Four new surgeries were successfully performed in two weeks! 6.2-6.16
html On June 2, Gaobo Medical Group’s Hepatobiliary Tumor Innovative Diagnosis and Treatment Center (hereinafter referred to as the “Hepatobiliary Tumor Center”) was the chairman of the Interventional Oncology Committee of the Chinese Anti-Cancer Association, Peking University First Hospital Interventional Vascular Under the leadership and guidance of Professor Zou Yinghua, director of surgery and leader of the hepatobiliary tumor interventional department of Gaobo Medical Group, the first hepatic arterial chemoembolization (TACE) at Gaobo Medical Group's Beijing Gaobo Boren Hospital was successfully performed. In just two weeks, the Hepatobiliary Cancer Center has successively implemented three new cases of percutaneous radiofrequency ablation (RFA) of liver tumors, hepatic arterial infusion chemotherapy (HAIC), and percutaneous transhepatic biliary drainage (PTCD) Surgery allows them suffering from liver cancer to regain their lives in desperate situations.❤ On June 10, the first percutaneous radiofrequency ablation (RFA) of liver tumors was successfully performed!
❖ Operation record
The patient was in the supine position. Ultrasound confirmed the puncture point , and the upper abdomen was sterilized and draped. was anesthetized with 2% lidocaine + normal saline for local infiltration. Under ultrasound guidance, a Boston Scientific radiofrequency ablation needle was used to puncture the tumor in the right lobe of the liver. After the puncture was successful, ultrasound and CT were combined to perform parallel needle placement and ablation treatment to maximize the ablation range. Adequately cover and exceed the tumor area. After multiple ablation cycles are completed, the puncture tract is ablated, the needle is removed, and local dressing is covered, and the operation is completed.
The operation went smoothly, the patient's vital signs were stable during the operation, and he did not complain of obvious pain.
❖ Preoperative enhanced CT to check the lesion status
❖ Surgical silhouette
Preoperative preparation
Assessment of local radiofrequency needle insertion site under CT guidance
Popular science time
What is radiofrequency ablation (RFA)?
Radiofrequency ablation is a minimally invasive in-situ tumor treatment technology. It uses imaging technology such as ultrasound or CT to locate and guide electrode needles to be directly inserted into the tumor. Radiofrequency energy is used to generate high temperature in the local tissue of the lesion, dry it, and finally solidify and inactivate it. Soft tissue and tumors. The principle is that when the electronic generator generates radiofrequency current, the electrode needle causes high-speed ion vibration and friction in the surrounding tissue, which is then converted into heat energy and conducted outward over time, thereby causing local tissue thermal coagulation, necrosis and degeneration, and at the same time achieving liver cancer treatment. The purpose of minimally invasive and radical treatment.
❤ On June 16, the first case of hepatic arterial infusion chemotherapy (HAIC) was successfully implemented!
❖ Surgical path
The catheter was inserted through the radial artery, and chemotherapy was continued for 24 hours after the operation.
❖ Operation record
The patient was placed in a supine position, with the left wrist and forearm sterilized and draped. Under ultrasound guidance, the distal end of the left radial artery was punctured. After success, a 5F sheath was inserted, a multifunctional catheter was introduced, and the cannula was intubated to under the guidance of a guide wire. The and angiograms of the proper hepatic artery showed multiple intrahepatic masses of varying sizes with mild staining at the edges and no other obvious abnormalities. Fix the catheter, wrap it with dressing, and return to the ward to pump medicine through the catheter.
The operation went smoothly, the patient did not complain of obvious discomfort and returned to the ward safely.
❖ Surgical silhouette
Professor Zou Yinghua’s preoperative visit
Intraoperative positioning and disinfection
Popular science time
1. What is hepatic arterial infusion chemotherapy (HAIC)?
Hepatic arterial infusion chemotherapy uses intravascular interventional technology to perform hepatic artery catheterization, injecting anti-tumor drugs directly into the hepatic artery through the catheter to complete the infusion of chemotherapy drugs. Compared with systemic chemotherapy, infusing chemotherapy drugs into the hepatic artery can increase the concentration of local drugs in tumor tissues and reduce the distribution of chemotherapy drugs in other organs, thereby producing a strong anti-tumor effect and reducing systemic side effects.
2. Advantages of local hepatic artery administration compared to systemic intravenous administration:
• Low incidence of adverse reactions and wider indications;
• Due to the first-pass effect of intra-arterial infusion of chemotherapy drugs, the drugs are concentrated in the tumor and flow through the body Reducing the use of drugs in other organs reduces the damaging effects of chemotherapy drugs on the heart, brain, kidney and other organs, thereby reducing the side effects of chemotherapy drugs;
• has little impact on subsequent surgical operations;
• In terms of administration time, hepatic artery infusion chemotherapy It is continuous infusion chemotherapy. Depending on the specific condition of the patient, the infusion time ranges from 24 hours to 72 hours. Through long-term slow infusion, the effect of chemotherapy drugs can be maximized.
Generally speaking, through local arterial administration, the local concentration is high and the peripheral concentration is low; the effectiveness is high and the side effects are small.
3. Advantages of transradial artery surgery compared with traditional transfemoral artery:
Traditional hepatic arterial infusion chemotherapy punctures the femoral artery at the base of the thigh, sends the catheter into the hepatic artery, and directly delivers large doses and high concentrations of chemotherapy drugs. A method of injecting chemotherapy drugs into the nutrient blood vessels of liver lesions, or leaving a catheter in the nutrient blood vessels, and continuously pumping chemotherapy drugs within 24-72 hours. Although the treatment pathway established by femoral artery puncture is relatively easy to operate, the patient needs to keep the lower limbs straight and immobilized during the drug infusion process, and the patient needs to perform femoral artery compression for 8 hours after the operation, which makes eating and defecation very inconvenient. .
The radial artery approach at the patient's wrist has the following advantages:
• Less damage: When operated through the radial artery, the patient can move freely after the operation without the need for braking and compression like the transfemoral artery approach.
• minimally invasive operation: only has a small needle hole at the puncture point; digital subtraction angiography (DSA) guides the operation to accurately achieve targeted killing of lesions.
• Fewer hemorrhagic complications: Due to the superficial location of the radial artery, puncture damage is very small. It is easy to apply pressure and bandage to the puncture point to stop bleeding, which greatly reduces hemorrhagic complications.
• No need to be forced to stay in bed: solves the problem of back pain, urinary retention, difficulty urinating and other uncomfortable symptoms caused by long-term immobilization, which is beneficial to the patient's recovery and greatly improves the surgical comfort and comfort of the surgical patient. Quality of medical care.
❤ On June 16, the first ultrasound+DSA-guided dual-intervention percutaneous transhepatic biliary drainage (PTCD) was successfully performed!
❖ Operation record
The patient was in the supine position. The right rib was sterilized and draped. The puncture point was determined under fluoroscopy. After local anesthesia, a biliary needle was used to percutaneously puncture the right intrahepatic bile duct. After successful angiography, the right intrahepatic bile duct was widely dilated and the common bile duct was far away. The end is not visible. The guide wire is introduced through the puncture needle , and the sheath is introduced through the guide wire. After the angiography shows that the position is correct, the hardened guide wire and the 8F external drainage tube are introduced, and the distal end is looped into the dilated biliary tract. The skin is fixed and covered with dressing. The operation is completed. .
The operation went smoothly, and the patient did not complain of obvious discomfort. He returned to the ward and was given hepatoprotective anti-inflammatory and symptomatic supportive treatment.
❖ Surgery silhouette
Preoperative preparation
Check the needle insertion situation during the operation
❖ Postoperative bilirubin decrease
❖ Postoperative drainage tube photos
Popular science time
1. percutaneous transhepatic biliary drainage (PTCD)?
Percutaneous transhepatic biliary drainage refers to percutaneous transhepatic puncture of the bile duct and placement of a drainage tube under the guidance of medical imaging equipment (usually X-ray fluoroscopy under DSA or B ultrasound ) to allow bile to flow outside the body or to the uterus. A range of techniques for the bowel. It is mainly used for palliative biliary drainage in patients with biliary obstruction and obstructive jaundice caused by advanced duct tumors.
2． There are corresponding treatments for patients with jaundice
Percutaneous transhepatic biliary drainage is used to treat obstructive jaundice. Under the guidance of medical imaging equipment, a puncture needle (PTC needle) is inserted into the biliary tract through the skin and part of the liver tissue, and then through the exchange The guide wire is used to implant the drainage tube or biliary stent into the biliary tract to clear the biliary tract, drain bile and thereby treat the disease.
PTCD is an important treatment method for the treatment of obstructive jaundice caused by tumors and other diseases. For patients with indications for surgical resection, preoperative PTCD can improve liver function by reducing jaundice, reduce the incidence of perioperative complications, and improve surgical safety; For patients who have lost the chance of surgical resection, PTCD can delay the progression of liver disease. The progression of functional failure improves patients' end-stage quality of life and is sometimes the only way to treat obstructive jaundice.
Liver cancer is detected early and treated with intervention. Relying on the Gaobo Medical Group Hepatobiliary Tumor Innovative Diagnosis and Treatment Center platform, the interventional medicine team will continue to improve medical technology and service levels, use clinical multi-disciplinary diagnosis and treatment systems, provide patient-centered full personalized diagnosis and treatment of liver cancer, and protect the health of patients!
■ Expert Introduction
Zou Yinghua
Interventional Vascular Surgery, Peking University First Hospital
Chief Physician, Professor, Doctoral Supervisor
Chairman of the Interventional Medicine Special Committee of the Center for Continuing Education of the National Health Commission
National Health Commission Minimally Invasive Intervention and Peripheral Tumors Team leader of the Vascular Intervention Special Ability Training Project
Chairman of the Medical Specialty Education Training and Digitalization Committee of the Chinese Society of Health Information and Medical Health Big Data
Vice President of the Interventional Physician Branch of the Chinese Medical Doctor Association
Special Committee of Interventional Oncology of the Chinese Anti-Cancer Association Former Chairman
Deputy Chairman of the Liver Cancer Expert Committee of the Chinese Association for Medical Promotion
Deputy Chairman of the Interventional Branch of the Chinese Society of Biomedical Engineering
Chief Editor of the Chinese Journal of Interventional Imaging and Therapeutics
Chairman of the Interventional Medicine Branch of the Beijing Medical Association
Vascular Surgery of the Beijing Medical Association Vice chairman of the branch
