Robotic Assistance For Percutaneous Needle Insertion in Lub raum: Preclinical Proof On A Swine Tsiaj Model
Jul 04, 2023
Abstract
1. Keeb kwm
Peb tau soj ntsuam qhov raug, kev nyab xeeb, thiab muaj peev xwm ntawm kev suav tomography (CT)-coj kev pabcuam neeg hlau rau kev tso cov koob txhaj tshuaj hauv lub raum.
2. Cov txheej txheem
Fiducials surgically implanted rau hauv ob lub raum ntawm ob tug npua tau siv los ua lub hom phiaj rau kev siv rab koob txuas ntxiv tom ntej. Robotically-pab koob insertions thiab CT acquisitions tau koom tes nrog kev soj ntsuam ua pa. Ib qho pib scan ntim cov ntaub ntawv teeb tsa tau siv rau kev npaj cov koob txhaj tshuaj txhais cov tawv nqaij nkag thiab lub hom phiaj taw tes. Tom qab ntawd, rab koob ntxig tau ua raws li tus neeg hlau qhov chaw. Qhov tseeb ntawm qhov kev tso ntawm rab koob tau raug soj ntsuam ntawm qhov kev ncua deb ntawm rab koob thiab lub hom phiaj ua ntej ntawm lub koob txhaj tshuaj tom qab txhaj tshuaj. Kev ncua ncua kev sib piv-txhim kho CT scan tau txais los ntsuas kev nyab xeeb.
3. Cov txiaj ntsig
Yim koob trajectories tau ua nrog lub sij hawm nruab nrab ntawm cov txheej txheem ntsuas los ntawm kev tig ntawm lub tshuab neeg hlau mus rau tom qab koob ntxig CT scan ntawm 21 min (interquartile ntau 15.5-26.5 min). Kev tshuaj xyuas qhov muag tsis pom ntawm qhov tseeb ntawm rab koob yog 2.3 ± 1.2 hli (txhais tau tias ± tus qauv sib txawv) hauv qhov sib txawv ntawm sab nraud, 0.7 ± 1.7 hli hauv qhov tob sib txawv, thiab 2.8 ± 1.3 hli hauv peb-dimensional Euclidian sib txawv. Tag nrho cov koob tau muab tso rau hauv thawj qhov kev sim, uas tau txiav txim siab 100 feem pua ua tau, tsis muaj koob hloov kho. Qhov angulation thiab qhov ntev ntawm qhov trajectory tsis cuam tshuam rau qhov tseeb ntawm rab koob. Ob txoj kev cuam tshuam me me tau ntsib: 2 subcapsular hematomas (13 × 6 mm thiab 35 × 6 mm) hauv tib tsiaj.
4. Cov lus xaus
Robotically-assisted needle insertion tau pom tias ua tau, nyab xeeb, thiab raug nyob rau hauv tus qauv swine raum. Cov kev tshawb fawb loj ntxiv yog xav tau.
5. Cov ntsiab lus
Cov txheej txheem ablation, Biopsy (needle), raum, cov txheej txheem kho neeg hlau, thiab Tomography (x-ray suav).
Nyem qhov no kom paub tias Cistanche yog dab tsi
Taw qhia
Thermal ablations ntawm lub raum mob qog noj ntshav tau pom cov txiaj ntsig zoo hauv kev kho mob raum qog me me, thiab suav nrog kev kho mob muaj peev xwm hauv ntau cov lus qhia los ntawm urological thiab radiological societies [1, 2]. Thaum cov kev kho mob no, ntau yam kev yees duab yuav siv tau rau cov duab qhia percutaneous insertions ntawm koob thiab sojntsuam mus rau hauv cov qog nyob rau hauv lub cev los yog biopsy los yog thermal ablation raws li ib feem ntawm niaj hnub kuaj mob cancer thiab kev kho mob [3]. Ultrasound muaj qhov zoo ntawm kev saib xyuas lub sijhawm tiag tiag thaum lub koob txhaj tshuaj thiab kev kho mob, tab sis muaj kev cuam tshuam los ntawm tus neeg mob lub morphology. Computed tomography (CT) yog siv dav hauv lub raum ablation rau koob taw qhia, thiab rab koob robotic kev taw qhia raws li CT kev taw qhia tsis ntev los no tau tsim nrog lub hom phiaj tseem ceeb ntawm kev ua kom raug, rov tsim dua tshiab, muaj peev xwm ntawm txhua qhov angulation, thiab txo lub sijhawm ntawm cov txheej txheem, tus lej. ntawm kev hloov kho koob, kev kawm nkhaus, cov neeg ua haujlwm thiab tus neeg mob raug hluav taws xob [4–8]. EPIONE® cov cuab yeej neeg hlau (Quantum Surgical, Montpellier, Fabkis) yog cov cuab yeej siv hluav taws xob uas pab tus kws kho mob thaum lub sijhawm CT-guided percutaneous koob insertion thiab tsis ntev los no tau CE cim tom qab kev soj ntsuam ntxov rau daim siab mob ablation. Peb ntawm no qhia txog kev ntsuam xyuas tsiaj rau koob ntxig rau hauv lub raum.
Cov txheej txheem
Txoj kev tshawb no tau ua tiav ntawm tag nrho ob tus swine, ua raws li cov cai tswj kev noj qab haus huv tsiaj, Biovivo's Standard Operating Procedures, thiab cov hauv paus ntsiab lus ntawm Kev Ntsuas Zoo. Cov txheej txheem raug xa mus rau VetAgro Sup Ethics Committee (tus naj npawb 1934).
1. Kawm cov ntsiab lus kawg
Cov ntsiab lus tseem ceeb ntawm kev tshawb fawb yog qhov tseeb thiab kev nyab xeeb ntawm kev txhaj tshuaj. Lub koob txhaj tshuaj raug txhais tau tias yog qhov kev ncua deb ntawm rab koob thiab qhov nruab nrab ntawm lub hom phiaj fiducial. Ib rab koob tso rau hauv 5 hli ntawm lub hom phiaj fiducial txhais cov txheej txheem raws li qhov tseeb. Kev soj ntsuam kev nyab xeeb tau txais los ntawm cov txheej txheem cuam tshuam txog cov teeb meem uas tau soj ntsuam los ntawm tus kws kho mob radiologist uas tau tshuaj xyuas tom qab tso CT thiab los ntawm kev soj ntsuam kev soj ntsuam ntawm tus kws kho tsiaj. Cov xwm txheej tsis zoo tau raug txhais raws li Kev Cai Lij Choj Cov Lus Qhia rau Kev Tsis Txaus Siab 5.0 [9].
Cov ntsiab lus thib ob yog qhov ua tau thiab kev hloov kho ntawm kev tso koob. Feasibility tau txhais raws li qhov feem pua ntawm cov koob txhaj tshuaj tau zoo, zam los ntawm cov teeb meem uas tau ntsib nrog cov cuab yeej kho mob kuaj thaum muaj kev cuam tshuam. Qhov kev tso kawm tiav tom qab ntawd tso cai rau cov txheej txheem ua tiav yam tsis muaj kev rov hais dua ntawm kev npaj thiab kev tso tawm, tom qab kev qhia tso tawm thiab kev tswj xyuas. Kev hloov kho koob tau raug txhais raws li tus naj npawb ntawm koob repositioning xav tau kom ncav cuag lub hom phiaj.
Cistanche capsules
2. Robotic ntaus ntawv
EPIONE® cov cuab yeej siv neeg hlau (Quantum Surgical, Montpellier, Fabkis) muaj lub laub txawb uas nqa lub caj npab neeg hlau uas muaj koob qhia, lub laub zaub txawb, tus neeg mob siv (Quantum Surgical, Montpellier, Fabkis) txuas rau ntawm daim tawv nqaij tsiaj, uas saib xyuas tus neeg mob cov lus tsa suab xws li ua pa, nrog kev pab ntawm lub koob yees duab navigation mobile (NDI Polaris Vega, Ontario, Canada) (Daim duab 1a).
3. Npaj cov tsiaj
Ob tug tsiaj uas hnyav li ntawm 50 kg tau muab tso rau hauv cov tshuaj loog thiab tau txais cov tshuaj morphine ua ntej ntawm {{10}}}.1 mg/kg (subcutaneous route). Cov tshuaj loog tau raug ntxias nrog xylazine ntawm 1.5 mg / kg (intramuscular route) thiab tiletamine ntxiv rau zolazepam ntawm 3.75 mg / kg (intramuscular route). Tom qab ntawd cov tsiaj tau muab tso rau hauv tub yees thiab muab tso rau hauv cov tshuaj loog siv Isoflurane-O2 thiab txhaj tshuaj curare cisatracurium (0.1 txog 0.4 mg / kg los ntawm txoj hlab ntshav) txuas ntxiv ntau zaus raws li qhov tsim nyog, txhawm rau txwv kev ua pa ntawm cov tsiaj. Txhua tus tsiaj tau raug kho nrog 8 radiopaque fiducials (4 ib lub raum) ntsuas 1 hli × 5 hli (GTP 1820≠2, Geotek Medical, Ankara, Qaib ntxhw) 1 lossis 2 hnub ua ntej kev sim. Cov kws kho mob tau muab tso rau hauv kev phais kom paub tseeb tias tus neeg hlau tuaj yeem tsom mus rau txhua qhov chaw uas lawv nyob hauv lub raum, thiab tsis yog cov uas tau cog lus percutaneously. Thaum kawg ntawm qhov kev phais, cov tsiaj tau tsim.
4. CT raws tu qauv
Tag nrho cov CT scans tau ua tiav siv {{0}}slice Brightspeed CT scanner (General Electric Healthcare, Chicago, IL). Tsiaj txhu nyob rau hauv txoj hauj lwm ventral thiab abdominopelvic acquisitions tau ua nrog ib tug 35-cm teb ntawm saib. Cov kev ntsuas ntsuas yog 120 kV, 150 mA, 0.8 s gantry tig lub sijhawm, thiab 0.938 suab. Cov tshuaj ntsuam xyuas tau rov tsim dua tshiab nrog 0.625-mm hlais tuab siv 'SOFT' convolution kernel kuj muab los ntawm General Electric, tus qauv mos cov ntaub so ntswg convolution kernel.
5. Percutaneous robotically guided needle insertions Koob trajectory npaj
Lub ntim CT ua ntej tau txais nyob rau hauv apnea thiab thauj mus rau hauv cov cuab yeej siv tshuab robotic. Tom qab ntawd, rab koob trajectory tau txiav txim siab kom ncav cuag qhov nruab nrab ntawm ib qho fiducial thiab kom tsis txhob muaj pob txha thiab cov qauv tseem ceeb hauv plab (Video 1 hauv Cov Khoom Siv Ntxiv). Ntawm plaub fiducials implanted nyob rau hauv txhua lub raum, ob fiducials raug xaiv nyob rau hauv txhua lub raum thiab yog li cov txheej txheem tau rov ua dua ob zaug ib lub raum.
6. Robotically-pab koob insertion
Tag nrho cov txheej txheem tau ua los ntawm ib tus kws paub txog kev cuam tshuam hluav taws xob (ntau tshaj 10 xyoo ntawm kev paub hauv cov txheej txheem duab qhia). Tus neeg hlau caj npab raug xa mus rau nws txoj haujlwm 'HOME' ua ntej. Daim ntawv qhia koob tau txuas rau ntawm caj npab neeg hlau. Tom qab ntawd, lub software cia li nyob rau 'tus neeg mob' cov cim qhia hauv cov duab. Txoj hauj lwm ntawm txhua tus cim tau raug txheeb xyuas thiab hloov kho manually thaum twg tsim nyog. A 17-gauge pov tseg coaxial biopsy koob (Bard Medical, Covington, USA) nrog rau qhov ntev koob (los ntawm 10.6 mus rau 14.7 cm), piv txwv li, ib rab koob nrog qhov ntev me ntsis siab dua qhov ntev ntawm txoj kab, raug xaiv rau hauv kev npaj software. Cov neeg hlau caj npab tau manually coj los ze rau thaj tsam ntawm kev txaus siab los tso ob qho tib si 'tus neeg mob' siv thiab daim ntawv qhia koob nyob rau hauv lub koob yees duab kho qhov muag pom. Tom qab ntawd, tus neeg hlau caj npab cia li tso lub koob qhia nyob rau hauv txoj kab nrog cov phiaj xwm phiaj xwm. Tom qab qhov kev txiav ntawm daim tawv nqaij tau ua nyob rau ntawm lub koob nkag, lub koob tau muab tso rau hauv lub koob qhia thiab thawb mus rau qhov kawg ntawm txoj hauj lwm (cov khoom siv ntxiv: Video 2 thiab Fig. 1b). Lub koob tau raug tso tawm ntawm daim ntawv qhia koob thiab lub caj npab neeg hlau tau txav deb ntawm qhov chaw puncture.
Cistanche tubulosa
7. Daim ntawv pov thawj qhov chaw
Ib daim duab CT scan tau txais hauv qab apnea los ntsuas qhov tseeb ntawm rab koob. Cov txheej txheem tau suav tias ua tiav thaum tus neeg teb xov tooj txiav txim siab lub koob txhaj tshuaj tsawg dua lossis sib npaug li 5 hli ntawm lub hom phiaj. Txwv tsis pub, kev sim ntxiv tau tso cai nrog tib txoj kev npaj. Kev sim thib peb tsis raug tso cai.
8. Kev ntsuas kev nyab xeeb
Tsib feeb tom qab tshem rab koob, qhov sib piv-txhim kho CT scan ntawm thaj chaw plab hnyuv tau ua 60 s tom qab txhaj tshuaj ntawm 30 mL ntawm voxel (Omnipaque® 350 mg / mL, General Electrics Healthcare, Chicago, IL) ntawm tus nqi ntawm 2.2 mL. /s. Txhua yam teeb meem ntsig txog txheej txheem uas tuaj yeem piav qhia ntawm CT scan no tau tshaj tawm.
9. Apnea repeatability test
Txhawm rau kom paub tseeb tias lub raum tau muab tso rau ntawm tib qhov chaw nyob rau hauv rov qab apnoea, ib qho kev ntsuas rov ua dua tau ua rau tag nrho cov fiducials tso rau hauv ob lub swines, siv lub tshuab ua pa. Apnea raug ntxias thaum lub sij hawm tag nrho CT scan acquisitions thiab robotically-pab koob insertions los ntawm kev kaw lub qhov cua thaum kawg ntawm tas sij hawm.
Ob qhov kev soj ntsuam CT uas tsis tau ua tiav tau txais thaum lub sijhawm apnea los ntsuas lawv qhov rov ua tau dua. Hauv nruab nrab, tsiaj ua pa tau rov pib dua. Qhov chaw ntawm txhua tus fiducial tau txiav txim siab ntawm ob lub CT scans, siv Digital imaging thiab kev sib txuas lus hauv cov tshuaj (DICOM) ua haujlwm nrog tus qauv DICOM duab saib software (Myrian v2.4, Intrasense, Montpellier, Fabkis; https://intrasense.fr /fr/). Cov kev sib koom ua ke ntawm txhua tus txheeb ze rau tus neeg mob siv tau raug txiav txim siab thiab peb-dimensional (3D) Euclidean sib txawv ntawm ob qhov kev yuav khoom tau suav los txiav txim siab qhov kev hloov pauv ntawm fiducial nyob rau hauv rov qab apnoea. Apnoeas tau txiav txim siab rov ua dua yog tias qhov kev hloov pauv ntawm 8 radiopaque fiducials qis dua 2 hli nyob rau hauv-nruab nrab ntawm ob qhov kev tshuaj ntsuam CT tom ntej. Kev hloov pauv ntawm cov fiducials nyob rau tom qab apnea tau suav hais tias yog 'tus neeg mob' siv los ua kom rov ua dua tshiab ntawm kev ua haujlwm ntawm cov neeg hlau.
10. Kev txheeb cais
Rau qhov kev tshawb fawb ua ntej no, tsis muaj cov piv txwv tshwj xeeb suav nrog. Cov lus piav qhia ntawm cov kev kawm sib txawv tau ua los ntawm kev siv, txhais tau tias, tus qauv sib txawv, qhov nruab nrab, min, thiab max rau ntau qhov sib txawv thiab siv zaus thiab feem pua rau qhov zoo sib xws.
Qhov kev tso kawm ntawm rab koob raug txiav txim los ntawm kev suav 3D Euclidean sib txawv ntawm txoj haujlwm ntawm rab koob thiab qhov nruab nrab ntawm fiducial (lub hom phiaj taw tes). Lub Myrian® Duab saib (Myrian v2.4, Intrasense, Montpellier, Fabkis; https://intrasense.fr/fr) tau siv los ua kom tau txais kev sib koom ua ke ntawm cov ntsiab lus hauv DICOM cov duab thiab ntsuas 3D Euclidian sib txawv, sab nraud deviation, thiab qhov tob sib txawv. Cov kev sib txawv no tau piav raws li qhov sib txawv ntawm qhov ntau.
Txhua qhov kev ntsuas tau ua qhov muag tsis pom los ntawm tus kws paub txog kev cuam tshuam hluav taws xob. 3D sib txawv, qhov sib txawv ntawm sab nraud, thiab qhov sib txawv ntawm qhov sib txawv tsawg kawg yog qhov kev kwv yees kwv yees (thiab 95 feem pua ntawm qhov txwv) tau muab los siv tus qauv zoo rau tus tsiaj; p-tus nqi ntsuas rau qhov tsis zoo ntawm qhov nruab nrab mus rau 5 mm tau suav.
Kev soj ntsuam kev soj ntsuam tau ua los txheeb xyuas qhov muaj peev xwm cuam tshuam qhov tseeb ntawm qhov kev tso ntawm rab koob (angulations, daim tawv nqaij nkag mus rau lub hom phiaj deb).
Tag nrho cov kev sim tau yav tom ntej suav nrog hauv kev txheeb xyuas kev txheeb xyuas. Tsis muaj ntaub ntawv imputation ploj lawm. Txhua qhov kev txheeb xyuas txheeb cais tau tsim los siv SAS® 9.4 software (Cary, NC, USA).
Cistanche hmoov
Kev sib tham
Qhov tseeb ntawm kev tso koob yog qhov tseem ceeb rau kev ua tiav ntawm percutaneous biopsy lossis thermal ablation. Hauv peb qhov kev sim, 3D Euclidean sib txawv ntawm rab koob mus rau lub hom phiaj ntawm 1.2 mus rau 4.6 hli, nrog qhov nruab nrab (SD) ntawm 2.8 (1.3) mm qhia tias peb tau ntsib qhov raug siab xav tau los ua kom biopsy thiab thermal ablation txhim khu kev qha. Tsawg heev cov lus ceeb toom ntawm kev siv neeg hlau hauv lub raum muaj rau kev sib piv. Peb cov txiaj ntsig tau muab piv nrog cov neeg nyob hauv lub raum puncture hauv Hiraki li al. multiorgan sim, qhov nruab nrab (SD) ntawm koob qhov tseeb qhov chaw nyob rau hauv lub raum yog 2.9 (1.{12}}) mm [10]. Ntxiv mus, raws li tau hais los ntawm Engstrand li al., rab koob lateral deviation tuaj yeem suav hais tias yog qhov tseem ceeb tshaj plaws uas yuav tsum tau xav txog thaum ntsuas qhov tseeb, vim tias nws nyuaj rau kev them nyiaj thiab feem ntau yuav tsum tau puncture tshiab lossis koob redirection [11], thaum lub qhov yuam kev qhov tob tuaj yeem raug them los ntawm kev thawb lossis rov qab cov koob ntawm tib lub puncture tract. Hauv txoj kev tshawb fawb tam sim no, qhov sib txawv ntawm sab nraud tau txiav txim siab qis qis, los ntawm 0.7 mus rau 4.3 hli, traduced los ntawm qhov zoo siab 0 feem pua kev hloov kho koob lossis thib ob, tshwj xeeb tshaj yog thaum piv rau lwm yam CTguided robotic koob tso rau hauv lub raum, uas qhia qhov nruab nrab ntawm 2 mus rau 4 koob hloov kho [10].
Nyob rau hauv txoj kev tshawb no, angulations ntawm koob trajectories nyob rau hauv lub z-axis ranged ntawm -59.8 degree rau ntxiv 28.5 degree . Cov angulations no tsis cuam tshuam qhov tseeb lossis lub sijhawm ua haujlwm.
Xya tawm ntawm 8 (87.5 feem pua) trajectories tau tawm ntawm ib lub dav hlau (Ntau dua los yog sib npaug rau 5 degree nyob rau hauv lub z-axis), yog li countering ib qho ntawm cov kev txwv CT nyob rau hauv guiding koob insertion thaum sab nraum lub dav hlau axial txheeb xyuas los ntawm Wood li al. . [12]. Qhov tseeb, kev pom ntawm qhov ntev ntawm cov koob sab nraud ntawm lub dav hlau axial yog qhov nyuaj ntawm CT imaging raws li ntau lub dav hlau axial yuav tsum tau tshuaj xyuas kom pom qhov ntev ntawm rab koob, lossis ntim nrog ntau qhov kev tsim kho yuav tsum tau ua yog li poob lub peev xwm ze li ntawm lub sijhawm. ntawm CT thiab nce irradiation [13]. Lub angulation me me tuaj yeem tswj tau nrog kev cuam tshuam gantry angulation thaum ua tau. Ntawm qhov tod tes, tau txais angulation nrog lub gantry muaj txiaj ntsig ntawm kev txwv tsis pub nkag mus rau tus neeg mob thiab ua rau nws tsis tuaj yeem ntxig koob ntev [14]. Yog li ntawd, qhov kev coj ua zoo tshaj plaws yog txwv cov koob trajectory mus rau lub dav hlau axial lossis kev txwv craniocaudal angulation.
Tam sim no, tus neeg mob thiab tus kws kho mob irradiation hmoov tsis yog ib feem ntawm CT-guided needle insertions [4, 15–18]. Hauv qhov kev paub dhau los no, tsuas yog ob qho CT tau txais yuav tsum tau muab tso rau koob: CT rau kev npaj thiab CT kom paub meej txog txoj haujlwm koob. Lub koob tau muab tso rau ntawm qhov ua tsis taus pa tsis muaj x-rays ntxiv. Txawm hais tias tus tsiaj thiab tus neeg teb xov tooj hluav taws xob raug ntsuas tsis tau ntsuas, tus neeg teb xov tooj irradiation tsis yog, thiab nws yuav tsum txo cov neeg mob irradiation nrog kev siv cov neeg hlau. Ib txoj kev tshawb fawb piv rau kev sib piv pub dawb piv rau cov neeg hlau ntxig tau pom tias muaj ntau dua cov kab hluav taws xob tag nrho ntawm 1075.77 mGy / cm thiab 636.4 mGy / cm rau freehand thiab robotic needle insertions, feem; Qhov no yog qhov nkag siab, vim qhov xav tau ntau dua kev kuaj xyuas thiab koob tshuaj rau cov txheej txheem pub dawb [19].
Hais txog kev nyab xeeb, peb tau sau ob qib 1 txheej txheem ntsig txog hematoma ntawm yim txoj hauv kev, uas zoo ib yam li qhov tau tshaj tawm yav dhau los los ntawm lwm tus rau npua, nrog ib qho pararenal hematoma tawm ntawm tsib punctures [6, 10].
Lub kaw lus peb tau soj ntsuam tsis muaj nyiaj them rau lub hom phiaj kev txav los yog rab koob dabtsi yog khoov [15], kev koom ua ke kaw-loop nquag them nyiaj uas xav tias yuav txhim kho lub hom phiaj raug nrog cov neeg siv kev sib koom ua ke [20]. Peb ntseeg hais tias kev txhaj tshuaj sai thiab yooj yim muaj qhov zoo dua li kev rov ua dua cov duab thiab qhov kev ntxig ncaj ncaj txo qis qhov kev pheej hmoo ntawm lub cev hloov chaw. Cov ntaub so ntswg deformation thiab lub hom phiaj hloov chaw los ntawm rab koob nws tus kheej zoo li tsawg heev raws li qhia los ntawm peb qhov tseeb ntsuas. Nws tuaj yeem xav tias thaum muaj kev sib tsoo yog ua los ntawm tes, rab koob tau txais qee qhov kev hloov pauv uas ib leeg tuaj yeem hloov pauv lub cev thiab lub hom phiaj [19–22]. Ib qho tseem ceeb ntawm cov cuab yeej peb tau siv yog tias lub tshuab ntsuas pa ua pa tuaj yeem cuam tshuam nrog kev ua pa ua pa hauv cov ntsiab lus ntawm kev siv tshuaj loog nrog cov tshuab ua pa raws li tau lees paub los ntawm peb qhov kev kuaj mob apnea repeatability. Cov cuab yeej no yog qhov tshwj xeeb tshaj yog muaj txiaj ntsig thiab cuam tshuam rau qhov tseeb ntawm rab koob [23].
Txoj kev tshawb no muaj kev txwv. Tsuas yog 17-gauge biopsy koob uas muaj peev xwm khoov qis tau siv thaum punctures nrog me me beveled caliber koob tej zaum yuav ntau dua rau khoov. Txawm li cas los xij, Hiraki et al. pom tau tias tsis muaj qhov sib txawv tseem ceeb hauv qhov tseeb qhov tseeb raws li hom koob siv [10]. Ntxiv mus, lub ntsis ntawm cov koob no yog ntse heev, uas tej zaum yuav tsis yog cov ntaub ntawv rau ablation koob nyob rau hauv kho mob. Lwm qhov kev txwv ntawm txoj kev tshawb fawb no yog qhov tsis muaj kev sib piv ntawm qhov tseeb ntawm cov txheej txheem kev pab neeg hlau thiab kev tso cai pub dawb. Nws yuav yog qhov txaus siab los sib piv qhov kev tso chaw pub dawb rau kev pab cuam neeg hlau thiab kawm yog tias tus neeg siv kev paub dhau los yuav muaj kev cuam tshuam loj rau qhov raug, qhov tshwm sim, thiab cov teeb meem nyuaj. Thaum kawg, ib tus neeg teb xov tooj tau ua txhua qhov kev ntxig, txawm hais tias, yav dhau los peb tau pom tias qhov tseeb tsis txawv ntawm cov neeg ua haujlwm tshiab thiab cov neeg ua haujlwm paub txog [24], thiab peb ntseeg tias thaum siv cov neeg hlau, tsawg heev yog sab laug rau cov neeg siv kev paub. Thaum kawg, ib qho ntawm cov kev txwv ntawm txoj kev tshawb no yog qhov kev siv tshuaj loog dav dav yuav tsum tau ua rau apnea vim sedation tsis tuaj yeem ua rau tus tsiaj thiab vim tias lub cev niaj hnub no tau mob siab rau thermal ablation. Kev soj ntsuam ntxiv yog xav tau nyob rau hauv kev xyaum kho mob los txiav txim seb tus neeg mob tus kheej-apnoea validated los ntawm apnea repeatability kuaj nyob rau hauv peb lub cev yuav tso cai rau kom meej robotic navigation ntawm koob.
Cistanche extract
Niaj hnub no ultrasound yog ib qho ntawm cov kev yees duab nrov tshaj plaws rau cov koob txhaj tshuaj hauv daim siab thiab lub raum vim nws muaj thiab muaj peev xwm ntawm lub sijhawm. Txawm li cas los xij, qee qhov teeb meem tshwm sim thiab qhov tseem ceeb, tus neeg mob morphology thiab cov qog nqaij hlav hauv qhov tob yog qhov nyuaj rau pom txawm tias muaj kev pab ntawm qhov sib txawv-hloov ultrasound. CT tuaj yeem siv tau tab sis nws tsis yog lub sijhawm ntsuas kev ntsuas lub sijhawm, thiab muaj qee qhov kev txwv sab nraud ntawm lub dav hlau axial, thiab txawm tias qhov kev sib txawv ntawm qhov sib txawv tso cai rau kev pom zoo ntawm cov qog nqaij hlav, qhov kev txhim kho no yuav sai sai thiab yog li tsis muaj nyob rau hauv tag nrho cov txheej txheem. ntawm koob insertion. MRI tsis tshua muaj los coj cov koob txhaj tshuaj. Lub raum ablation nyob rau hauv ib qho kev mob siab rau, nrog rau ob qho tib si US thiab CT tau tshaj tawm, kom sib koom ua ke cov txiaj ntsig ntawm ob txoj kev [25]. Ntau cov ntawv tshaj tawm ntawm fusion imaging siv rau thermal ablations tau tsim nyob rau hauv xyoo tas los no qhia txog qhov nyuaj ntawm ib qho txheej txheem. Fusion imaging tau raug tshaj tawm los ua kom pom tseeb ntawm cov qog nqaij hlav tab sis muaj qee qhov nyuaj kom tau txais kev tso npe raug [26, 27]. Cov txheej txheem neeg hlau tso cai rau siv ib qho CT nrhiav tau nrog kev txhim kho siab tshaj plaws los npaj cov koob txhaj tshuaj thiab kev kho mob thiab tso cai rau kev ua kom zoo dua qub raws li tau pom los ntawm peb cov apnea reproducibility. Tau kawg, peb tsis muab kev saib xyuas lub sijhawm tiag tiag, tab sis nws muaj peev xwm yog tias xav tau, kom tau txais cov duab tom qab ablation CT rau kev pom zoo ntawm ablation kev nyab xeeb margins.
Hauv kev xaus, peb tau muab cov ntaub ntawv ntxiv ua rau cov ntaub ntawv tsis tshua muaj hais txog kev siv rab koob neeg hlau, los ntawm kev tshaj tawm txog 100 feem pua kev vam meej thiab raug muab tso rau hauv lub raum hauv ib rab koob angulation yam tsis muaj teeb meem loj. Cov txiaj ntsig tau txais txiaj ntsig zoo no yuav tawm tsam kev tso rab koob pub dawb los ntawm cov kws tshaj lij hluav taws xob cuam tshuam loj thiab tso cai rau qhov raug siab rau cov neeg ua haujlwm tsis tshua muaj kev paub lossis cov chaw zov me nyuam thaum kev kho mob qog noj ntshav hauv lub raum me me yog qhov nyuaj rau cov neeg laus. Cov txiaj ntsig no qhia tias kev taw qhia rab koob pab neeg hlau yog ib feem ntawm lub neej yav tom ntej ntawm kev cuam tshuam ntawm oncology thiab yuav tsum tau ua kom muaj kev nyab xeeb, raug, thiab rov ua dua tshiab thiab kho cov txheej txheem kho mob rau cov neeg mob qog noj ntshav.
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Thierry de Baere1,2, Charles Roux1,2, Guillaume Noel3, Alexandre Delpla1,2, Frederic Deschamps1,2, Eloi Varin1,2 thiab Lambros Tselikas1,2
1 Department of Interventional Radiology, Gustave Roussy, Villejuif, Fab Kis teb.
2 Université Paris-Saclay, Villejuif, Fabkis.
3 Department of Pre-Clinical, Biomedical and Analytical Investigations, Biovivo/Claude Bourgelat Institut, VetAgro Sup, Marcy l'Etoile, Fabkis.
