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Ultrasound-guided thermal ablation has become an important method for treatment of hepatocellular carcinoma (HCC) due to its advantages of minimally invasive and less complications, which not only has curative effect, but also can enhance the anti-tumor immune response of patients. However, as a local treatment, tumor recurrence has become the primary problem affecting curative effect of thermal ablation. In recent years, immunotherapy combined with local therapy has exhibited great exploration value with the emergence of immune checkpoint inhibitors. The advancements of ultrasound-guided thermal ablation combined with immune checkpoint inhibitors in treatment of HCC were mainly reviewed in this article.
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Objective To explore the thermal effects of the second-generation argon plasma coagulation (VIO APC/APC2) on ex vivo human stomach tissue with different mode ,output power and application time .Methods The thermal effects of VIO APC were studied on fresh surgery-resected human stomach tissues .Different output powers were combined with mode "forced (F )","pulse , effect 1 (P1 )" and "pulse , effect 2 (P2 )";three application time ,the depth and maximum diameter of each injury were recorded .Results The depth of tissue injuries was correlated with output power (P<0 .001) ,energy (P=0 .008) and mode (P=0 .013) .The maximum diameter of injuries was correlated with output power (P<0 .001) ,application duration (P=0 .001) ,energy (P<0 .001) and mode (P=0 .001) .The incidence of harmful damage was only related to mode (P=0 .012) .The depth of tissue injuries was P1> F> P2 (P<0 .05) ,and the maximum diameter of injuries was P2> P1> F (P<0 .05) . Conclusion Different modes of VIO APC can create different thermal effects on the gastric tissues .Compared with F mode ,P1 mode creates deeper injuries while P2 mode creates larger but shallow injuries .All the three modes may cause injuries involving muscularis propria .
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ABSTRACT Objective To evaluate safety and effectiveness of nodule volume reduction and thyroid function after percutaneous laser ablation treatment in patients with benign nonfunctioning thyroid nodules. Methods Prospective single-center study, from January 2011 to October 2012, which evaluated 30 euthyroid and thyroid antibodies negative patients with benign solitary or dominant nodule with indication of treatment due to compressive symptoms and aesthetic disturbances. The clinical and laboratory (thyroid ultrasound, TSH, FT4, TG, TG-Ab, TPO-Ab and TRAb levels) evaluations were performed before the procedure, and periodically 1 week, 3 months and 6 months after. The ablation technique was performed under local anesthesia and sedation. In each treatment, one to three 21G spinal needle were inserted into the thyroid nodule. The laser fiber was positioned through the needle, which was then withdrawn 10mm to leave the tip in direct contact with the nodule tissue. Patients were treated with a ND: Yag-laser output power of 4W and 1,500 to 2,000J per fiber per treatment. The entire procedure was performed under US guidance. Results Thirty patients, with a total of 31 nodules submitted to laser ablation were evaluated. The median volumetric reduction of the nodule was approximately 60% after 12 months. No statistical significance was observed on thyroid function and antibodies levels. There was a peak on the level of thyroglobulin after the procedure due to tissue destruction (p<0.0001). No adverse effects were observed. Conclusion Percutaneous laser ablation is a promising outpatient minimally invasive treatment of benign thyroid nodule.
RESUMO Objetivo Avaliar a segurança e a efetividade da redução de volume nodular e função tireoidiana após tratamento com ablação percutânea por laser em pacientes com nódulos tireoidianos benignos não funcionantes. Métodos Estudo unicêntrico prospectivo, de janeiro de 2011 a outubro de 2012, que avaliou 30 pacientes eutireoideos (com anticorpos antitireoide negativos), com nódulo solitário ou dominante benigno, com indicação de tratamento devido a sintomas de compressão e distúrbios estéticos. As avaliações clínica e laboratorial (ultrassonografia de tireoide, TSH, FT4, TG, TG-Ab, TPO-Ab e TRAb) foram realizada antes do procedimento e periodicamente − 1 semana, 3 meses e 6 meses depois. A técnica de ablação consistiu em procedimento realizado sob a anestesia local e sedação. Em cada tratamento, uma a três agulhas espinhais 21G foram inseridas no nódulo tireoidiano. A fibra laser foi posicionada através da agulha que foi, então, retirada 10mm, para deixar a ponta em contato direto com o nódulo. Os pacientes foram tratados com uma potência de saída ND: Yag-laser de 4W e 1.500 a 2.000J por fibra por tratamento. Todo o procedimento foi guiado por ultrassonografia. Resultados Foram avaliados 30 pacientes, com total de 31 nódulos submetidos à ablação a laser. A redução média volumétrica do nódulo foi de aproximadamente 60% após 12 meses. Não foi observada significância estatística na função da tireoide e nem nos níveis de anticorpos. Houve pico no nível de tiroglobulina após o procedimento devido à destruição do tecido (p<0,0001). Nenhum efeito adverso foi observado. Conclusão A ablação com laser é um tratamento minimamente invasivo promissor para tratamento do nódulo benigno da tireoide.
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Thyroid Nodule/surgery , Laser Therapy/methods , Organ Size , Pain, Postoperative , Autoantibodies/blood , Thyroxine/blood , Calcitonin/blood , Thyrotropin/blood , Prospective Studies , Follow-Up Studies , Treatment Outcome , Thyroid Nodule/pathology , Thyroid Nodule/blood , Laser Therapy/adverse effectsABSTRACT
BACKGROUND: To achieve a prolonged therapeutic effect in patients with lumbar facet joint syndrome, radiofrequency medial branch neurotomy (RF-MB) is commonly performed. The purpose of this study was to evaluate the prognostic value of paravertebral muscle twitching when performing RF-MB in patients with lumbar facet joint syndrome. METHODS: We collected and analyzed data from 68 patients with confirmed facet joint syndrome. Sensory stimulation was performed at 50 Hz with a 0.5 V cut-off value. Patients were divided into 3 groups according to the twitching of the paravertebral muscle during 2 Hz motor stimulation: ‘Complete’, when twitching was observed at all needles; ‘Partial’, when twitching was present at 1 or 2 needles; and ‘None’, when no twitching was observed. The relationship between the long-term effects of RF-MB and paravertebral muscle twitching was analyzed. RESULTS: The mean effect duration of RF-MB was 4.6, 5.8, and 7.0 months in the None, Partial, and Complete groups, respectively (P = 0.47). Although the mean effect duration of RF-MB did not increase significantly in proportion to the paravertebral muscle twitching, the Complete group had prolonged effect duration (> 6 months) than the None group in subgroup analysis. (P = 0.03). CONCLUSIONS: Paravertebral muscle twitching while performing lumbar RF-MB may be a reliable predictor of long-term efficacy when sensory provocation under 0.5 V is achieved. However, further investigation may be necessary for clarifying its clinical significance.
Subject(s)
Humans , Ablation Techniques , Catheter Ablation , Fasciculation , Low Back Pain , Needles , Prognosis , Zygapophyseal JointABSTRACT
Objective To investigate the reasons and the methods of prevention and cure for serious complications of radiofrequency ablations in the treatments of hepatocellular carcinomas. Methods A total of 410 patients with BCLC at A or B stage of hepatocellular carcinomas in our hospital were enrolled between November 2014 and June 2009. These patients underwent a total of 504 times radiofrequency ablations for the treatments of liver lesions. This retrospective study analysed the reasons and the strategies of prevention and cure for the serious complications. Results In the patients with a total of 504 times radiofrequency ablations, 2 patients had massive hemorrhage caused by puncture injuries, 2 patients had the tumors which were close to the liver capsules and 1 patient had bile peritonitis caused by the injury of thermal ablation on the gallbladder. The maximum diameter of tumor was 5 cm. That tumor was close to the gallbladder. 2 patients had needle tract metastases caused by incompletely needle path ablations. 1 of the 2 patients had a tumor near the liver capsule, and the other patient had un-enough temperature for needle path ablation. Tumor outbreaks were happened in 2 patients. 1 of the 2 patients had a tumor which was located in the liver capsule and close to the portal vein. The other patient had a 12 cm diameter tumor with rich blood supplement. 2 patients had liver abscesses. 1 of the 2 patients had a tumor near the ascending colon, and the other patient had diabetes. 1 patient had colonic perforation caused by thermal ablation. The tumor in that patient was located in the right hepatic lobe segment and adjacent to the ascending colon. The incidence of serious complications was 1.98% (10/504). Conclusions The incidence of the serious complications of radiofrequency ablations for the treatments of hepatocellular carcinomas is relatively low. The main reasons for the serious complications were direct injuries caused by punctures, heat radiation injuries, tumors adjacent to large blood vessels, gallbladders and intestines, tumors with abundant blood supplement, needle paths fail to cross normal liver tissues, low scores of liver function, weak immune system and diabetes. The key points for avoiding and reducing the serious complications are preoperative evaluations of patients' basic situations, choices of appropriate puncture channels and control ranges of ablations when tumors are close to important blood vessels, intestines and gallbladders.
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Objective To investigate the curative effect of complete ablation and partial ablation of parathyroid for secondary hyperparathyroidism (SHPT) by using ultrasound-guided radiofrequency ablation (RFA) or microwave ablation (MWA). Methods A total of 26 patients with hyperparathyroidism secondary to uremia, who were admitted to authors’ hospital during the period from October 2012 to September 2013 to receive full ablation (n=11) or partial ablation (n=15) of parathyroid with MWA or RFA and were followed up for at least 9 months after the treatment, were included in this study. The clinical data were retrospectively analyzed. The therapeutic effect and the influence of MWA and RFA on the serum calcium levels were compared between the two ablation methods. Results Analysis of parathyroid hormone (PTH) levels indicated that in full ablation group the postoperative PTH level was gradually decreased , when compared with the preoperative level, until it became stable and maintained the normal level, and no recurrence was observed;in partial ablation group the postoperative PTH level was decreased first with a subsequent rebound about nine months after the treatment, and this PTH level was higher than the PTH level of full ablation group as well as higher than the normal level (P<0.05). On the 15 patients of partial ablation group, recurrence was seen in 5. Analysis of serum calcium levels showed that the postoperative serum calcium level was decreased in both groups, but in partial ablation group the serum calcium levels determined at 3 and 9 months after the treatment were higher than those in full ablation group (P<0.05). In 11 patients of full ablation group, hypocalcemia occurred in 4. Conclusion In treating SHPT, full ablation of parathyroid is not likely to have postoperative relapse, but it might carry the risk of hypocalcemia; while partial ablation of parathyroid is likely to have postoperative relapse, but the serum calcium level can be well controlled. Considering from the view that controlling of the serum calcium level is clinically very important, partial ablation of parathyroid may be more suitable for clinical purpose.
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Objective To explore the thoracic and diaphragmatic complications of treating hepatic malignant tumor using thermal ablation techniques.Methods The patients received thermal ablations were involved as subjects from January 2002 to December 2013.The thoracic and diaphragmatic complications of treating hepatic malignant tumor with percutaneous thermal ablation were retrospectively analyzed.Results A total of 1 520 patients with 2 789 hepatic tumors [average largest diameter of tumor (2.30 ± 1 .03)cm] underwent 2 066 thermal ablation treatments.Five hundred and six radiofrequency ablation (RFA)and 1 560 microwave ablation procedures were performed,respectively.The complete ablation rate was 96.8%(2 701/2 789)at 1 month after treatment.The major thoracic and diaphragmatic complication rates were 0.8%(1 7/2 066 ),meanwhile the minor complication rates were 6.5% (134/2 066 ).Conclusions The thoracic and diaphragmatic complication rate of percutaneous thermal ablation is low in the treatment of hepatic malignant tumors.However,the major complications may cause serious consequences.Therefore, the patients of diaphragm-abutting liver tumors are fully assessed before thermal ablation treatments,and relevant prevention measures are completed.Open or laparoscope is used to assist thermal ablation treatment when necessary.