , Quimioterapia , Neoplasias Hepáticas , Diagnóstico por Imagen , Cirugía General , Microondas , Usos Terapéuticos , Siembra Neoplásica , Derrame Pleural , Cirugía General , Estudios Retrospectivos , Ultrasonografía IntervencionalRESUMEN
The purpose of the study was to prospectively evaluate safety and assisted with ethanol injection for hepatocellular carcinoma abutting gastrointestinal tract. 263 patients with 319 hepatic tumors that underwent percutaneous microwave ablation with curative intention were included. 101 lesions located less than 5 mm from gastrointestinal tract were in gastrointestinal group. 218 lesions located more than 5 mm from hepatic surface, gastrointestinal tract and first or second branch of hepatic vessels were in control group. The temperature of marginal ablation tissue proximal to gastrointestinal tract was monitored and controlled to fluctuating between 45 degrees C and 59 degrees C for more than 10 min for tumors in the gastrointestinal group. Ethanol (1-21 ml) was injected into marginal tissue in 62 of 101 lesions of the G1 group. 96 of 101 tumors (95.0%) in the gastrointestinal group and 208 of 218 tumors (95.4%) in the control group achieved complete ablation (P = 0.89). Local tumor progression for all the tumors were in the first year and the 6-,12- month local tumor progression rate in the gastrointestinal group and the control group were 6.9%, 11.9% and 7.3%, 8.3%, respectively (P = 0.21). There were neither immediate nor periprocedural complications in both groups. There was no delayed complication of gastrointestinal and bile ducts injury. Tumor seeding happened in one (1.1%) of the gastrointestinal group and three (1.8%) of the control group (P = 0.92). Under strict temperature monitoring, microwave ablation assisted with ethanol injection is safe and achieves a high complete ablation rate for hepatocellular carcinoma adjacent to gastrointestinal tract.
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<p><b>OBJECTIVE</b>To study the feasibility of using Narcotrend (NCT) in monitoring the anesthetic depth during endotracheal intubation in sevoflurane anesthesia.</p><p><b>METHODS</b>Thirty ASA I-II patients (aged 20-49 years) undergoing gynecologic surgery under general anesthesia with tracheal intubation were randomized into sevoflurane group (n=15) and sevoflurane plus rocuronium group (n=15). In the former group, anesthesia was induced with sevoflurane at the primary concentration of 8% till the final end expiratory concentration reaching 2 MAC(minimum alveolar concentration) for 3 min, followed then by tracheal intubation and further observation of the indicators for another 3 min. The patients in sevoflurane plus rocuronium group received identical anesthesia procedures except for the administration of intravenous injection of rocuronium (0.6 mg/kg) after the loss of eyelash reflex. The NCT, BIS and hemodynamics were recorded during the process.</p><p><b>RESULTS</b>No significant differences were noted in NCT, bispectral index (BIS), MAP and heart rate before tracheal intubation between the two groups (P>0.05). The NCT and BIS increased significantly after tracheal intubation in sevoflurane group (P<0.05), but remained below 60. No significant changes in NCT and BIS occurred during intubation in sevoflurane plus rocuronium group (P>0.05). The mean arterial pressure (MAP) and heart rate were significantly increased in both groups after tracheal intubation in comparison with those before tracheal intubation (P<0.05), but the increment in sevoflurane group was significantly greater (P<0.05).</p><p><b>CONCLUSION</b>NCT may reflect the changes of the anesthetic depth resulting from the nociceptive stimulus of tracheal intubation in sevoflurane- induced anesthesia. NCT and BIS can not serve such a purpose in combined anesthesia with sevoflurane and rocuronium.</p>
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Adulto , Humanos , Persona de Mediana Edad , Adulto Joven , Androstanoles , Anestesia , Anestésicos Intravenosos , Hemodinámica , Intubación Intratraqueal , Métodos , Éteres Metílicos , Monitoreo Intraoperatorio , MétodosRESUMEN
Objective To analyze the CT and MRI characteristics of the pineal region tumors (PRTs) to improve the accuracy of diagnosis and differential diagnosis.Methods The MRI and CT findings of 28 patients with PRTs proved by operation and pathology were retrospectively analyzed.Eight of them were performed preoperative 1H-MRS and DWI examination and thier data were analyzed too.Results of these 28 patients,11 were diagnosed as having germinoma,4 teratoma,3 astrocytoma,3 meningioma,2 pinealocytoma and 1 epidermoid cyst,1 pineoblastoma,1 hamartoma and 1 dermoidcyst.The main imaging characteristics were cystic tumors in the pineal region,variational density/signal intensity with few tumors having their specified morphology,density/signal intensity and enhancement style.The germinomas and the pineoblastomas were mainly homogeneous solid masses with symmetrical density/signal.The astrocytoma was cystic-solid,mostly,with changing shapes and odds density/signal.The mature teratoma showed blending density/signal.The 1H-MRS showed typical high Cho peak and low NAA peak in the astrocytoma; no NAA peak was found in the meningeoma; high Cho peak and no Lip peak were found in the pineoblastoma; the germinoma was noted having Lip peak.Conclusion Observation on the changes of the morphologic features,density/signal intensity and enhancement style can help in the differential diagnosis of PRTs.DWI and 1H-MRS examinations can improve the accuracy of differential diagnosis to some extent,but some PRTs remain to be non-differentiable.