1.What is interventional ultrasound?
Interventional ultrasound emerged in the 1960s. It is the introduction of the required instruments (puncture needle, drainage tube, etc.) into the human body under the surveillance or guidance of real-time ultrasound to perform various puncture biopsies, imaging, as well as aspiration, intubation or other physical treatment operations to obtain cytological, histological, bacteriological, biochemical and physiological information, and to combine them with ultrasound images and other clinical information (symptoms, signs, laboratory tests, etc.) It is a new discipline to make diagnosis or treatment of diseases. For example, in diagnosing diseases, interventional ultrasound, i.e. percutaneous puncture under ultrasound guidance, can accurately extract cystic and solid lesions of many organs such as liver, kidney and pancreas for cytological and histological examination. And intracavitary ultrasound can further clarify the diagnosis of certain difficult diseases; intraoperative ultrasound can evaluate the effect of surgery, and in the treatment of diseases, interventional ultrasound treatment can be performed under ultrasound guidance for organ cysts, abscesses, effusions and other diseases such as puncture and aspiration, intubation and drainage, drug injection, etc. Tumor patients can undergo ultrasound-guided drug injection (sclerotherapy, biological agents, chemotherapy drugs), microwave curing for one-time inactivation, multi-shot radiofrequency ablation, etc.
China’s interventional ultrasonography started almost at the same time with foreign countries, and by the early 1980s ultrasound intervention became increasingly mature, and its perfect combination with clinical is increasingly favored by clinicians and patients, and on the basis of continuous improvement and enhancement ultrasound intervention has been applied in the diagnosis and treatment of many diseases such as internal, external, gynecological and pediatric. It is collectively known as the three major clinical treatment systems with interventional radiology and interventional nuclear medicine. Ultrasound lends doctors a pair of “wise eyes” that can penetrate the human body, while interventional ultrasound gives ultrasound doctors a new patented treatment weapon – “needle without knife” (i.e. Needle surgery). This allows some examinations and treatments to be performed accurately through the skin without the need for surgery. It can replace some surgical procedures and has the effect of less surgical trauma.
2. Advantages of interventional ultrasound.
In clinical practice, there are many diseases that do not necessarily require open surgery such as liver cysts, kidney cysts, breast cysts, thyroid cysts, ovarian cysts, etc., and then liver and kidney abscesses, pelvic abscesses, subseptal abscesses, etc., and also patients with obstructive jaundice and the placement of drainage tubes for hydronephrosis due to bladder tumors, etc. We can do the above treatment entirely with the help of interventional ultrasound, which has the following aspects compared with open surgery Advantages.
(1) Accurate display of the lesion.
Real-time ultrasound can accurately display the precise location of the lesion and can find the best needle entry point on the surface of the body, not only that, but also determine the site of the needle, the angle of the needle, the direction and depth of the needle, real-time ultrasound can simultaneously display the different anatomical levels of the human body, can accurately display the site of the needle tip and the direction of the needle, to ensure that the needle tip does not pierce important organs, blood vessels and bile ducts, and adjust the position and direction of the needle tip at any time The position and direction of the needle tip can be adjusted at any time to hit the target with the best needle route, which minimizes the risk of puncture.
(2) Easy and rapid operation.
Other imaging guidance requires long preparation time and the possibility of instrument movement) is very small, while ultrasound guidance is both easy and rapid, and can be performed in the outpatient clinic or at the patient’s bedside, providing great convenience to the patient. We can finish a biopsy in ten minutes and cyst puncture treatment in 30 minutes, which significantly shortens the diagnosis and treatment time.
(3) Radiation injury, called “the healthiest treatment measure”.
No matter in X-guided, CT-guided or MRI-guided, patients can be more or less exposed to radioactive contamination or nuclear contamination, which may not be harmful to patients once or twice, but the more times of repetition, the more contamination they will suffer. Ultrasound guidance avoids multiple times of radioactive contamination or nuclear contamination, and for the same reason, it also limits the number of other guided interventions.
(4) Patients have less tissue damage and less pain.
The damage is reduced can be caused by two reasons, on the one hand, ultrasound in real time to select the best route of needle entry, avoiding damage to the important organs of excess tissue, on the other hand, the selection of appropriate puncture apparatus to minimize the damage and minimize patient pain. For example, for cystic tissue puncture with good sound transmission, we choose the thinnest needle tool (1,2L inner diameter) for puncture, and if the cystic material has poor sound transmission, we choose a thicker (1,6L inner diameter) needle tool. If an abscess is suspected, or if the abscess is mechanized, it is necessary to use the coarsest needle possible. In this way, the patient’s pain is reduced to a minimum, there are usually no significant complications, and no hospitalization is required, while the treatment is most effective.
(5) Low cost.
Regardless of CT, MRI, isotope-guided interventions, the cost is more expensive, and the cost is higher for patients who need repeated examinations, ultrasound-guided interventions reduce the burden of patients to ensure the quality of treatment.
(6) Minimally invasive, no scars.
Because the instruments we use are needles or fine drains, there is no great dermal damage and no scars, and the postoperative period is more beautiful.
3. Indications and efficacy of interventional ultrasound.
Above we have talked about what is interventional ultrasound and the advantages of interventional ultrasound, so what type of surgery can interventional ultrasound actually do? When it comes to interventional ultrasound, all medical practitioners know it without exception, but how much benefit can it bring to patients? What types of procedures can it perform, and what are the long-term outcomes? I would like to explain two major aspects.
On the diagnostic side and on the treatment side, where the treatment side contains three aspects – treatment of cystic masses, treatment of solid masses, and palliative intubation of tumors.
In principle, all cystic masses found by ultrasound can be treated by interventional ultrasound. However, due to the limited acceptance of patients and the lack of definite conclusion or expert evidence on the therapeutic effect of some cysts (such as mesenteric cysts and bronchogenic cysts), interventional ultrasound is feasible for some superficial cysts, such as fossa cysts, thyroid cysts and breast cysts, except for these cysts. Especially for symptomatic single or multiple simple cysts of liver and kidney ≥5cm, parapelvic cysts with compression, large cysts of polycystic liver and kidney, cysts with compression symptoms or causing dysfunction, we can treat them by injecting sclerosing agent after puncture and fluid extraction under ultrasound guidance, and if the cysts are combined with infection, we can also drain them through interventional ultrasound placement, which is even more effective than surgery. Since 2000, our department has performed more than 1000 cases of liver, kidney and ovarian cysts with satisfactory long-term results and a one-time cure rate of 98%.
② Interventional ultrasound sclerotherapy of substantial organ tumors: data show that sclerosing agent can not only kill tumor cells, but also improve the immune function of the body, so that patients can extend their lives and improve the quality of life, small hepatocellular carcinoma (diameter ≤ 3cm), especially for severe cirrhosis and heart, liver, lung and kidney insufficiency, improper location of the tumor, multiple lesions and can not be surgically removed suitable for hepatocellular carcinoma sclerosing agent injection For hepatocellular carcinoma larger than 3cm with more complete envelope, it is relatively suitable for hepatocellular carcinoma sclerotherapy; the sclerotherapy of hepatocellular carcinoma in our department in recent years can not say that every patient can come back to life, but at least it can delay the development of hepatocellular carcinoma and prolong life, a patient with primary hepatocellular carcinoma has survived for five years after sclerotherapy, which fully proves that interventional sclerotherapy is very effective for parenchymal organ tumors, and a few of them can be cured. In addition, it has the advantages of no incision, small trauma, low cost, repeated use and real efficacy as mentioned above, which is a new method for treating parenchymal organ tumors.
The advantages and roles of ultrasound intervention in the diagnosis of certain diseases: as long as there is a liquid dark area visible by ultrasound in the thoracic and abdominal cavities, puncture aspiration or tube drainage can be performed to clarify the diagnosis or aspiration treatment; thoracic and abdominal abscesses that can be shown by ultrasound, especially for those in deeper locations such as subdiaphragmatic abscess, liver abscess and perirenal abscess, are extremely difficult to make accurate judgments by routine clinical examination. The application of ultrasound-guided puncture can rapidly clarify the diagnosis and place a tube for drainage, which is the main indication for ultrasound intervention. For all kinds of imaging examinations suspected to have occupying lesions confirmed by ultrasound imaging, in principle, we can perform puncture of lesions in the peripheral part of the chest (chest wall, pleura, peripheral part of the lung), superficial tissues and organs (breast, thyroid, superficial lymph nodes, etc.), abdominal cavity (liver, gallbladder, pancreas, spleen, both kidneys, adrenal glands, gastrointestinal tract, retroperitoneum, prostate, rectum) and other deep parts of the body, and then perform histocytological The biopsy is then performed for definitive diagnosis. This biopsy is usually used to make a differential diagnosis of benign and malignant masses in the liver, bile, pancreas, kidney, retroperitoneal tumors, prostate, superficial organs, and peripheral masses in the chest wall and lungs.
Interventional ultrasound can be said to be the surgery of “using needles without knives”, which can relieve your long-standing pain with needles. Health this goal, we sincerely hope that everyone can be healthy and happy, “the least pain, spend the least money, the best efficacy” is our purpose, when you are at a loss for disease, if you think of “interventional ultrasound treatment.