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Objective:To identify the risk factors for survival prognosis of patients with early-stage hepatocellular carcinoma (HCC) after ultrasound-guided percutaneous microwave ablation (US-PMMA), and to compare the overall survival (OS), cancer specific survival (CSS) and disease-free survival (DFS) between different early-stage HCC patients.Methods:A total of 1 563 patients with early-stage hepatocellular carcinoma (HCC) who underwent MWA in the interventional ultrasound department of the Chiese PLA General Hospital from January 2002 to December 2017 were retrospectively analyzed. Propensity score matching (PSM) balanced the baseline parameters between the elderly group (≥60 years) and the young group (<60 years). Multivariate Cox regression analysis was used to identify the risk factors of OS, CSS and DFS. OS, CSS and DFS probabilities for different patients stratified by respective predictors were calculated with Kaplan-Meier method and compared using the Log-Rank test.Results:All parameters were balanced except for age after PSM.Tumor diameter(95% CI=1.1-1.4, P<0.001), number of tumors(95% CI=1.2-1.9, P<0.001), γ-GT (95% CI=1.0-1.0, P<0.001) and AFP (HR=1.5, 95% CI=1.2-1.8, P<0.001) were shared predictors for OS, CSS and DFS. Age (95% CI=1.2-1.8, P<0.001) and neutrophile to lymphocyte ratio (NLR) (95% CI=1.0-1.0, P=0.043) were another two predictors for both OS and CSS. Albumin predicted OS only, and sex and cirrhosis just predicted DFS. Over the follow-up period (12-156 months), log-rank tests showed that all predictors significantly affected the corresponding OS, CSS or DFS(all P<0.01). Among them, multiple tumors had the greatest impact on OS, CSS and DFS. Compared with patients with single lesion, OS, CSS and DFS in patients with multiple lesions decreased by 9.2%, 2.5% and 4.1% respectively at the 12 years of follow-up, and the median survival time was shortened by 12.3 months, 25.0 months and 11.3 months, respectively (log-rank P=0.049 for OS; P=0.007 for CSS; P<0.001 for DFS). Conclusions:The prognostic benefits from MWA treating early-stage HCC in patients with different survival risk factors are different. Clinically feasible correction of hypoproteinemia and liver disfunction are of great significance to improve the prognosis of early-stage HCC patients after US-PMMA.
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Objective:To investigate the safety and efficacy of ultrasound-guided transversus abdominis plane (TAP) combined with paracervical block in percutaneous microwave ablation(PMWA) of uterine fibroids.Methods:Twenty-four patients with uterine fibroids who underwent PMWA after ultrasound-guided TAP combined with paracervical block in Sichuan Cancer Hospital from October 2021 to January 2022 were retrospectively analyzed. The success rate and adverse reactions of TAP combined with paracervical block were recorded, and the types and doses of rescue analgesics used during and after operation were recorded. The pain degree of patients was recorded by NRS(numeric rating scales) during and 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 12 hours and 24 hours after operation, and the satisfaction of patients was recorded.Results:The success rate of TAP combined with paracervical block was 100%, and there were no adverse reactions during and after operation. During the operation, 5 patients(20.83%) had mild pain, which was tolerable and did not need intervention, 4 patients(16.67%) presented with moderate pain, and the NRS scores were 4, 4, 5 and 6 respectively, the symptoms were relieved after rescue analgesia. All patients completed one ablation, no ablation failure or secondary ablation. Some patients had mild pain after operation, which could be tolerated without intervention, and all were relieved naturally within 6 hours. All patients returned home on the day of ablation and were 100% satisfied with the analgesic effect.Conclusions:Ultrasound-guided TAP combined with paracervical block in PMWA of uterine fibroids is safe and effective, which is worthy of clinical promotion.
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OBJECTIVE:To observe clinical efficacy and safety of recombinant human endostatin(rh-endostatin)com-bined with CT-guided percutaneous microwave ablation in the treatment of non-small cell lung cancer(NSCLC)complicat-ed with chronic obstructive pulmonary disease (COPD). METHODS:A total of 80 cases of NSCLC complicated with COPD were selected from our hospital during Feb. 2014-Feb. 2016,and then divided into control group and observation group according to random number table,with 40 cases in each group. Control group was treated by CT-guided percutane-ous microwave ablation. Observation group was additionally given rh-endostatin injection 7.5 mg/m2,once a day,d1-14, added into 500 mL 0.9％ sodium chloride injection,ivgtt lasting for 4 h,for consecutive 14 d,on the basis of control group;7 d later,next course was performed. A treatment course lasted for 21 d,and they received 4 courses of treat-ment. Survival time,clinical efficacy as well as KPS score and lung function indexes before and after treatment,the oc-currence of ADR were compared between 2 groups. RESULTS:Median survival time of observation group(19.8 months) was significantly longer than that of control group(15.2 months),and total response rate of observation group(72.5％) was significantly higher than that of control group (55.0％),with statistical significance (P0.05). After treat-ment,KPS score and above lung function indexes levels of 2 groups were increased significantly,and those of observa-tion group were significantly higher than those of control group,with statistical significance (P0.05). CONCLUSIONS:rh-endostatin combined with CT-guided percutaneous microwave ablation in the treatment of NSCLC complicated with COPD show good clinical efficacy with less ADR,and can significantly improve lung function and quality of life.
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Objective To use ultrasound-guided percutaneous microwave for simultaneous ablation of a nodule in submandibular gland and another in the ipsilateral thyroid gland. Methods A 57-year old man presented non-painful nodules in his right submandibular gland and right thyroid lobe simultaneously, with the sizes being 10 mm×10 mm×9 mm and 13 mm× 11 mm×10 mm separately. Percutaneous microwave ablation and biopsy were conducted for both nodules simultaneously under ultrasound guidance. The short-term effects were documented both clinically and ultrasonographically. Results The ablation therapy was completed uneventfully and took a total of 20 min. The ablation time was 185 seconds for the submandibular nodule and 72 seconds for the thyroid nodule. No intra-operative complications such as bleeding, edema or nerve injury were observed. No symptoms of injuries to the facial nerve, glossal nerve or recurrent laryngeal nerve were observed during a 2-month follow-up. Ultrasound examination revealed that the ablated area was shrank and kept unenhanced on CEUS. Conclusion Microwave ablation therapy is suitable for the conjoint treatment of concomitant nodular lesions in multiple neck organs. The method is economical, efficient, minimally invasive, and is worth of more clinical practices.
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Objective To modify the strategy and methodology of percutaneous microwave ablation for treatment of hepatocellular carcinoma (HCC), so as to simplify the therapeutic process and improve the therapeutic effect. Methods A total of 92 HCC patients with 149 nodes, with an average diameter of (4. 9 ± 3. 4) cm, were treated by the newly designed cooling circulation microwave electrode. Continuous ablation was used for tumors with diameters less than 6 cm and ring-shaped continuous ablation was applied for tumors with diameters more than 6 cm. Microwave ablation was used to treat tumors with diameters less than 4 cm. For tumors with diameters more than 4 cm, transcatheter arterial chemoembolization (TACE) was used before microwave ablation and nutrient arteries were given priority for ablation. Ring-shaped continuous ablation strategy and double antenna ablation strategy were adopted for tumors over 6 cm. Enhanced CT scans were performed at regular intervals to evaluate the therapeutic effect and the one-, two- and three-year survival rates were observed. Results (1) The complete necrosis rates for once, twice, and multiple ablations were 76. 5% (114/149), 86. 6% (129/149) and 95. 3% (142/ 149), respectively. (2) The one-, two- and three-year survival rates in our group were 94. 6% (87/92), 72. 9% (62/85) and 61.4% (35/57), respectively. Conclusion Single microwave ablation is effective for small HCC. Double antenna ablation + first ablation of nutrient artery + TACE was effective for huge HCC. Ring-shaped continuous ablation strategy can greatly reduce ablation points and simplify the ablation process, which is probably a new way for in situ complete necrosis of huge HCC.
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Objective: To investigate the safety and efficacy of percutaneous microwave ablation (PMWA) for huge liver cavernous hemangiomas(LCHs), and to assess the potential advantages of extracting blood from the hemangioma during the ablation procedures. Methods: A water-cooled microwave antenna named KY-2100 compatible with a frequency of 2,450 MHz generator was used to perform heating ablation in 19 patients for their LCHs guided by contrast-enhanced ultrasound under general anesthesia; the patients had multiple LCHs, at least with one having a diameter longer than 6 cm. Twenty lesions matched in their maximal size in 10 patients were ablated assisted with or without extracting blood from the hemangiomas. The relevant factors for the safety and ablation duration, thoroughness of ablation, and complications were comprehensively assessed. Results: The ablation durations varied from 39 to 163 min in the 19 patients, with an average of (93±39.85) min. For those maximum-length matched lesions, blood extraction significantly shortened the ablation duration compared to non-blood extraction group ([29.61±14.07] min vs [41.57±14.93] min, P<0.05). Except for slight elevation of serum ALT level ([133.58±46. 29] U/L) in 75% patients, there were no other complications such as intra-peritoneal bleeding, bile leakage, or hemoglobinemia. The average hospital stay was (4±0.95) days. All the ablated LCHs shrank markedly, with the maximal diameter decreased by 82.54%. The hemangioma-induced symptoms were relieved in all patients. Conclusion: PMWA is technically feasible, safe and effective for treating LCHs. It can be an attractive alternative for surgical resection of hemangiomas at high-risk locations. And prompt extraction of focal blood can reduce the bleeding risk and shorten ablation duration.