摘要:目的： 探讨肝癌患者行射频消融术围手术期的肝功能变化情况,以及相应的护理措施。方法:对2006～2009年6月在我院接受射频消融术治疗的91例肝癌患者,监测其围手术期的肝功能指标,如丙氨酸氨基转移酶及总胆红素等变化情况,分析射频消融术对肝功能的影响,总结相应的护理措施。 结果:全组无死亡病例。射频消融术后早期丙氨酸氨基转移酶及总胆红素与术前有显著差异（P＜005）。结论: 肝癌患者行射频消融术后早期肝功能减退,应加强护理措施,促进患者恢复。 Abstract: Objective: To explore the influence of radiofrequency ablation (RFA) on hepatic function of patients suffering hepatocelluler carcinoma and to summarize corresponding nursing measures.Methods: Ninetyone patients suffering hepatocelluler carcinoma received RFA were studied with their hepatic function preoperation and postoperation. Alanine aminotransferase (ALT) and total bilirubin (TB) were selected as the liver functional parameters,and perioperative changes of the two parameters were measured. Influence of RFA on hepatic function was analyzed and corresponding nursing measures were summarized. Results: Significant changes of ALT and TB were observed early after RFA,and there were statistical difference between preoperation and postoperation (P＜005). Conclusion: Proper nursing measures should be applied to improve hypohepatia and promote recovery of patients.
Objective To investigate the reasons and preventions of bleeding after percutaneous microwave ablation for liver cancer. Methods The data of 156 patients with liver cancer between September 2006 and December 2009 treated with percutaneous microwave ablation (226 times) were recorded. The reasons and preventions of bleeding after percutaneous microwave ablation were analyzed. Results Eleven patients (11 times) suffered from bleeding. The rate of bleeding is 4.87% (11/226), including 2 cases of biliary bleeding, 9 cases of intraperitoneal hemorrhage. All patients who suffered from bleeding firstly received medical therapy to control bleeding, 5 cases were successful; in the other 6 cases who failed in medical therapy, 1 case was stopped bleeding with opening procedures, 4 cases received transcatheter embolization to stop bleeding with gelatin sponge, 1 case died due to excessive blood loss. According to Chi-square test result, the bleeding was significantly related with liver cirrhosis, lower platelet count, obvious prolongation of prothrombin time, subcapsular tumor, Child-Pugh B/C grade, and re-ablation （P=0.044, 0.041, 0.028, 0.001, 0.016, 0.016）. The multiple variables logistic regression analysis showed that liver cirrhosis, platelet count, prothrombin time, location of tumor, and Child-Pugh grade were the influential factors of bleeding after microwave ablation （OR=5.273, P=0.036; OR=8.534, P=0.043; OR=4.893, P=0.045; OR=7.747, P=0.010; OR=6.882, P=0.015）. Conclusions There were some factors were significantly related with the bleeding after percutaneous microwave ablation: liver cirrhosis, abnormal blood clotting function （lower platelet count and prolongation of prothrombin time）, tumor located on the surface of liver, and Child-Pugh C grade. When failed to stop bleeding with medical therapy, transcatheter embolization is an effective method to control bleeding.
Objective To evaluate the effect on microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of combining radiofrequency ablation (RFA) with arsenious acid (AA) locally treating liver VX2 tumor in rabbits. Methods Twenty-eight New Zealand White rabbits with implanted liver VX2 tumors were randomly divided into four groups, control group (n=7), AA group (n=7), RFA group (n=7) and combination (RFA+AA) group (n=7). All rabbits were killed 14 days after treatment. MVD and VEGF expression were examined by immunohistochemistry. Results The MVD degraded one by one in control group,AA group,RFA group and RAF+AA group, which were (38.50±0.44), (23.07±0.47), (18.65±0.39) and (11.36±0.36)/HP respectively, compared while each two groups, P＜0.05. The VEGF expression also degraded one by one, the ratio of positive cases were 7/7, 5/7, 4/7 and 2/7 respectively, compared while each two groups, P＜0.05. There was positive correlation between VEGF expression and MVD (Person conefficient of product-moment correlation r=0.47, P＜0.01). Conclusion Combining RAF with AA therapy can greatly decrease MVD and VEGF expression of tumor tissue.
Objective To explore efficacy and safety of radiofrequency ablation (RFA) in the treatment of large hepatocarcinoma. MethodsFortythree cases of large hepatocarcinoma underwent RFA with the expandable cluster electrode,eight of all cases had undergone transcatheter artery chemoembolization (TAE) for 1-2 sessions within 2 months before RFA; the tumors were 5-10 cm in diameter, mean 7.5 cm. Hepatic function examination, alphafetoprotein, enhanced CT scans,color ultrasonography and needle biopsy were performed,pre and posttreatment. Complete necrosis was evaluated by dynamic enhanced CT scans and biopsy. Therapeutic time and sessions of RFA,length of stay in hospital and complications of RFA were observed; and thirtynine of 43 cases after RFA were followed up for 12-18 months.ResultsFortythree cases of large hepatocarcinoma received RFA for 67 sessions， 1-3 sessions per case，mean 1.6 sessions; therapeutic time 55-150 min,mean 75 min; length of stay in hospital 3-15 day， mean 8.7 day; major complications of RFA included local skin burn of electrode board in 2 cases （4.6%） and moderatetolarge right pleural effusion in 3 cases （7.0%），overall complications rate was 11.6%; complete necrosis was achieved in 41.0% of cases which were evaluated by dynamic enhanced CT scans at least 6 months followed RFA; of thirtyone cases of positive AFP, AFP level became negative in 3,decreased obviously in 5 within 6-12 months after RFA; in 12-18 months followup,oneyear survival rate was 69.2%.Conclusion RFA appears to be safe, effective and minor invasive for the treatment of large hepatocarcinoma.
Abstract： Objective To analyze the influence of preoperative left atrial dimension （LAD） on the effectiveness of surgical radiofrequency ablation for the treatment of atrial fibrillation （AF） through a 5-year postoperative follow-up of AF patients after surgical radiofrequency ablation. Methods Clinical data of 433 patients with persistent or permanent AF who received bipolar radiofrequency ablation procedures during concomitant cardiac surgery in Beijing Anzhen Hospital from 2006 to 2009 were retrospectively analyzed. All the patients were divided into 4 groups according to their preoperative LAD：Group A， 75 patients with their LAD＜50 mm， including 22 males and 53 females with their average age of 56.50±10.05 years；Group B， 89 patients with their LAD ranging from 50 to 60 mm， including 32 males and 57 females with their average age of 55.63±10.28 years；Group C， 117 patients with their LAD ranging from 60 to 70 mm， including 41 males and 76 females with their average age of 55.13±10.96 years；and Group D， 152 patients with their LAD＞70 mm， including 68 males and 84 females with their average age of 53.22±11.49 years. Postoperative ECG records right after surgery， before discharge， at 6 months and 1，2，3，4 and 5 years during follow-up were collected. The relationship between preoperative LAD and postoperative sinus rhythm restoration rate was analyzed. Results There was statistical difference in sinus rhythm restoration rate right after surgery（P=0. 011）， before discharge（P=0. 002）， at 6 months（P＜ 0. 001） and 1 year （P＜0. 001）， 2 years（P＜0. 001）， 3 years（P＜0. 001）， 4 years（P＜0. 001） and 5 years（P= 0. 006） during follow-up among the 4 groups. Postoperative sinus rhythm restoration rates right at 6 months and 1，2，3， 4 and 5 years during follow-up was 90.4%， 89.9%， 90.3%， 91.3%， 89.1%， and 90.9% in Group A， 80.2%，79.0%，78.1%， 76.1%，72.5%，70.0% in Group B，74.7%，74.0%，71.2%，72.4%，70.0%， and 64.7% in Group C， and 61.8%，57.6%，56.8%，53.9%，50.7%，and 48.6% in Group D， respectively. Conclusion Patients with a larger preoperative LAD have a lower postoperative sinus rhythm restoration rate after surgical radiofrequency ablation for the treatment of AF.
Objective To compare short-term clinical outcomes of bipolar/unipolar radiofrequency （RF） ablation for the treatment of permanent atrial fibrillation（AF） of patients with rheumatic valvular heart disease. Methods Clinicaldata of 124 patients with rheumatic valvular heart disease and permanent AF who underwent heart valve replacement and concomitant bipolar/unipolar RF ablation in Wuhan Asia Heart Hospital from February 2011 to December 2011 were retros- pectively analyzed. According to different RF ablation methods，all the 124 patients were divided into bipolar group and unipolar group. There were 62 patients in the bipolar group including 29 males and 33 females with their age of 44.20±8.61 years，and 62 patients in the unipolar group including 33 males and 29 females with their age of 46.40±9.48 years. Electrocardiogram examinations were performed at the time of intraoperative heart re-beating，the very postoperative day，7 days，1 month，3 months and 6 months postoperatively to detect restoration of sinus rhythm. Results There was no in-hospital death or ablation-related complication in either group. Aortic cross-clamp time（70.05±22.02 min vs. 54.47±20.65 min，P=0.025） and RF ablation time（25.12±3.00 min vs. 15.70±3.02 min，P=0.000）of the bipolar group were significantly longer than those of the unipolar group. At the time of intraoperative heart re-beating，the lst and 7th day after operation， sinus rhythm restoration rates were 88.71%，87.10%，80.65% respectively in the bipolar group，85.48%，77.42%，72.58% respectively in the unipolar group，and there was no statistical difference between the two groups （P＞0.05）. In the 1st，3rd and 6th postoperative month，sinus rhythm restoration rates of the bipolar group （79.03%，75.81%，72.58% respectively） were significantly higher than those of the unipolar group （59.68%，50.00%，48.38% respectively，P＜0.05）. Conclusion Clinical outcomes of RF ablation for the treatment of permanent AF of patients with rheumatic valvular heart disease are satisfactory. Unipolar RF ablation has the advantage of being time-saving and easier technique，while short-term sinus rhythm restoration rate of bipolar RF ablation is higher than that of unipolar RF ablation for the treatment of permanent AF.
Abstract： Objective To summarize the clinical outcomes of maze procedure using bipolar radiofrequency ablation accompanied with valve replacement for the surgical treatment of permanent atrial fibrillation（AF） and rheumatic valve diseases. Methods A total of 124 patients with permanent AF and rheumatic valves diseases undergoing surgical treatment from March 2006 to October 2010 in the First Affiliated Hospital of Sun Yat-sen University were randomly divided into ablation group and control group using coin method with 62 patients in each group. The mean atrial fibrillation duration was（56.1±47.1） months in ablation group, and patients in this group underwent maze procedure using bipolar radiofrequency ablation and valve replacement. The mean atrial fibrillation duration was（43.8±25.6） months in control group, and patients in this group underwent only valve replacement. Demographic characteristics, cardiopulmonary bypass（CPB）time, aortic cross-clamping（ACC）time, mechanical ventilation time, intensive care unit（ICU） length of stay, postoperative complications and follow-up outcomes were compared between the two groups. Results The demographic characteristics of the two groups were not statistically different （P＞0.05）. The CPB time and ACC time between the two groups were not statistically different （P＞ 0.05）. The postoperative hospital stay of ablation group was significantly longer than that of control group （15.8±6.1 d vs. 12.9±3.1d，P=0.001）. No patient needed permanent pacemaker implantation in either group. Postoperative ejection fraction of ablation group was significantly higher than that of control group（59.6%±9.2% vs. 55.5%±5.4%，P＜ 0.01）. The rate of sinus rhythm maintenance at 6 months, 12 months, 18 months, 24 months during follow-up in ablation group were 88.5%, 87.5%, 87.1% and 82.4% respectively, 3.3%, 2.2%, 0.0%, and 0.0% in control group respectively, which was statistically different between the two groups（P＜ 0.05）. Conclusion Maze procedure using bipolar radiofrequency ablation is an effective surgical procedure for the treatment of permanent atrial fibrillation.
Abstract： Objectives To determine the atrial expression of the collagen Ⅰ, collagen Ⅲ and the transforming growth factorbeta 1 (TGF-β1) in patients with rheumatic heart disease (RHD) and permanent atrial fibrillation(PAF) and to investigate the relationship between the extent of atrial fibrosis and the effectiveness of radiofrequency maze procedure in patients with RHD and PAF. Methods A total of 40 patients with RHD and PAF (≥6 months) who underwent a radiofrequency maze procedure with concomitant valvular surgery were collected for the experimental group. We acquired 100 mg of the left auricle tissue in each patient and followed up these patients after 3, 6 months of [CM(158mm]surgery. Then we assigned these patients to nonAF group and persistent AF group according to the results of the 6month followup. Another 10 patients with RHD and sinus rhythm(SR) who underwent valvular surgery alone were assigned to SR group and their left auricle tissue was also obtained. In order to determine the extent of atrial fibrosis, we observed the amount of collagen volume fraction Ⅰ，Ⅲ(CVF-Ⅰ,CVF-Ⅲ) by semiquantitative analysis with picrosirius red staining method. Using the β actin protein as the endogenous reference gene, we detected the expressions of TGF-β1 mRNA by semiquantitative reverse transcriptionpolymerase chain reaction(RT-PCR) technique. Results Each group has the same clinical baseline. At 6month follow-up, 28 among the 40 patients were categorized into the nonAF group and 12 into the AF group. (1) Patients in the nonAF group and the AF group had higher mRNA expressions of TGF-β1, CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ compared with the SR group (F=6.487, P=0.003; F=3.711, P=0.032; F=3.697, P=0.032). The AF group had higher mRNA expressions of TGF-β1, CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ than the nonAF group (t=4.372, P=0.043; t=4.603, P=0.038; t=4.776, P=0.035). But the CVFⅢ had no significant differences among the three groups (P＞0.05). (2) The patients whose left atrial function recovered after Maze procedure had lower mRNA expression than those patients whose left atrial function did not recover in the nonAF group (t=5.570, P=0.027). (3) The TGF-β1 mRNA expression has a positive correlation with both the contents of CVF-Ⅰ and left atrial diameter (r=0.786, Plt;0.05; r=0.858, Plt;0.05). Multiple logistic regression analysis revealed that the mRNA expression levels of TGF-β1, CVF-Ⅰ and left atrial diameter were independently associated with the postoperative persistence of atrial fibrillation. Conclusion The extent of atrial fibrosis in patients with RHD and PAF may be related to the sinus rhythm restoration and maintenance after AF surgical radiofrequency ablation and the resumption of atrial function.
Objective To observe the effect of radiofrequency ablation technology for the treatment of infected wounds in minipigs. Methods Infected wounds of full-thickness skin defects (about 6.15 cm2/wound) were prepared in 8 6-month-old minipigs (weighing, 30-35 kg) using the method of Davis et al. The 160 wounds were randomly divided into 4 groups (n=40). Infected wounds were debrided with the radiofrequency ablation technology in group A, with the electric knife in group B, and with the scalpel in group C; no treatment was done in group D as a control. The healing rate, healing time, and tissue filling rate were observed; bacterial quantitative examination and histological examination were done at 0, 2, 7, and 14 days after operation. Results All infected wounds were successfully established after 48 hours when Staphylococcus aureus dilution were inoculated. The wounds after radiofrequency ablation technology treatment were fresh and flat with slight bleeding; the healing time of group A was significantly shorter than that of groups B, C, and D (P lt; 0.05), and the healing rate of group A was significantly higher than that of groups B, C, and D at 7 and 14 days after operation (P lt; 0.05). The tissue filling rate of group A was significantly higher than that of groups B, C, and D at 2 days after operation (P lt; 0.05); the tissue filling rates of groups A, B, and C were significantly higher than that of group D at 7 and 14 days after operation (P lt; 0.05). At 0, 2, 7, and 14 days, there were significant differences in the bacterial count per gram tissue among 4 groups (P lt; 0.05), the order from low to high was groups A, B, C, and D. The histological observation showed that the surface of wound was smooth in group A at 0 day, and group A was better than the other groups in wound healing; at 2 days, some exudates were observed in 4 groups, but it was least in group A. There was inflammatory cell infiltration in various degrees in 4 groups at 7 and 14 days; it was lightest in group A with thick epithelium and dense collagen bundles, followed by groups B and C, and it was severe in group D. Conclusion The radiofrequency ablation technology can effectively remove the necrotic tissues of infected wounds, remarkably reduce the number of bacteria, improve the healing rate, and shorten the healing time of wounds.
Objective To formulate an evidence-based treatment plan for a child patient with Asymptomatic Wolff-Parkinson-White (WPW) Syndrome. Methods Based on the clinical problems whether the patients with asymptomatic WPW syndrome need prevent catheter ablation or not, we used “asymptomatic WPW syndrome” as the keywords and searched The Cochrane Library (Issue 3, 2007), MEDLINE (1981 to 2007), ACP Journal Club (1991 to 2007), BMJ Clinical Evidence (1999 to 2007) and NGC (1998 to 2007) for systematic reviews, randomized controlled trials (RCTs), controlled clinical trials and treatment guidelines. The methodological quality of the included studies was assessed to identify the current best evidence. Results Two RCTs were retrieved in MEDLINE. The results showed arrhythmic events increased significantly in the high-risk control group than those in the ablation group, and in the patients with multi-pathways than those with only one pathway. Based on the current evidence, integrated with clinical expertise and the patients’ values, the patients underwent electrophysiologic test and the result showed the dominance pathway in the right side and the concealed accessory pathway in the left side. Then prevent catheter ablation was performed, and no cardiovascular complications occurred in the following 12 months, which confirmed that the plan was proved optimal. Conclusion The findings of this study should reassure physicians and parents alike that in the children with the WPW syndrome who are at high risk for arrhythmias, ablation is an appropriate option.