摘要:目的:探討聯合應用激光汽化減壓(percutaneous laser disc discompression,PLDD)、射頻熱凝靶點消融、臭氧注射治療腰椎間盤突出癥的的個體化選擇。方法: 自2006年6月,在CT引導下選擇性聯合應用PLDD、射頻和臭氧治療腰椎間盤突出癥患者267例,突出椎間盤的特點個體化選擇穿刺路徑和治療方法;其中PLDD聯合臭氧治療92例(A組),射頻聯合臭氧治療67例(B組),PLDD、射頻和臭氧三者聯合治療108例(C組)。結果:所有患者均順利完成手術,于術后1周、1個月,3個月及6個月隨訪記錄VAS評分和Macanab優良率。三組患者VAS評分經方差分析,手術前、后有顯著性差異(Plt;0.05),術后1周至6個月的VAS評分統計無顯著性差異(Pgt;0.05);術后三組間VAS評分、Macanab優良率比較無顯著性差異(Pgt;0.05)。結論: 選擇性聯合應用微創技術進行個體化的立體治療,具有擴大微創手術適應癥、提高手術療效的優勢,值得推廣和利用。Abstract: Objective: To investigate the selectivity and individualization of using percutaneous laser disc discompression(PLDD) and ozone injection combined with radiofrequency thermocoagulation and target ablation curing lumbar intervertebral disc protrusion. Methods: From June 2006, 267 lumbar disc herniation cases were operated that guided by CT, the characteristic of the liable disc was confirmed by magnetic resonance imaging and CT before the procedure. 92 cases (A group) were treated by PLDD combined with ozone injection,67 case were treated by radiofrequency thermocoagulation and target ablation combined with ozone injection, 108 cases were treated by PLDD and ozone injection combined with radiofrequency thermocoagulation and target ablation. Results: All case been successfully operated, the theraptic effect was evaluated by comparing the value of VAS and excellent and good rate of therapy at preoperation and at 1 week, 1month,3 months, 6 months after operation. The value of VAS in three groups at postoperation were remarkably lower than preoperation (Plt;0.05). The excellent and good rate of therapy at 6 months was respectively 94.5％ in group A,94.0％ in group B and 95.4％ in group C,no significant difference was observed between the three groups(Pgt;0.05).Conclusion: The selectivity and individualization of using PLDD and ozone injection combined with radiofrequency thermocoagulation and target ablation curing lumbar intervertebral disc protrusion can enlarge the indication and improve the clinical curative effect, it should be spreaded in clinic.
Transjugular intrahepatic portosystemic shunt (TIPS) has become a standard therapy for complications of portal hypertension. The key to maximizing the therapeutic efficacy of TIPS lies in balancing the reduction of portal hypertension-related complications (such as rebleeding and ascites) against the risk of complications from excessive shunting (such as hepatic encephalopathy and liver function deterioration). Given the significant heterogeneity among patients, including the etiology of cirrhosis, hepatic reserve function, and comorbidities, traditional “one-size-fits-all” shunting strategy has proven insufficient. Therefore, the concept of individualized planning for intrahepatic portosystemic shunts has emerged. This strategy aims to achieve personalized and precise shunting through careful patient selection, optimized hemodynamic target setting, controlled shunt diameter, and integrated adjuvant therapies.