Based on the experience of more than 10 000 times of radiofrequency ablation treatment and the clinical and basic research results of radiofrequency ablation treatment of liver cancer obtained during the period, the author shares the experience of radiofrequency ablation indication selection, preoperative preparation, concept of radiofrequency ablation and postoperative follow-up of liver cancer. The purpose is to explore how to improve the curative effect of RFA treatment for small liver cancer, and reduce local residue, recurrence, as well as relevant complications.
Objective To systematically evaluate the effectiveness and safety of pulsed field ablation (PFA) and radiofrequency ablation (RFA) in the treatment of atrial fibrillation. Methods Computer searches were conducted on PubMed, EMbase, The Cochrane Library, The Web of Science, China Biomedical Literature Database, CNKI, Wanfang, and VIP databases, with a search period from the establishment of each database until April 2025. Two researchers conducted literature screening, data extraction, and quality evaluation of the included studies based on predetermined inclusion and exclusion criteria. Standardized electronic forms were used for data extraction, with a focus on the balanced dataset after propensity score matching (PSM). Quality evaluation was conducted using the improved Newcastle Ottawa scale (NOS). Meta analysis was conducted using RevMan 5.4 and Stata 18.0 software, and subgroup analysis was performed based on the study type (whether PSM method was used or not). ResultsFinally, 14 studies were ultimately included, of which 6 studies applied the PSM method, with a total sample size of 3 172 cases (PFA group: 1 582 cases; RFA group: 1 590 cases. NOS score≥5 points. The meta-analysis results showed that the PFA group had a lower recurrence rate of atrial fibrillation [OR=0.75, 95%CI (0.63, 0.90), P=0.002], surgical complications [OR=0.63, 95%CI (0.41, 0.98), P=0.04], and surgical time [WMD=–37.32, 95%CI (–45.85, –28.78), P<0.001] compared to the RFA group, and the differences were statistically significant. In addition, compared to the PFA group, the RFA group had a shorter X-ray exposure time [WMD=7.65, 95%CI (4.41, 10.88), P<0.001], and the difference was statistically significant. There was no statistically significant difference between the two groups in terms of re ablation rate [OR=1.17, 95%CI (0.59, 2.31), P=0.65] and acute surgical success rate [OR=0.86, 95%CI (0.22, 3.35), P=0.82]. ConclusionCompared with RFA, PFA treatment for atrial fibrillation can reduce the recurrence rate, shorten the surgical time, and reduce surgical complications, indicating its good effectiveness and safety in the treatment of atrial fibrillation.
ObjectiveTo investigate the feasibility, safety and effectiveness of radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery.MethodsThe clinical data of 107 patients with rheumatic mitral disease and atrial fibrillation who underwent mitral valve replacement and radiofrequency ablation at the same time in our hospital from January 2014 to October 2018 were retrospectively analyzed. The patients were divided into two groups: a totally thoracoscopic surgery group (n=51, including 20 males and 31 females, aged 50.57±5.24 years) and a median sternotomy group (n=56, including 21 males and 35 females, aged 52.12±5.59 years) according to the surgical methods. The preoperative, intraoperative and postoperative data of the patients were compared.ResultsAll operations were successfully completed without death. In terms of bleeding volume, drainage volume, ventilator-assisted breathing time, hospital stay and incision length, the totally thoracoscopic surgery group was better than the median sternotomy group, and the difference was statistically significant (P<0.05). The cardiopulmonary bypass time and radiofrequency ablation time in the totally thoracoscopic surgery group were longer than those in the median sternotomy group (P<0.05). There was no significant difference in the operation time, aortic occlusion time, postoperative complications, left ventricular ejection fraction, left atrial diameter and sinus rhythm maintenance between the two groups (P>0.05). There was no atrioventricular block, pulmonary vein stenosis, atrioesophageal fistula, coronary artery injury, stroke or hemorrhage during the follow-up.ConclusionRadiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery is safe and effective, and it is worthy of clinical application.
ObjectiveTo compare the effectiveness of radiofrequency ablation (RFA) combined with transilluminated powered phlebectomy (TIPP) vs. high ligation and stripping (HLS) combined with TIPP in patients with varicose veins of lower limbs.MethodsA retrospective analysis was made on the clinical data of 190 patients (206 limbs) of varicose veins of lower limbs who underwent surgical treatment in our hospital from December 2017 to July 2018, of them 88 patients (96 limbs) in RFA combined with TIPP group and other 102 patients (110 limbs) in HLS combined with TIPP group. The treatment effectiveness and quality of life was assessed with venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) in three months and one year after surgery. Doppler ultrasound was used to evaluate the closure of great saphenous vein.ResultsBaseline characteristics were similar between the two groups (P>0.05). The RFA combined with TIPP group was better than the HLS combined with TIPP group in operation time, intraoperative bleeding, hospital stay time, postoperative bed time, resumption time of activities, as well as incidences of skin induration and limb numb (P<0.05). Occlusion rates of great saphenous vein in 3 months was 93.8% (90/96) in the RFA combined with TIPP group and 97.3% (107/110) in the HLS combined with TIPP group, and in one year was 91.7% (88/96) and 97.3% (107/110) respectively, there was no significant difference between the two groups at the same time point (P>0.05). The VCSS scores and CIVIQ-14 scores also improved significantly in two groups in 3 months and 1 year follow up (P<0.05), but there was no significant differences between the two groups at the same time point (P>0.05).ConclusionsRFA combined with TIPP is an effective method for the treatment of varicose veins of lower limbs. Compared with HLS, RFA has the same good effectiveness and quality of life, but it has the advantages of short operation time, rapid postoperative recovery, and less postoperative complications.
ObjectiveTo analyze the correlation between the gray value of epicardial fat and the prognosis of patients with atrial fibrillation (AF) treated by thoracoscopic radiofrequency ablation.MethodsThe clinical data of 97 patients, including 75 males and 22 females with an average age of 57.8±9.4 years, who underwent thoracoscopic radiofrequency ablation in Fuwai Hospital from 2017 to 2018 were analyzed retrospectively. The left atrial fat volume and average gray scale were calculated by left atrial enhanced CT. According to the average gray scale of left atrial fat tissue, the patients were divided into three groups: a high gray scale group, a medium gray scale group and a low gray scale group. The patients were followed up at 3, 6 and 12 months after operation. The end point of follow-up was the recovery rate of sinus rhythm. Survival analysis was used to analyze the correlation between CT features of epicardial fat enhancement and prognosis.ResultsAfter adjustment of body mass index, body surface area, gender and left atrial end diastolic diameter, regression analysis showed that the fat gray of left atrial enhanced CT was correlated with the type of AF (OR=0.30, 95%CI 0.12-0.79, P=0.014). Cox regression analysis showed that the fat gray value of left atrial CT predicted the recurrence of AF after thoracoscopic radiofrequency ablation (OR=0.92, 95%CI 0.85-0.99). The Kaplan-Meier curve showed significant difference in the long-term recurrence rate of AF among the three groups (P=0.011). The lower left atrial fat enhanced CT gray scale was, the higher long-term recurrence rate of AF was.ConclusionThe gray value of left atrial fat enhanced CT can effectively predict the recurrence of AF after radiofrequency ablation in thoracoscopic surgery.
ObjectiveTo investigate influence of left atrial contraction on lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation. MethodsClinical data of 57 patients with lone atrial fibrillation underwent minimally invasive radiofrequency ablation in Department of Cardiothoracic Surgery, Xinhua Hospital, Medical School of Shanghai Jiaotong University from September 2010 to December 2011 were retrospectively analyzed. According to the absence of mitral A velocity, patients were divided into Group A (absence of mitral A velocity, 20 patients with their age of 56.32±17.18 years, including 5 females) and Group B (mitral A velocity exists, 37 patients with their age of 60.33±11.22 years, including 17 females). Minimally invasive radiofrequency ablation via thoracoscope were performed in all patients. Preoperative and postoperative left atrial diameter (LAD), left ventricular ejection fraction (LVEF) and mitral A velocity, as well as clinical and follow-up data were recorded and compared. ResultsPreoperative clinical characters were not statistically different between two groups (P > 0.05). All the patients were followed up for 24.3±8.8 months (range, 12-26 months). Rate of postoperative atrial fibrillation recurrence in group A was significantly higher than that in group B (20.0% vs. 2.7%, P < 0.05). LAD and LVEF of 57 patients at 6 months after surgery were significantly higher than preoperative LAD and LVEF (P < 0.05), but there was no statistic difference between two groups (P > 0.05). ConclusionDamage of left atrial contraction was related to lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation. Absence of mitral A velocity could be a crucial predictor of postoperative lone atrial fibrillation recurrence.
Objective To investigate the risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy. Methods The clinical data of patients with liver metastases treated by radiofrequency ablation in our hospital from January 2010 to April 2022 were collected retrospectively and analyzed by univariate and multivariate logistic regression analysis. Results A total of 57 patients were included in the study, and the total number of postoperative infections was 19 (33.33%). Univariate logistic regression analysis showed that the tumor location, maximum tumor diameter, number of tumors, ablation times, and ablation duration were related to the occurrence of infection after radiofrequency ablation (P<0.01). The results of multivariate logistic regression analysis showed that the tumor location [OR=6.45, 95%CI (1.11, 37.35), P=0.037] and ablation duration [OR=1.49, 95%CI (1.16, 1.91), P=0.002] were independent risk factors for infection after radiofrequency ablation in patients with choledocho-jejunostomy. Conclusions For patients with metastatic liver cancer with a history of choledochojejunostomy, the tumor location and the duration of ablation are closely related to postoperative infection. We should strengthen the indivi-dualized management of such patients during and after operation should be strengthened to promote disease recovery.
ObjectiveTo compare the clinical therapeutic efficacy of radiofrequency ablation (RFA) and external beam radiation (XRT) in the treatment of early hepatocellular carcinoma (HCC). MethodsThe early HCC patients were collected in the SEER (Surveillance, Epidemiology, and End Results) database, from 2010 to 2015, according to the established inclusion and exclusion criteria. The patients were assigned into an XRT group and a RFA group according to according treatment plans. The propensity score matching (PSM) was performed at a ratio of 1∶4 based on age, gender, race, alpha-fetoprotein (AFP), cirrhosis, and tumor diameter. The overall survival of the patients of the two groups was compared, and the risk factors affecting the long-term prognosis for the early HCC patients were analyzed. ResultsA total of 2 861 early HCC patients were collected, including 2 513 in the RFA group and 348 in the XRT group. After PSM, a total of 1 582 patients were enrolled, including 343 in the XRT group and 1 239 in the RFA group. After PSM, the proportion of tumor with larger diameter (>5 cm) in the XRT group was still higher than that in the RFA group (P<0.001), but there were no statistically significant differences in the other clinical pathological characteristics between them (P>0.05). The Kaplan-Meier survival curves of the RFA group was better than that of the XRT group (HR=1.65, P<0.001); The stratified analysis based on the tumor diameter revealed that the survival curves of the RFA group were superior to those of the XRT group in the HCC patients with tumor diameters <3 cm, 3–5 cm, and >5 cm (<3 cm: HR=1.79, P<0.001; 3–5 cm: HR=1.50, P<0.001; >5 cm: HR=1.67, P=0.003). The results of the multivariate Cox regression model analysis showed that the older age (≥65 years), higher AFP level (≥400 μg/L), larger tumor diameter (≥3 cm), and later AJCC stage (stage Ⅱ) were the risk factors for overall survival in the early HCC patients (HR>1, P<0.05), while the XRT treatment was a risk factor for shortening overall survival in the HCC patients [HR(95%CI)=1.62(1.41, 1.86), P<0.001]. ConclusionThe data analysis results from the SEER database suggest that the long-term overall survival of RFA treatment is superior to XRT treatment for patients with AJCC stage Ⅰ or Ⅱ.
ObjectiveTo indirectly compare the efficacy and safety of bipolar radiofrequency ablation versus hysterectomy in abnormal uterine bleeding by using network meta-analysis. MethodsThe PubMed, EMbase, Web of Science, Cochrane Library, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of different surgical methods in abnormal uterine bleeding from inception to May 20, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then performed by using Stata 16.0 software. ResultsA total of 39 RCTs involving 3 307 patients were included. The results of network meta-analysis showed that hysterectomy was superior to bipolar radiofrequency ablation in terms of amenorrhea rate and reintervention rate, while the hospital stay and patient satisfaction rate were opposite. ConclusionCurrent evidence shows that bipolar radiofrequency ablation has more advantages in terms of hospital stay and satisfaction rate, while hysterectomy has more advantages in terms of amenorrhea rate and reintervention rate. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
摘要:目的:探讨三维电解剖标测系统(CARTO)指导下进行房性心动过速射频消融的方法及效果。方法:对40例房性心动过速患者应用CARTO标测心房, 构建三维电解剖图,分析房性心动过速的电生理机制。局灶性房速消融最早激动点,大折返性房速消融折返环的关键性峡部。选择利用常规方法行消融的28 例患者作为对照组。比较两组消融的成功率、X线曝光时间。结果:38例患者CARTO三维标测系统标测提示为局灶性房性心动过速, 最早激动点位于右心房35例,其中冠状静脉窦口8例(20%)、间隔部10例(25%)、侧壁8例(20%)、上腔静脉口附近4例(10%)、后壁4例(10 %),1例患者(2.5%)有3种类型房速(分别为间隔部、上腔静脉口的局灶房速和三尖瓣峡部依赖的大折返房速)。位于左心房的局灶房速3例,分别位于右上肺静脉口(2.5%)、左上肺静脉口(2.5%)及左心耳(2.5%)。2例患者为大折返房速(5%),1例为三尖瓣峡部依赖性,1例为围绕界嵴的大折返房速。均消融成功(100%),随访4~16个月,均无复发。常规消融组成功率为89.3%(Plt;0.05)。CARTO组X线曝光时间比常规组明显缩短,分别为(13.8±5.5 ) min 和( 30.4±12.9 ) min,差异有统计学意义（Plt;0.05）。结论:应用CARTO标测房性心动过速, 对分析房性心动过速的机制准确快速, 能有效指导射频消融。Abstract: Objective: To evaluate the methods and effects of radiofrequency ablation of atrial tachycardia guided by CARTO. Methods: The atria of 40 cases were mapped by three dimensional electroanatomic mapping system. In order to analyse the mechanism of atrial tachycardia and perform the ablation of the earliest excited point in focal atrial tachycardia and isthmus in macroreentry atrial tachycardia. 28 cases ablated by conventional procedure were selected as controlled group. The success rate and fluoroscopic time were compared between the two groups. Results: Focal atrial tachycardia was seen in 38 patients. The sites of origin from right atrium were at the coronary sinus ostium in 8 cases (20%), septal in 10 cases (25%), lateral wall in 8 cases (20%), superior vena cava ostium in 4 cases (10%), posterior wall in 4 cases (10%). One case had 3 types of atrial tachycardia (2.5%). The sites of origin from left atrium were at right pulmonary vein ostium in 1 case (2.5%), left pulmonary vein ostium in 1 case (2.5%), left auricular appendage in 1 case (2.5%). 2 cases were macroreentry atrial tachycardia (5%). Ablation was performed successfully (100%) without any complication. No recurrence was found during a followup of 416 months. Success rate in conventional group was 89.3%(Plt;0.05)。Comparing the CARTO group and conventional group, the fluoroscopic time was shorter, ( 13.8±5.5 ) min vs ( 30.4±12.9 ) min （Plt;0.05).Conclusion: The mechanism of atrial tachycardia can be evaluated quickly and accurately. Ablation can be performed safely and effectively guided by CARTO.