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Microwave Ablation of Hepatocellular Carcinoma and Liver Metastases: Challenges, Opportunities, and Future Directions 微波消融治疗肝细胞癌和肝转移:挑战、机遇和未来方向
Pub Date : 2022-01-21 DOI: 10.1055/s-0041-1741521
Lindsay M. Stratchko, E. K. Koepsel, T. Ziemlewicz, E. Knott, J. Hinshaw, S. Wells, P. Laeseke, Fred T. Lee Jr
Chronic liver disease predisposes patients to the development of hepatocellular carcinoma (HCC), and the degree of liver dysfunction helps dictate the management of patients with primary hepatic malignancy. Percutaneous ablation is an increasingly utilized treatment modality for patients with hepatocellular carcinoma who are poor surgical candidates, particularly when treatment goals include sparing hepatic parenchyma in the setting of hepatic dysfunction. Various thermal and non-thermal ablation modalities have historically been used to treat HCC. With advances in ablation technology, modern microwave (MW) ablation systems have become increasingly utilized in HCC as well as hepatic metastatic disease management due to larger and more predictable ablation zones. The evolution of ablation technology has resulted in the growth of ablation as a safe and effective treatment option for patients with primary and secondary liver tumors.
慢性肝病易使患者发展为肝细胞癌(HCC),肝功能障碍的程度有助于决定原发性肝恶性肿瘤患者的治疗。对于不适合手术治疗的肝细胞癌患者,经皮消融是一种越来越多的治疗方式,特别是当治疗目标包括在肝功能障碍的情况下保留肝实质时。各种热消融和非热消融方式历来用于治疗HCC。随着消融技术的进步,现代微波(MW)消融系统由于更大和更可预测的消融区域而越来越多地用于HCC和肝转移性疾病的治疗。消融术技术的发展使得消融术成为原发性和继发性肝脏肿瘤患者安全有效的治疗选择。
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引用次数: 0
Interventional Techniques to Support Enteral Nutrition 介入技术支持肠内营养
Pub Date : 2022-01-20 DOI: 10.1055/s-0042-1742295
Simon Long, D. Fernando, Christina Boyd, J. Katrivesis, Harold Park
In patients requiring nutritional support, enteral nutrition has been shown to have many benefits, including improved long-term outcomes, when compared to parenteral alternatives. Given our baseline comfort with medical imaging and knowledge of anatomy, Interventional Radiologists can support a patient's caloric needs and circumvent more invasive surgical methods for placing feeding tubes.
在需要营养支持的患者中,与肠外替代方案相比,肠内营养已被证明具有许多益处,包括改善的长期预后。鉴于我们对医学成像和解剖学知识的基本了解,介入放射科医生可以支持患者的热量需求,并避免更多的侵入性手术方法来放置喂食管。
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引用次数: 1
Comparison of Outcomes with Triple-Regimen versus Double-Regimen Transarterial Chemoembolization 三方案与双方案经动脉化疗栓塞的疗效比较
Pub Date : 2022-01-20 DOI: 10.1055/s-0042-1756460
A. Smolock, Osmani Deochand, W. Rilling, P. Patel, E. Hohenwalter, S. White, M. Scheidt
Abstract We sought to evaluate differences in outcomes between double versus triple transarterial chemoembolization (TACE). TACEs over a 1-year period were retrospectively reviewed and divided into two groups: double and triple. Imaging response and complications were made on a per-procedure basis. Student's t -test was used to calculate differences in continuous variables, and chi-square test was used to calculate differences in categorical values.Overall tumor response was similar between the two groups, and there were no significant differences in complications between groups. Outcomes are similar between double and triple conventional TACE, suggesting that adding a third drug may only contribute to cost.
我们试图评估两次和三次经动脉化疗栓塞(TACE)结果的差异。回顾性分析1年期间的tace,分为两组:两组和三组。影像学反应和并发症以每次手术为基础。连续变量间的差异采用学生t检验,分类值间的差异采用卡方检验。两组总体肿瘤反应相似,两组并发症无显著差异。两倍和三倍常规TACE的结果相似,这表明添加第三种药物可能只会增加成本。
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引用次数: 0
Sclerotherapy of Symptomatic Nonparasitic Splenic Cysts: Excellent Long-Term Treatment Response' 硬化疗法治疗症状性非寄生虫性脾囊肿:长期疗效优异
Pub Date : 2022-01-14 DOI: 10.1055/s-0041-1742245
M. Dölle, H. Wedemeyer, M. Gebel, A. Potthoff, S. Zender
Background Splenic cysts are rare and occur in 0.5 to 2% of the population. They are usually asymptomatic and do not require therapy. In case of symptomatic nonparasitic splenic cysts, potential therapy includes partial splenectomy or laparoscopic cyst de-roofing as well as ultrasound-guided sclerotherapy with 1% polidocanol or 10% sodium chloride (NaCl) as an interventional alternative. So far, single-session sclerotherapy of symptomatic nonparasitic cysts is recommended only if clear-transparent cyst fluid is aspirated. Materials and Methods We report a case series of 17 patients with symptomatic macroscopically turbid nonparasitic splenic cyst fluid who underwent ultrasound-guided fine needle sclerotherapy with either polidocanol ± 10% NaCl (n = 12) or 10% NaCl alone (n = 5) and a follow-up of a maximum of 12 years after first intervention. Clinical, sonographic, and laboratory chemistry data were recorded at baseline and during the follow-up. Results The mean follow-up time was 43.65 ± 40.18 months. At the end of the follow-up, a 79% reduction of cyst size was achieved. The maximum size reduction in the polidocanol group was 76 ± 18% and 84 ± 21% in the sodium chloride group (p >0.05). At the end of follow-up, 15 out of the 17 patients did not have any further symptoms. Despite the cystic fluid being turbid, it was hardly possible to detect a microbiological superinfection. Conclusion Sclerotherapy of splenic cysts leads to a significant size regression in all patients, independent of the sclerotherapy agent used with fewer systemic toxic side effects of polidocanol treatment. It was shown that in a tertiary care center with significant experience, sclerotherapy of splenic cysts is also safe and successful and can lead to a drastic regression of cyst size and symptoms. This shows that interventional therapy is a good alternative to surgical procedures.
背景:脾囊肿是罕见的,发生率为0.5% - 2%。它们通常是无症状的,不需要治疗。对于有症状的非寄生性脾囊肿,可能的治疗方法包括部分脾切除术或腹腔镜囊肿去顶术,以及超声引导下用1%聚多卡因醇或10%氯化钠(NaCl)作为介入治疗的替代方案。到目前为止,对于有症状的非寄生性囊肿,单次硬化疗法仅推荐在吸出透明囊肿液的情况下使用。材料和方法我们报告了17例有症状的宏观上浑浊的非寄生虫性脾囊肿液患者的病例系列,他们接受了超声引导下的细针硬化治疗,分别使用聚多卡因醇±10% NaCl (n = 12)或单独使用10% NaCl (n = 5),并在首次干预后进行了最长12年的随访。在基线和随访期间记录临床、超声和实验室化学数据。结果平均随访时间43.65±40.18个月。在随访结束时,囊肿大小缩小了79%。聚多卡因组最大缩小幅度为76±18%,氯化钠组最大缩小幅度为84±21% (p >0.05)。在随访结束时,17名患者中有15名没有任何进一步的症状。尽管囊性液体是浑浊的,但几乎不可能检测到微生物重复感染。结论脾囊肿硬化治疗后,所有患者的脾囊肿均显著缩小,与使用的硬化治疗剂无关,且多酚治疗的全身毒副作用较小。研究表明,在具有丰富经验的三级保健中心,脾囊肿的硬化治疗也是安全成功的,并可导致囊肿大小和症状的急剧消退。这表明介入治疗是外科手术的一个很好的选择。
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引用次数: 0
State of the Art: Contrast Enhanced 4D Ultrasound to Monitor or Assess Locoregional Therapies 最新进展:造影增强四维超声监测或评估局部治疗
Pub Date : 2022-01-11 DOI: 10.1055/s-0041-1741520
M. Tantawi, S. Shamimi-Noori, C. Shaw, J. Eisenbrey
Abstract Locoregional therapies (LRTs) are an essential management tool in the treatment of primary liver cancers or metastatic liver disease. LRTs include curative and palliative modalities. Monitoring treatment response of LRTs is crucial for maximizing benefit and improving clinical outcomes. Clinical use of contrast-enhanced ultrasound (CEUS) was introduced more than two decades ago. Its portability, cost effectiveness, lack of contraindications and safety make it an ideal tool for treatment monitoring in numerous situations. Two-dimensional dynamic CEUS has been proved to be equivalent to the current imaging standard in the guidance of LRTs, assessment of their adequacy, and detection of early tumor recurrence. Recent technical advances in ultrasound transducers and image processing have made 3D CEUS scanning widely available on most commercial ultrasound systems. 3D scanning offers a broad multiplanar view of anatomic structures, overcoming many limitations of two-dimensional scanning. Furthermore, many ultrasound systems provide real-time dynamic 3D CEUS, also known as 4D CEUS. Volumetric CEUS has shown to perform better than 2D CEUS in the assessment and monitoring of some LRTs. CEUS presents a valid alternative to the current imaging standards with reduced cost and decreased risk of complications. Future efforts will be directed toward refining the utility of 4D CEUS through approaches such as multi-parametric quantitative analysis and machine learning algorithms.
局部治疗(LRTs)是原发性肝癌或转移性肝病治疗中必不可少的管理工具。lrt包括治疗和姑息方式。监测lrt的治疗反应对于最大限度地提高疗效和改善临床结果至关重要。对比增强超声(CEUS)的临床应用是在二十多年前引入的。它的便携性、成本效益、无禁忌症和安全性使其成为许多情况下治疗监测的理想工具。二维动态超声造影在指导lrt、评估其充分性、发现早期肿瘤复发等方面已被证明与现行影像学标准相当。超声换能器和图像处理的最新技术进步使得3D超声造影扫描广泛应用于大多数商用超声系统。三维扫描提供了解剖结构的广泛的多平面视图,克服了二维扫描的许多限制。此外,许多超声系统提供实时动态3D超声造影,也称为4D超声造影。容积超声造影在一些lrt的评估和监测方面表现优于二维超声造影。超声造影是目前影像学标准的有效替代方案,成本低,并发症风险低。未来的工作将通过多参数定量分析和机器学习算法等方法来改进4D CEUS的效用。
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引用次数: 0
Laparoscopic Liver Resection: Surgical Techniques 腹腔镜肝切除术:外科技术
Pub Date : 2022-01-11 DOI: 10.1055/s-0041-1742153
B. Sullivan, R. Wolf, Z. Jutric
Abstract Laparoscopic liver resection has evolved from a technique to remove small anterior liver lesions with smaller incisions to a major method for the performance of almost every type of liver resection.
腹腔镜肝切除术已经从一种以较小切口切除肝前小病变的技术发展成为几乎所有类型肝切除术的主要方法。
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引用次数: 0
Sarcopenia of Cirrhosis and the Therapeutic Potential of Transjugular Intrahepatic Portosystemic Shunt Creation 肝硬化肌肉减少症和经颈静脉肝内门静脉系统分流术的治疗潜力
Pub Date : 2022-01-10 DOI: 10.1055/s-0041-1742214
B. Schlansky, K. Farsad
Abstract Sarcopenia is a major sequela of cirrhosis, contributing to significant morbidity and mortality. Advances in body composition analysis using medical imaging have begun to identify changes in skeletal muscle and fat that are prognostic of the impact of sarcopenia on medical outcomes in cirrhosis and other pathologies. Recently, observational studies have shown a correlation between transjugular intrahepatic portosystemic shunt (TIPS) creation and a reversal of the progressive muscle loss in cirrhosis. This reversal is also associated with improved clinical outcomes and survival. This review summarizes current understanding of cirrhotic sarcopenia, and discusses the implications of TIPS creation in reversing this process.
肌肉减少症是肝硬化的主要后遗症,发病率和死亡率都很高。利用医学成像技术进行身体成分分析的进展已经开始确定骨骼肌和脂肪的变化,这些变化是肌肉减少症对肝硬化和其他病理的医疗结果影响的预后。最近,观察性研究表明经颈静脉肝内门静脉系统分流术(TIPS)的产生与肝硬化进行性肌肉损失的逆转之间存在相关性。这种逆转也与临床结果和生存率的改善有关。这篇综述总结了目前对肝硬化肌肉减少症的认识,并讨论了TIPS在逆转这一过程中的意义。
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引用次数: 0
Endoscopic Operating Platforms and Advancements 内镜手术平台和进展
Pub Date : 2022-01-07 DOI: 10.1055/s-0041-1740599
I. Sethi, Amy Rosenbluth
Abstract The first endoscope was created in 1805 by Philip Bozini in Germany. This endoscope was known as “Lichtleiter,” a light guiding instrument. In the 1950s, the first models of fiberoptic endoscopes were introduced. Since then, the technology associated with endoscopic surgery has grown by leaps and bounds. This article aims to explore current operating platforms and emerging technology associated with endoscopic surgery.
第一个内窥镜是1805年由德国的Philip Bozini发明的。这种内窥镜被称为“Lichtleiter”,一种光导仪器。在20世纪50年代,光纤内窥镜的第一个模型被引入。从那时起,内窥镜手术相关技术突飞猛进。本文旨在探讨与内窥镜手术相关的当前操作平台和新兴技术。
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引用次数: 0
Gallbladder Cryoablation: Clinical and Technical Considerations 胆囊冷冻消融:临床和技术考虑
Pub Date : 2022-01-04 DOI: 10.1055/s-0041-1742101
H. McGregor
Abstract As many as 500,000 cholecystectomies are performed per year in the United States. Frail patients are at higher risk from cholecystectomy, with reported postoperative complication and mortality rates as high as 31 and 5% in patients older than 75 years. Percutaneous cholecystostomy drainage is commonly employed in high-risk patients with cholecystitis, with over 12,000 cases performed annually. Cholecystostomy, however, is not a definitive treatment, with up to 30% of patients having a recurrent episode of cholecystitis within 4 months after tube removal. Gallbladder cryoablation has emerged as a minimally invasive procedure that achieves transmural gallbladder wall necrosis in a single session resulting in gallbladder fibrosis and involution. Early clinical data have been promising, with reported technical success of 86% and clinical success of 100% at up to 500 days of follow-up. Several challenges and unknowns remain, however, including optimal patient selection and procedural technique, the potential need for adjunct procedures to occlude the cystic duct, the implications of the immunostimulatory effects of cryoablation, and the impact of the presence of gallstones on outcomes. This article reviews the rationale behind gallbladder cryoablation, updates early clinical outcomes, and discusses the challenges that remain for the adoption of the technique for the treatment of benign gallbladder disease.
在美国,每年有多达50万例胆囊切除术。体弱患者胆囊切除术的风险更高,据报道,75岁以上患者的术后并发症和死亡率分别高达31%和5%。经皮胆囊造瘘引流术是胆囊炎高危患者常用的治疗方法,每年有超过12000例胆囊炎患者采用经皮胆囊造瘘引流术。然而,胆囊造口术并不是一种确定的治疗方法,高达30%的患者在取管后4个月内再次发生胆囊炎。胆囊冷冻消融已成为一种微创手术,可在一次手术中实现经壁胆囊壁坏死,导致胆囊纤维化和复旧。早期临床数据很有希望,据报道,在长达500天的随访中,技术成功率为86%,临床成功率为100%。然而,仍然存在一些挑战和未知因素,包括最佳患者选择和手术技术,可能需要辅助手术来阻塞胆囊管,冷冻消融的免疫刺激作用的意义,以及胆结石的存在对结果的影响。本文回顾了胆囊冷冻消融的基本原理,更新了早期临床结果,并讨论了采用该技术治疗良性胆囊疾病所面临的挑战。
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引用次数: 0
Variceal Hemorrhage: Decompression, Obliteration, or Both? 静脉曲张出血:减压,闭塞,还是两者兼而有之?
Pub Date : 2022-01-04 DOI: 10.1055/s-0041-1742100
B. McCafferty, H. E. Khudari, A. Salei, A. Gunn
Abstract Variceal hemorrhage is a morbid condition that frequently mandates the involvement of interventional radiology to achieve successful and sustained hemostasis. Primary image-guided therapies for variceal hemorrhage include a transjugular intrahepatic portosystemic shunt and transvenous obliteration. Knowledge of variceal pathophysiology and anatomy, current techniques, and the evidence supporting therapeutic selection is paramount to successful patient outcomes. The purpose of this review is to provide the reader a framework of the available literature on image-guided management of bleeding varices to assist in clinical management.
摘要静脉曲张出血是一种病态的情况,经常要求介入放射学的参与,以实现成功和持续的止血。图像引导下静脉曲张出血的主要治疗方法包括经颈静脉肝内门静脉系统分流术和经静脉闭塞术。静脉曲张病理生理学和解剖学的知识,当前的技术,以及支持治疗选择的证据对成功的患者结果至关重要。本综述的目的是为读者提供一个关于图像引导下出血静脉曲张治疗的现有文献框架,以协助临床治疗。
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引用次数: 0
期刊
Digestive disease interventions
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