The precise anatomical division of liver segments is the foundation of liver surgery, while the anatomical division of the S9 segment of liver is a further precise division of the caudate lobe of the liver. This article retrospectively analyzed and summarized the precise minimally invasive ablation and follow-up results of four representative lesions of the S9 segment of liver, including primary liver cancer, recurrent liver cancer, metastatic liver cancer, and focal liver hyperplasia, treated at Affiliated Dongguan Hospital of Southern Medical University. The aim of this study is to explore the minimally invasive ablation effect of lesions located at the S9 segment of liver under CT guidance.
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.
ObjectiveTo evaluate the safety and efficacy of microwave ablation (MWA) in the treatment of lung tumors.MethodsThe clinical data of 31 patients with lung neoplasms treated with MWA from January 2019 to August 2020 in a single center were retrospectively analyzed. There were 17 males and 14 females at an age of 63.4±10.4 years. The characteristics of the lesions, technical success rate, technical efficiency, local progression rate, adverse reactions and complications were recorded in detail.ResultsThere were 39 target lesions with an average diameter of 20.2±10.6 mm. A total of 36 MWA procedures were completed. The initial technical success rate was 84.6% (33/39), and the technical efficiency was 92.3% (36/39). The median postprocedure hospital stay was 2.0 (2.0, 3.0) d. A total of 12.9% (4/31) of the patients had local progression, and the local control rate was 87.1%. The main adverse reactions were pain (12/36, 33.3%), cough (6/36, 16.7%), post-ablation syndrome (6/36, 16.7%) and pleural effusion (3/36, 8.3%). The main complications were pneumothorax (11/36, 30.6%), hemorrhage (8/36, 22.2%), cavitation (2/36, 5.6%) and pulmonary infection (1/36, 2.8%). The median follow-up time was 13.0 (8.0, 18.0) months. No patient died during the follow-up.ConclusionMWA is safe and effective in the treatment of lung tumors with controllable complications. Successive researches with large sample, and medium and long-term follow-ups are needed to explore the significance of combined therapies.
Objective To analyze the common post-operative complications of microwave ablation in situ in the treatment of bone tumors and the prevention and control strategies. Methods Between March 2009 and July 2012, 73 cases of bone tumors were treated with microwave ablation in situ, of which 54 cases met the inclusion criteria. There were 31 males and 23 females with a median age of 27 years (range, 9-74 years), including 37 malignant tumors and 17 benign tumors. In 49 primary bone tumors, 17 cases were in stage 3, 13 in stage IIA, and 19 in stage IIB according to Enneking grading system. The postoperative complications, managements, and outcomes in patients were analyzed. Results After operation, 54 patients were followed up 12-40 months (mean, 24 months). Seven kinds of complications occurred in 21 patients (38.9%) with 3 cases suffered from more than one, including pathologic fracture in 4 cases (7.4%), deep infection in 2 cases (3.7%), nerve injury in 7 cases (13.0%), deep vein thrombosis of the lower extremity in 1 case (1.9%), medial collateral ligament heat injury of the knee in 1 case (1.9%), hematoma in 2 cases (3.7%), and fat liquefaction of incision and flap necrosis in 8 cases (14.8%). Conclusion Pathologic fracture is the primary complication which results in a second surgery. Deep infection is the main complication that often leads to failure of the limb salvage. Nerve injury and poor wound healing are the most common complications. Good control of microwave temperature is the key to successful operation, and the related preventive strategies could reduce complications.
ObjectiveTo evaluate the effectiveness and safety of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with laparoscopic-assisted microwave ablation (Lap-MWA) for the liver resection in the treatment of unresectable primary hepatic carcinoma. Methods This study analyzed the clinical data of 12 hepatic carcinoma patients who underwent ALPPS combined with Lap-MWA for the liver resection from January 2019 to June 2021 in the Department of Hepato-Pancreato-Biliary Surgery of Qinzhou First People’s Hospital. The patients had insufficient future liver remnant (FLR) and different degrees of liver cirrhosis. The 1-stage ALPPS was to perform after the laparoscopic-assisted ligation of the portal vein of the loaded tumor. At the same time, the microwave ablation was used for the liver parenchyma segmentation under the guidance of laparoscopic ultrasound (LUS) without separating liver parenchyma. Other steps were the same as classic ALPPS. Results All the 12 patients successfully completed the operation. The 1-stage ALPPS lasted 90–130 min, (110.25±35.34) min; the blood loss was 80–140 mL, (100.37±42.24) mL. The interval between 2 stages was 12–16 d, (14.0±2.5) d. The FLR/standard liver volume (SLV) increased to (58.00±3.30) %. The 2-stage ALPPS lasted 120–180 min, (150±30) min; the blood loss was 300–1 200 mL, (453.50±107.70) mL; the hospital stay after 2 stages of ALPPS operations was 11–16 d, (14±2) d. Among all patients, 4 U of leukocyte suspension was transfused in 1 patient, and pleural ascites occurred in 3 patients. There were no serious complications such as liver failure and severe infection, and no death cases. The total hospital stay was 14–22 d, (17±3) d. After the 1-stage ALPPS, the total bilirubin, white blood cells, glutamic-pyruvic transaminase level increased (P<0.05), and total bilirubin and white blood cells gradually returned to the normal level on the 5th day after 1-stage ALPPS. On the 1st day after finishing the 2-stage ALPPS, albumin and hemoglobin decreased, while white blood cells, total bilirubin, prothrombin time and glutamic-pyruvic transaminase increased in varying degrees (P<0.05). And on the 5th day after the 2-stage ALPPS, all indicators gradually returned to normal. All the patients were followed up for 6–30 months, (20±6) months. Two patients died of tumor recurrence and metastasis at 6.2 months and 13 months after the surgery, respectively. No recurrence was found in other patients, and their life quality was good. Conclusion Preliminary results of this study indicate that ALPPS combined with Lap-MWA is safe and effective for the treatment of unresectable primary hepatic carcinoma.
ObjectiveTo compare the efficacy and safety of computed tomography (CT)-guided percutaneous versus electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation (MWA) for the treatment of pulmonary nodules. MethodsA retrospective analysis was conducted on the data of high-risk pulmonary nodule patients who underwent MWA at the Nanjing Drum Tower Hospital between 2022 and 2023. The pathological diagnosis rate, complications, and progression-free survival (PFS) rate were compared between the CT group and the ENB group. ResultsThere were 61 patients in the CT group, including 30 males and 31 females, with an average age of (67.22±9.13) years. There were 53 patients in the ENB group, including 29 males and 24 females, with an average age of (65.29±13.76) years. The pathological diagnosis rate in the CT group was slightly higher than that in the ENB group (88.52% vs. 71.69%, P=0.03). However, the ENB group exhibited a lower incidence of perioperative complications, including pneumothorax (16.39% vs. 3.77%, P=0.03), hemoptysis (19.67% vs. 5.66%, P=0.05), and pain (22.95% vs. 7.55%, P=0.03). There was no statistically significant difference in PFS rate between the two groups [HR=1.17, 95%CI (0.23, 5.81), P=0.85]. ConclusionBoth CT-guided and ENB-guided MWA are effective treatment modalities for high-risk pulmonary nodules.
Objective To explore the clinical value and experience of ultrasound guided combined with laparoscopic microwave ablation in treatment for special site liver cancer.Methods The clinical data of 9 patients with liver cancer treated by ultrasound guided combined with laparoscopic microwave ablation in our hospital from February 2008 to October 2010 were analyzed retrospectively.Results There were 6 cases of primary liver cancer, 3 cases of metastatic hepatic carcinoma. Eight cases of multiple tumors, 1 case of single tumor.There were one or more lesions invading liver capsular,a total of 13 lesions in all the patients. Among them,6 lesions located in diaphragm, 3 closed to bowel, 2 neared stomach,1 located in gallbladder bed and 1 in hilar.No serious complications and no death happened during operation.The following-up time was (9.2±4.7) months (4 to 18 months), there were 2 lesions of part residual, including 1 case of microwave ablation again,1 case of percutaneous ethanol ablation, and 11 lesions of complete ablation (84.6%,11/13) 1 month after operation by CT examination.Four cases recurred 3 months after operation by CT examination, including 2 cases of microwave ablation again,1 case of percutaneous ethanol ablation,1 patient with pulmonary metastasis and giving up treatment,1 patient with poor liver function and died of liver failure 6 months after operation;1 patient with multiple lesions died of brain metastases 10 months after operation; the rest were still alive.Conclusions Ultrasound guided combined with laparoscopic microwave ablation is a safe and effective method in the treatment for special site liver cancer,the curative effect is good and worth of spread.
Although surgical resection remains to be the best treatment strategy for stageⅠnon-small cell lung cancer (NSCLC), percutaneous thermal ablation offers an important option for patients who are unable to undergo surgical resection. Currently, there are three main thermal ablation methods used in the treatment of lung cancer, including radiofrequency ablation (RFA), microwave ablation (MWA) and argon-helium cryoablation (AHC). With the improvement of technique and the accumulation of experience in the treatment of lung cancer, some limitations are disclosed in the initial application of RFA, such as heat sink effect, skin burns and rapid carbonization. These shortcomings have been overcome in the development of MWA and AHC. The feasibility and safety of thermal ablation for the treatment of lung cancer has been demonstrated and its efficacy has been significantly improved (especially for the tumour diameter≤3 cm). This article will focus on the application and recent research developments of these ablation techniques in the treatment of lung cancer.
Microwave ablation (MWA), a form of thermal ablation in interventional radiology, uses electromagnetic waves to produce tissue-heating effects which generating tissue necrosis within solid tumors. Due to its exact effect, safety, high thermal efficiency, MWA became a minimally invasive surgery for lung cancer and a palliative treatment in patients who are nonsurgical candidate and solid tumors. MWA is accurate and effective for peripheral lung cancer and can effectively relieve airway obstruction, obstructive symptoms of pneumonia, atelectasis, breathing difficulties for central lung cancer. This review focuses on the application of MWA in the treatment of lung cancer.