无X线透视射频消融治疗心律失常

2012-01-01 刘小青 北京朝阳医院

    射频消融治疗已经成为治愈心律失常最有效的手段,尤其是对于房颤、房速以及室速等复杂心律失常而言,更有其无可替代的优势。然而现今的电生理手术离不开X线透视,不论是起搏器植入,抑或射频消融术,医生均需要依靠X线透视来判断导管或电极的准确位置,从而提高治疗的成功率和减少并发症。X线对人体最常见的损害是放射性皮炎,恶性肿瘤发生率是极低的。射频消融术引发肿瘤发生率大约为百

    射频消融治疗已经成为治愈心律失常最有效的手段,尤其是对于房颤、房速以及室速等复杂心律失常而言,更有其无可替代的优势。然而现今的电生理手术离不开X线透视,不论是起搏器植入,抑或射频消融术,医生均需要依靠X线透视来判断导管或电极的准确位置,从而提高治疗的成功率和减少并发症。X线对人体最常见的损害是放射性皮炎,恶性肿瘤发生率是极低的。射频消融术引发肿瘤发生率大约为百万分之650,而且照射累计时间在60min以上[1]。目前已有的文献报道若射频消融术X线暴露时间在15至35min左右,几乎无致癌风险。尽管射频术中X线对医生和患者造成严重影响的鲜有报道,而且从放射源设备到防护措施都有了很多改进,但长期以来医生以及科学技术人员都一直在努力寻找无X线指导手术的方法和设备,现在已经初见成效。
     现有可减少X线透视的消融技术
    心脏超声引导下消融
    现有常用的无X线影像技术中包括超声影像和核磁影像。就实时影像技术而言,仅超声技术而已。超声影像可以显示心内结构,同时可以定位导管,因此人们对超声辅助射频消融手术很早就开始探索了。经胸心脏超声(TTE)最早被引入心脏射频消融中,30年前Drinkovic N利用TTE直接定位右室起搏电极位置,指导心内电生理检查和射频术[2];因经胸超声的影像受到干扰较多,之后10年开始尝试了经食道心脏超声(TEE)来指导电极的放置以及射频消融术[3];随着超声技术的发展,将超声探头直接放置的心腔中,因此心内超声(ICE)成为指导消融的热门技术。从治疗普通室上速和房扑开始[4,5,6,7],到利用ICE指导房间隔穿刺(图1),进而治疗左侧旁道以及左房心律失常等[8],心内超声技术似乎成为了21世纪射频消融治疗技术领域最有希望的新星。但是超声影像毕竟不同于常规X线透视影像,从操作到读图对术者的要求较高,同时由于探头昂贵,如若反复使用增加交叉感染等原因,因此这项技术未能在射频消融领域广泛应用。在二维心内超声技术上,科学技术人员进一步发展出三维立体的超声模型,强生公司的CARTOSound就是其中的代表,虽然技术上是一种进步,但操作复杂,而且对于呼吸影响以及分辨率低的因素,也制约其发展(图2)[9]。事实上这也并不是真正的三维超声,目前三维超声已经诞生,通过体表超声探头就可以实时重建心脏结构,现在多数用于先心病的诊治,尚未有文献报道应用在射频消融术中。尽管超声技术很大程度上减少了对于X线的依赖,但ICE本身在体内放置的过程需要借助X线透视,因此ICE并非真正零透视技术。
    冷冻消融
    虽然目前常用的射频能源消融房颤已经取得了良好效果,但是在左心房应用射频能源消融有引起肺静脉狭窄、血栓栓塞、心房破裂以及左房食道瘘等并发症的危险。冷冻消融作为一种新的更有效和更安全的消融能源逐渐受到关注。采用冷冻球囊消融隔离肺静脉是不能离开X线辅助,因此严格来说并非无射线。但冷冻球囊技术使得X线暴露时间大大缩短,而且也可以利用心脏内超声辅助更进一步减少射线暴露。[10,11,12]由于有NavX系统的出现,冷冻导管可以再系统中被清楚的定位,因此已经可以做到零透视消融。[13]
    三维电解剖标测系统
    目前应用的电解剖标测系统有CARTO、非接触球囊标测系统EnSite Array和EnSite NavX。在射频消融治疗室上速、房扑、房颤以及室速等过程中,这些系统可以极大的降低X射线照射时间,有的甚至可以做到零透视。[13,14,15,16] CARTO系统目前是诊断和治疗复杂心律失常的重要的手术平台之一。工作原理是采用GPRS卫星定位原理将标测导管头端采集的磁场信号转换为电信号,与同时采集的心内电信号一起处理后输入到工作站中形成三维的电解剖标测图(图3)。在该图的指导下,可以大大减少手术中X线暴露时间。目前采用CARTO系统辅助的射频消融手术,包括房颤、房速、房扑、室上速以及室速等,但手术过程均不同程度的需要借助X线。随着技术的革新,将来也会出现零透视的系统。
    非接触球囊标测系统EnSite Array系采用非接触式电极测量空间电场技术,能在每一瞬间撷取心腔壁上3360点的电位并用等电位图表现出来,以确定心律失常的机制,并引导消融导管到达正确位置。但球囊的到位过程需要借助于X线,因此也无法做到零透视。
    Ensite NavX系统是另一个解决复杂心律失常的重要平台。其工作的原理同样也是利用空间电场技术来定位电极导管以及重建心脏电解剖模型。NavX是能真正做到不借助于X线,精确导引导管到达所需的部位,这对于电生理标测以及消融治疗意味着一种革命。
    无X线透视NavX系统导航射频消融手术
    NavX系统的优势在于可以真实的重建循环系统(包括血管和心脏)的解剖结构模型,并且清楚的显示置入血管及心腔中的导管的位置。这就是奠定了NavX可以不依靠X线透视,而完成电生理的检查和手术。
    Volkan等用NavX系统对26名年龄在12.7±7.5岁的患者进行了无透视下电生理射频消融手术。考虑到NavX系统对于参考电极的位移很敏感,因此手术均采用全麻,而且食道内置入的电极作为参考电极。具体步骤如下:
(1)建立右房模型
    穿刺双侧股静脉并置入鞘管,用可调弯4极电极重建右房模型。4极电极从股静脉插入后通过下腔静脉进入右房,此过程无需X线透视。由于均是儿童患者,因此建立右房模型的导管是4F的,头端比较柔软。
(2)定上下腔静脉口
    通过导管记录的电位可以帮助术者定位上腔静脉口以及下腔静脉口的位置。当导管从下腔进入右房时,电位出现是从电极的远端到近段依次出现, 那么远端电极从无电位到有电位时的位置确定是下腔静脉口;同样方法,从右房进入上腔时,电位从电极远端到近端依次消失,当电位消失时记录电极所在的位置就是上腔静脉口。
(3)定三尖瓣瓣环口
    电极上能同时记录到心房和心室电位,并且两电位振幅相当时表示瓣环所在位点。通过此方法将三尖瓣瓣环大体定位。
(4)定位His
    能记录到His电位的部位在模型上标定出来。
(5)电生理导管放置
    其余导管的放置可以在NavX模型的指导下进行,此时模型如同X线,术者可以清楚的看到导管头端的行进过程,如果进入分叉如肝静脉或者肾静脉时也能及时分辨作出调整。主要放置的导管有冠状窦、右房右室以及希氏束电极。
(6)电生理检查以及射频消融治疗(图4)
    采用常规X透视方法完成普通室上速的时间是193.5±80(90-360)min,采用NavX系统无透视完成手术的时间为208.2±64.5(105-360)min,两者之间无明显差异。手术过程中,无X线并未造成导管放置困难。放置导管的平均耗时约9.8±6.4(2-40)min。冠状窦电极放置的平均耗时32.1±12 (15-60)s。24例患者中有15例AVNRT,9例右侧旁道,其中1例有旁道且合并AVNRT。所有患者中有7例显性预激,4例隐匿性旁道,15例典型AVNRT,1例非典型AVNRT。对于年龄越小的患者,无透视下放置导管的时间越长(r=-0.45,P<0.05)。无透视导管消融成功率为92%,透视下消融成功率84%,二者无显著性差异。在无透视组有4例患者最终借助了X线透视,其中2例为婴儿分别为2月大和11月大,1例同时有典型和非典型AVNRT,1例为希氏束旁旁路伴有房颤。随访中无透视组复发率19%,对照组13%(P=NS)。[13]
    Miguel等人对采用NavX系统对AVNRT患者进行零透视消融对照研究。两组患者各50人,均诊断为AVNRT,A组采用NavX辅助无透视下射频消融治疗,B组采用常规的电生理检查及射频消融手术。A组有分成右房建模亚组(图5)和未建模亚组(图6)。NavX系统使用与上述方法基本一致,只是建立血管通道时,采用留下影子的方法而非建模方法(图7)。A组成功率100%,B组96%(P=0.15)。两组中无严重并发症,B组中3例A组中有1例发生一过性右束支传导阻滞,;B组中有1例出现一过性完全性房室传导阻滞。对于两组而言,诊断时间或者手术时间上无显著性差异,但A组中右房建模亚组与未建模亚组和B组相比,诊断时间和手术时间都有显著的延长。(表1)

*表示右房建模组与未建模组和B组相比有显著差异。
    B组X线透视时间为18±16min(3.5-77min),中位数14min,总计924min。A组中仅有1例患者因靶点靠近His而透视3.2min,其余49例患者均为零透视。随访6个月,A组中有2例患者复发(4%),B组排除手术未成功的也有2例复发(4.1%;P=NS)。[17]
    Earley等采用随机对照研究,比较采用NavX系统、CARTO系统辅助以及常规电生理三种方法进行比较。入选的患者包括AVNRT、旁道以及典型房扑。总计145例患者随机分入上述三组,结果是手术总时间、即刻和短期成功率、并发症发生率和长期随访结果在各组均相同[18]。NavX组最少X线暴露,与常规组比较,4(0-50)vs. 13(2-46)min(P<0.001);与CARTO比较,4(0-50)vs.6(1-55)min(P=0.008)。NavX系统和CARTO系统较常规组均可降低射线量50%以上(P<0.001)。NavX系统可以清楚地显示导管的位置,并且可以显示导管在静脉中的移动过程;而CARTO系统只有当导管进入至磁场后方能见到。CARTO系统目前还不能做到完全无透视,不过新的系统正在研发,届时透视时间也可趋于0。
    左侧旁道导致AVRT在青少年SVT中的比例非常高,减少这类人群治疗中的X线曝光量是非常有益的。目前尚未有文献报道使用NavX系统无透视下经主动脉逆行行左侧旁道消融,目前在北京朝阳医院电生理中心正在开展使用该系统无透视下定位并消融左侧旁道。与前面提到的方法类似,通过主动脉逆行进行消融。当消融导管从股动脉经降主动脉,过主动脉弓,跨主动脉瓣逆行至左室,该动脉通路可以进行三维重建,对于动脉窦部的重建可以清楚显示三个冠状动脉窦。(图8)靶点的位置由冠状窦内的电极位置提供参考,通过前传和逆传两种方法确定消融靶点。现有的数据显示,该方法可行且安全,成功率与常规方法相同,结果尚未发表。
    通过NavX指导无透视下行电生理检查和射频消融手术,目前为止未单独报道过有任何严重并发症,如心脏穿孔、心包填塞或者三度房室传导阻滞等,与射频相关的并发症与常规手术相同。采用NavX系统辅助无透视进行电生理检查和手术,对于患者和医生而言都是有益。尤其对于某些室上速的患者都是青少年儿童居多,尽量避免射线对他们的损害,是所有医生都需要关注的问题。与此同时,长期从事射频消融治疗的电生理医生可以极大程度的减少X射线的接触,保护了自身健康。因此NavX系统会在今后大有作为。
    然而要推广NavX系统,从技术层面有两个问题,其一术者导管操作的技术要过关,这是显而易见。另一个技术问题就是无透视下房间隔穿刺技术。房间隔穿刺是常规进行左房电生理检查以及射频治疗的必需操作,有些左侧旁道也需要在二尖瓣瓣上消融方可成功,因此若能做到无透视下进行房间隔穿刺,则NavX系统无透视消融的领域将大大扩宽。采用心腔内超声或者经食道超声引导房间隔穿刺已经有过报道,这些技术的确为医生提供了一个无透视穿房间隔的方法。Ewen J等尝试采用NavX系统无透视下进行房间隔穿刺[19],通过这种方法成功完成了3例房间隔穿刺术。具体步骤如下:
(1)通过SL1长鞘将4mm盐水灌注大头送入右房,建立右房模型。标出His,右心耳以及三尖瓣瓣环等重要结构。(图9)
(2)将大头与鞘管一起放置在上腔静脉,然后将导管撤出,换以扩张鞘以及J头导丝。
(3)为了能让穿刺针在扩张鞘内也能看见,将扩张鞘头端去掉一部分,露出针尖。穿刺针近端采用单极接线法,接到电生理多导记录仪(图10)。这样在NavX系统中就可以看到针尖成为了一个单极导管(图11)。
(4)将穿刺针、扩张鞘以及鞘管从上腔静脉回撤至房间隔,NavX中的体位显示为RAO 30°和LAO 40°。当进入卵圆窝时,対直指向His后部,可见针位于右房模型后部(图12)。
(5)穿刺时通过记录左房压力和观察回抽血液颜色来确定是否穿刺成功。
从费用层面而言,采用对于复杂心律失常而言,NavX系统与CARTO系统费用相接近,且稍低于CARTO。对于普通室上速,NavX与CARTO都较常规方法费用昂贵[18]。费用问题也同样限制了该系统在临床中广泛应用。但是由于NavX系统可以对导管到过的部位进行标记,比如一些特殊的解剖标记如His或CSo,一定程度上可以节省一些用于定位的导管。但节省导管也会对诊断打折扣,因此目前常规都使用标准的诊断程序。事实上,使用NavX额外所花的费用对于提高手术的安全性以及减少射线照射来说显然是非常值得的。

参考文献
1. Perisinakis K, Damilakis J, Theocharopoulos N, Manios E, Vardas P, Gourtsoyiannis N. Accurate assessment of patient effective radiation dose and associated detriment risk from radiofrequency catheter ablation procedures. Circulation 2001;104:58-62.
2. Drinković N. Subcostal echocardiography to determine right ventricular pacing catheter position and control advancement of electrode catheters in intracardiac electrophysiologic studies. M mode and two dimensional studies. Am J Cardiol.1981 Jun;47(6):1260-5.
3. Goldman AP, Irwin JM, Glover MU, Mick W. Transesophageal echocardiography to improve positioning of radiofrequency ablation catheters in left-sided Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol. 1991 Aug;14(8):1245-50.
4. Fisher WG, Pelini MA, Bacon ME. Adjunctive intracardiac echocardiography toguide slow pathway ablation in human atrioventricular nodal reentrant tachycardia: anatomic insights. Circulation. 1997 Nov 4;96(9):3021-9.
5. Olgin JE, Kalman JM, Chin M, Stillson C, Maguire M, Ursel P, Lesh MD.Electrophysiological effects of long, linear atrial lesions placed under intracardiac ultrasound guidance. Circulation. 1997 Oct 21;96(8):2715-21.
6. Mangrum JM, Mounsey JP, Kok LC, DiMarco JP, Haines DE. Intracardiac echocardiography-guided, anatomically based radiofrequency ablation of focalatrial fibrillation originating from pulmonary veins. J Am Coll Cardiol. 2002 Jun 19;39(12):1964-72.

7. Batra R, Nair M, Kumar M, Mohan J, Shah P, Kaul U, Arora R. Intracardiac echocardiography guided radiofrequency catheter ablation of the slow pathway in atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol. 2002 Feb;6(1):43-9.
8. T Szili-Torok, GP Kimman, D Theuns, J Res, JRTC Roelandt, L J Jordaens, Transseptal left heart catheterisation guided by intracardiac echocardiography,Heart 2001;86:e11
9. Yasuo Okumura, Benhur D. Henz, Susan B. Johnson, T. Jared Bunch, Christine J. O’Brien; David O. Hodge, Andres Altman; Assaf Govari; Douglas L. Packer. Three-Dimensional Ultrasound for Image-Guided Mapping and Intervention Methods, Quantitative Validation, and Clinical Feasibility of a Novel Multimodality Image Mapping System. Circ Arrhythmia Electrophysiol. 2008;1:110-119.
10. Jensen-Urstad M, Bastani H, Braunschweig F, Drca N, Insulander P, Kennebäck G, Schwieler J, Tabrizi F. Cryoballoon ablation: a novel technique for treating focal atrial tachycardias from the pulmonary veins.Europace. 2009 Nov;11(11):1445-7.
11. Linhart M, Bellmann B, Mittmann-Braun E, Schrickel JW, Bitzen A, Andrié R, Yang A, Nickenig G, Lickfett L, Lewalter T. Comparison of cryoballoon and radiofrequency ablation of pulmonary veins in 40 patients with paroxysmal atrial fibrillation: a case-control study. J Cardiovasc Electrophysiol. 2009 Dec;20(12):1343-8.
12. Nölker G, Heintze J, Gutleben KJ, Muntean B, Pütz V, Yalda A, Vogt J, Horstkotte D. Cryoballoon Pulmonary Vein Isolation Supported by Intracardiac Echocardiography: Integration of a Nonfluoroscopic Imaging Technique in Atrial Fibrillation Ablation. J Cardiovasc Electrophysiol. 2010 Jun 9.
13. Tuzcu V. A nonfluoroscopic approach for electrophysiology and catheter ablation procedures using a three-dimensional navigation system. Pacing Clin Electrophysiol. 2007 Apr;30(4):519-25.
14. Sporton SC, Earley MJ, Nathan AW, Schilling RJ. Electroanatomic versus fluoroscopic mapping for catheter ablation procedures: a prospective randomized study. J Cardiovasc Electrophysiol 2004;15:310-315.

15. Earley MJ, Showkathali R, Alzetani M, et al. Radiofrequency ablation of arrhythmias guided by non-fluoroscopic catheter location: a prospective randomized trial. Eur Heart J 2006;27:1223-1229.
16. Kesek M, Wallenius N, Rönn F, Höglund N, Jensen S. Reduction of fluoroscopy duration in radiofrequency ablation obtained by the use of a non-fluoroscopic catheter navigation system. Europace 2006;8:1027-1030.
17. Alvarez M, Tercedor L, Almansa I, Ros N, Galdeano RS, Burillo F, Santiago P, Peñas R. Safety and feasibility of catheter ablation for atrioventricular nodal re-entrant tachycardia without fluoroscopic guidance. Heart Rhythm. 2009 Dec;6(12):1714-20.
18. Earley MJ, Showkathali R, Alzetani M, et al. Radiofrequency ablation of arrhythmias guided by non-fluoroscopic catheter location: a prospective randomized trial. Eur Heart J 2006;27:1223-1229
19.Ewen J. Shepherd & Scott A. Gall & Stephen S. Furniss .Interatrial septal puncture without the use of fluoroscopy reducing ionizing radiation in left atrial ablation procedures. J Interv Card Electrophysiol 2008; 22:183-187

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1279891, encodeId=30ce12e98910b, content=<a href='/topic/show?id=0b0546822fd' target=_blank style='color:#2F92EE;'>#射频消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46822, encryptionId=0b0546822fd, topicName=射频消融)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc7a157, createdName=jinweidong, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1297929, encodeId=5453129e929ae, content=<a href='/topic/show?id=c42d18892ad' target=_blank style='color:#2F92EE;'>#X线#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18892, encryptionId=c42d18892ad, topicName=X线)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c64275, createdName=piaojinhua, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421534, encodeId=b21d142153487, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531917, encodeId=a6b5153191ec9, content=<a href='/topic/show?id=264d46825d7' target=_blank style='color:#2F92EE;'>#射频消融治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46825, encryptionId=264d46825d7, topicName=射频消融治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7b312291842, createdName=zhanglin3083, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597699, encodeId=ece7159e6995c, content=<a href='/topic/show?id=28986582e02' target=_blank style='color:#2F92EE;'>#消融治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65827, encryptionId=28986582e02, topicName=消融治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f07818523366, createdName=zhishijing, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1279891, encodeId=30ce12e98910b, content=<a href='/topic/show?id=0b0546822fd' target=_blank style='color:#2F92EE;'>#射频消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46822, encryptionId=0b0546822fd, topicName=射频消融)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc7a157, createdName=jinweidong, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1297929, encodeId=5453129e929ae, content=<a href='/topic/show?id=c42d18892ad' target=_blank style='color:#2F92EE;'>#X线#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18892, encryptionId=c42d18892ad, topicName=X线)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c64275, createdName=piaojinhua, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421534, encodeId=b21d142153487, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531917, encodeId=a6b5153191ec9, content=<a href='/topic/show?id=264d46825d7' target=_blank style='color:#2F92EE;'>#射频消融治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46825, encryptionId=264d46825d7, topicName=射频消融治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7b312291842, createdName=zhanglin3083, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597699, encodeId=ece7159e6995c, content=<a href='/topic/show?id=28986582e02' target=_blank style='color:#2F92EE;'>#消融治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65827, encryptionId=28986582e02, topicName=消融治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f07818523366, createdName=zhishijing, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=)]
    2012-01-03 piaojinhua
  3. [GetPortalCommentsPageByObjectIdResponse(id=1279891, encodeId=30ce12e98910b, content=<a href='/topic/show?id=0b0546822fd' target=_blank style='color:#2F92EE;'>#射频消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46822, encryptionId=0b0546822fd, topicName=射频消融)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc7a157, createdName=jinweidong, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1297929, encodeId=5453129e929ae, content=<a href='/topic/show?id=c42d18892ad' target=_blank style='color:#2F92EE;'>#X线#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18892, encryptionId=c42d18892ad, topicName=X线)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c64275, createdName=piaojinhua, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421534, encodeId=b21d142153487, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531917, encodeId=a6b5153191ec9, content=<a href='/topic/show?id=264d46825d7' target=_blank style='color:#2F92EE;'>#射频消融治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46825, encryptionId=264d46825d7, topicName=射频消融治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7b312291842, createdName=zhanglin3083, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597699, encodeId=ece7159e6995c, content=<a href='/topic/show?id=28986582e02' target=_blank style='color:#2F92EE;'>#消融治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65827, encryptionId=28986582e02, topicName=消融治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f07818523366, createdName=zhishijing, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1279891, encodeId=30ce12e98910b, content=<a href='/topic/show?id=0b0546822fd' target=_blank style='color:#2F92EE;'>#射频消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46822, encryptionId=0b0546822fd, topicName=射频消融)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc7a157, createdName=jinweidong, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1297929, encodeId=5453129e929ae, content=<a href='/topic/show?id=c42d18892ad' target=_blank style='color:#2F92EE;'>#X线#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18892, encryptionId=c42d18892ad, topicName=X线)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c64275, createdName=piaojinhua, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421534, encodeId=b21d142153487, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531917, encodeId=a6b5153191ec9, content=<a href='/topic/show?id=264d46825d7' target=_blank style='color:#2F92EE;'>#射频消融治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46825, encryptionId=264d46825d7, topicName=射频消融治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7b312291842, createdName=zhanglin3083, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597699, encodeId=ece7159e6995c, content=<a href='/topic/show?id=28986582e02' target=_blank style='color:#2F92EE;'>#消融治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65827, encryptionId=28986582e02, topicName=消融治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f07818523366, createdName=zhishijing, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1279891, encodeId=30ce12e98910b, content=<a href='/topic/show?id=0b0546822fd' target=_blank style='color:#2F92EE;'>#射频消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46822, encryptionId=0b0546822fd, topicName=射频消融)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc7a157, createdName=jinweidong, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1297929, encodeId=5453129e929ae, content=<a href='/topic/show?id=c42d18892ad' target=_blank style='color:#2F92EE;'>#X线#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18892, encryptionId=c42d18892ad, topicName=X线)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c64275, createdName=piaojinhua, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421534, encodeId=b21d142153487, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531917, encodeId=a6b5153191ec9, content=<a href='/topic/show?id=264d46825d7' target=_blank style='color:#2F92EE;'>#射频消融治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46825, encryptionId=264d46825d7, topicName=射频消融治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7b312291842, createdName=zhanglin3083, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597699, encodeId=ece7159e6995c, content=<a href='/topic/show?id=28986582e02' target=_blank style='color:#2F92EE;'>#消融治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65827, encryptionId=28986582e02, topicName=消融治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f07818523366, createdName=zhishijing, createdTime=Tue Jan 03 03:45:00 CST 2012, time=2012-01-03, status=1, ipAttribution=)]

相关资讯

射频消融在非典型增生Barrett食管中的耐久性

 最近,美国学者Nicholas J. Shaheen等研究发现,对于非典型增生Barrett食管(BE)受试者,射频消融(RFA)治疗是一种可接受的安全方法,耐久性较好,并能降低疾病的3年进展率。相关内容发表于《胃肠病学》(Gastronenterology)杂志。   RFA可以根除伴有非典型增生的BE中的非典型增生和肠上皮化生,并降低食管的腺癌发生率。研究人员评估了长期根除率、新生鳞状上皮

肿瘤射频消融用于实体瘤治疗新近进展

  1990年,罗西(Rossi)等首先报道了利用射频消融(RFA)造成肝组织热损伤的动物实验结果,并提出利用RFA治疗肝肿瘤的理念。此后有关 RFA 治疗实体肿瘤的实验和临床研究报道日益增多。目前,RFA已广泛应用于肝、肾、肺、乳腺、骨肿瘤及子宫肌瘤等实体肿瘤的治疗。   治疗原理   RFA利用高频电磁波(30 MHz以下,肿瘤消融常为375 ~5

2011年第14届全国介入心脏病学论坛撷英

来源:医学论坛网   3月24-27日,由中国医师协会、中国医师协会心血管内科医师分会、中华医学会心血管病分会主办的第14届全国介入心脏病学论坛在泉城济南隆重举行。   规范化:中国心血管病介入治疗发展的主题   3月25日,借用卫生部心血管介入治疗网上直报系统获得的资料,大会主席霍勇教授分析了2010年我国经皮冠状动脉介入治疗(PCI)概况及与2009年的对比(见图)。      霍教