The use of interventional radiology in surgery. Key words: oncology, interventional radiology. History of the development of interventional radiology

B. INTERVENTIONAL RADIOLOGY

We must see the world as it is, and make it as it should be.

Daniil Granin

Medicine has long ceased to be a contemplative discipline. Its tasks are to control the life support systems of the body, actively intervene in the morphology and function of organs in order to quickly correct “breaks”. This trend in last years clearly and brilliantly manifested itself in medical radiology.

A new clinical direction has emerged at the intersection of radiation diagnostics and surgery- interventional radiology. The essence of interventional radiology is the combination of diagnostic, in this case radiation, and therapeutic measures in one procedure.

At the first stage, the radiologist determines the nature and extent of the lesion through radiation examination. At the second stage, usually without interrupting the study, he performs the necessary therapeutic manipulations.

The main areas of interventional radiology are as follows:

Endovascular,

Endobronchial,

Endobiliary,

Endourinade,

Rshs. P.55. Various types catheters for intravascular interventions.

Endoesophageal,

Percutaneous drainage of cysts and abscesses,

Radiation-guided aspiration biopsy,

Percutaneous operations on bones and joints.

All manipulations are carried out, as a rule, percutaneously using special instruments - needles, catheters, conductors, stylets, etc. (Fig. 11.55, 11.56). In terms of effectiveness, these gentle interventions are often not inferior to “major” surgery. At the same time, they make it possible to avoid open surgical access and reduce the patient’s stay in a medical institution.

The interventional procedure is performed under the control of the radiation method in real time. Control can be carried out using x-ray, ultrasonic methods, computed x-ray or magnetic resonance imaging.

Initially, interventional radiology developed mainly on the basis of radiological studies. The successes of interventional radiology were prepared by the entire course of scientific and technological progress. In order to carry out interventions on blood vessels, the digestive tract, biliary and urinary tract, it was necessary to create powerful X-ray installations with high-speed photography, television and recording equipment. It was necessary to go a long way to develop and improve angiography and design a number of special devices for catheterization of vessels, bile ducts, ureters, targeted punctures and biopsies of deep-seated organs.

Balloon occlusion - Rice. 11.56" Arrangement of a balloon for angioplasty.

X-ray interventional procedures performed by a specially trained radiologist in an X-ray diagnostic room equipped for surgical interventions and angiographic studies (see Fig. 11.22). Naturally, the rules of asepsis and antiseptics are fully observed. The office has all the equipment - instrumental and medicinal - to provide emergency care and resuscitate the patient. The preparation and premedication of the patient is carried out in the same way as for angiography.

X-ray endovascular interventions are intravascular transcatheter diagnostic and therapeutic procedures performed

under x-ray control. The main types of X-ray endovascular interventions developed by the mid-80s 1, but their development began much earlier. In 1964, C. Dogger and M. Judkins were the first to perform catheter dilatation of iliofemoral arteries narrowed as a result of atherosclerosis. Subsequently, C. Dotter was awarded the Nobel Prize for this research. The corresponding type of intervention is called transluminal angioplasty, or endovascular dilatation of blood vessels. In 1969 V.A. Khilko, through transcarotid access, blocked the vessels of the hemangioma skin skulls by inserting polystyrene balls into them. Interventions of this kind are called X-ray endovascular occlusion.

Endovascular dilatation, or angioplasty, is one of the most effective ways treatment of limited segmental vascular lesions - stenosis and occlusion (Fig. 11.57,11.58).

The question of whether a particular patient should undergo dilatation or reconstructive surgery is decided jointly by the surgeon and the radiologist. The range of indications for dilatation has expanded significantly in recent years. It is performed for atherosclerotic narrowing of the coronary vessels and brachiocephalic branches of the aorta, stenosis renal arteries, accompanied by renovascular hypertension, and the arteries of the transplanted kidney, narrowing of the visceral branches abdominal aorta, various occlusive processes in the iliac arteries and vessels lower limbs.

The dilatation procedure begins with the insertion of a standard angiography catheter into the affected vessel. A contrast agent is injected through it to accurately determine the topography, severity and nature of the stenosis. Then a therapeutic double-lumen catheter with a balloon is inserted into the lumen of the diagnostic catheter. The end of the catheter is placed in front of the narrowed area of ​​the vessel. The angiographic catheter is removed, and the guidewire of the therapeutic catheter is carefully advanced into the area of ​​stenosis. After this, a diluted contrast agent is poured into the canister using a syringe equipped with a pressure gauge, as a result of which the canister evenly stretches and puts pressure on the walls of the narrowed section of the vessel. As a result, small intimal tears occur and the medial tunic of the vessel is stretched; The atheromatous plaque may be damaged and crushed. Dilatation is repeated several times, after which the catheter is removed.

To prevent the vessel from narrowing again (restenosis), X-ray endovascular prosthetics. For this purpose, a metal (for example, nitinol) prosthesis (the so-called awning). In passing, we note that stenting is currently used not only for angioplasty, but also to prevent narrowing of the esophagus in case of cancer, the pyloric canal, bile ducts, trachea and large bronchi, ureter, nasolacrimal duct.

I For more details see: Rabkin IH, Shtevosov A.L., Gotman L.N. X-ray endovascular surgery. - M.: Medicine, 1987.

Rice. P.57. Angiograms before (a) and after (b) balloon angioplasty for femoral artery stenosis (observation by V.I. Prokubovsky).

Rice. 11.58. Angiograms before (a) and after (b) balloon angioplasty with severe atherosclerotic lesion abdominal aorta and iliac arteries(observation by V.I. Prokubovsky).

X-ray endovascular occlusion- transcatheter blockage of the vessel, its embolization. To do this, an embolic material is introduced through a catheter, which temporarily or permanently obstructs the lumen of the vessel. Depending on the caliber of the vessel and the purpose of the procedure, platinum microparticles, microspheres with ferromagnets, hemostatic gelatin sponge, metal spirals, and oil emulsions are used. X-ray endovascular occlusion is performed to stop bleeding (for example, pulmonary, gastric, intestinal), thrombosis of the aneurysm, and separation of congenital and acquired arteriovenous anastomoses. Embolization of the internal iliac artery is a means of stopping severe bleeding from pelvic trauma. X-ray endovascular occlusion is used before some surgical interventions, for example, during nephrectomy for kidney cancer, which makes the operation “bloodless” and facilitates the removal of the tumor.

X-ray endovascular interventions include many other manipulations: percutaneous closure of the patent arterial duct and defect in the septum of the heart, transcatheter embolectomy, transcatheter removal foreign bodies from the heart and pulmonary artery. Methods of selective administration of drugs and radioactive substances have become widespread. medicinal drugs to various parts of the vascular system. They are used in chemotherapy of tumors, non-occlusive mesenteric ischemia, for dissolving clots in the lumen of a vessel (drug thrombolysis) and treatment acute thrombosis. Great success has been achieved in thrombolytic therapy for patients with acute myocardial infarction and pulmonary embolism, as well as transcatheter therapy for acute pancreatitis and pancreatic necrosis. Local impact medicines is often more effective than intravenous or intramuscular.

Two innovations have received general recognition. The first is transcatheter insertion of a special filter into the vena cava. Through the veins of the upper limb, the filter is installed in the superior vena cava, and through femoral vein it is carried out into the inferior vena cava. The filter is an effective means of preventing pulmonary embolism (for example, thrombophlebitis). The second innovation involves administration through a catheter. flexible light guide probe, which is used for laser destruction of atheromatous plaques or blood clots (the so-called laser tunneling), or a device for mechanical clot retraction.

The scope of interventional radiology includes not only endovascular, but also a variety of extravasal (extravascular) manipulation. Performed under X-ray control bronchial catheterization in order to obtain material by biopsy of areas inaccessible to the bronchoscope bronchial tree, perform percutaneous transthoracic punctures of intrapulmonary and mediastinal formations. Are being intensively developed endobiliary x-ray surgical interventions. Through percutaneous puncture and catheterization of the bile ducts, decompression is carried out in case of obstructive jaundice, a temporary or permanent outflow of bile is created (external or internal drainage of bile ducts).

Rice. 11.59. Balloon ureter.

a - narrowing of the ureter in the upper third; b - the balloon is inflated in the narrowed area; c - significant decrease in stenosis after dilatation.

Pathways), drugs are administered to dissolve gallstones, remove small stones, eliminate strictures of the bile ducts, expand the anastomosis between the common bile duct and the digestive tract.

It is worth mentioning X-ray endourinary interventions. They are most often based on percutaneous puncture and catheterization of the renal pelvis in case of ureteral obstruction. Through an artificially created passage, kidney stones that are not subject to treatment are crushed and removed. lithotripsy- wave crushing. In the same way, nephrostomy is performed, medications are administered, a biopsy is performed, the stricture is dissected, and the ureter is ballooned (Fig. 11.59).

Balloon dilatation is also performed to eliminate strictures of the esophagus or stomach. Interventional interventions such as aspiration biopsy under x-ray control. It is used to establish the nature of intrathoracic and abdominal formations and infiltrates, which saves many patients from a trial thoracotomy or laparotomy, for puncture biopsy of the thyroid gland, lymph nodes, kidneys, liver, spleen. The same manipulation is successfully used for identification of non-palpable breast formations. Using puncture, percutaneous drainage of cysts and abscesses is carried out, which in some cases is an alternative to surgical interventions.

Besides X-ray television scanning, in some cases, they are used as a control computed tomography, especially often when performing a targeted puncture pathological formations, construction of stereotactic coordinates in the case of performing stereotactic operations on the brain.

In addition to radiological examinations, they are increasingly used as guiding and controlling studies. ultrasonic Due to the absence of the adverse effects of ionizing radiation, sonography allows for longer monitoring of the insertion of microsurgical instruments into the patient’s body and monitoring all stages of interventional procedures. To perform such procedures, modern ultrasound machines must be equipped with special puncture sensors.

IN Lately are beginning to be used as a control method magnetic resonance imaging, which becomes available when using an open-type MP tomograph.

At the intersection of radiology and surgery, a new clinical direction– interventional radiology. Its essence is the combination of diagnostic radiological and therapeutic measures in one procedure. First, the nature and extent of the lesions are determined using x-ray studies, and then the necessary therapeutic procedures are performed. These procedures are performed by an x-ray surgeon in an x-ray room equipped for surgical interventions and angiographic studies. Treatment procedures are usually carried out percutaneously using special instruments (needles, catheters, guidewires, stylets, etc.). X-ray endovascular interventions are the most widely used. In oncological practice, X-ray endovascular occlusion (transcatheter blockage of a vessel) is used, for example, to stop pulmonary, gastric, intestinal bleeding. It is also used for some surgical interventions (for kidney tumors this method facilitates the removal of the tumor). The X-ray endovascular method has become widespread for the selective administration of radioactive therapeutic drugs during tumor chemotherapy, since local impact drugs are often more effective than intramuscular or intravenous.

Extravasal (extravascular) manipulations are also performed. Under X-ray television control, catheterization of the bronchi is performed to obtain biopsy material. Under X-ray control, in particular CT, percutaneous transthoracic punctures of intrapulmonary or mediastinal formations are performed. An aspiration biopsy is performed to determine the nature of intrathoracic and abdominal formations and infiltrates, which saves patients from a trial thoracotomy or laparotomy. It is also carried out to identify non-palpable formations in the mammary gland. Punctures are performed using X-ray and television scanning, including CT, or using ultrasound. For targeted biopsy, various radiation diagnostic methods can be used. Each method has its own advantages and limitations. The choice of biopsy technique depends on the specific case and indication. Eg, cross section obtained using CT makes it possible to accurately localize anatomical structures and neoplasms, which allows the use of CT for organ puncture. CT is most often used in following cases: biopsy of formations, the visualization of which is difficult with other research methods; formations with a diameter of less than 3 cm, deep-lying formations or located close to blood vessels, intestines, bones; drainage of abdominal abscesses; repeat biopsy if other methods have failed.

From all of the above it follows that the use radiation methods research individual organs and systems should be used purposefully, taking into account the clinical objectives and nature of the disease.

Interventional radiology

branch of medical radiology that develops scientific basis and clinical application of therapeutic and diagnostic procedures carried out under the control of radiation examination. Formation of R. and. became possible with the introduction of electronics, automation, television, and computer technology into medicine. The intervention technology is based on the use of electron-optical converters, X-ray television devices, digital (digital) radiography, devices for high-speed X-ray filming, X-ray cinematography, video magnetic recording, devices for ultrasound and radionuclide scanning. A large role in the development of R. and. played a role in the development of a technique for percutaneous catheterization of blood vessels and the design of special instruments for catheterization of vessels, bile ducts, ureters, targeted punctures and biopsies of deep organs.

The intervention consists of two stages. The first stage includes a radiation study (X-ray television scanning, computed tomography, ultrasound or radionuclide scanning, etc.) aimed at establishing the nature and extent of the lesion. At the second stage, usually without interrupting the study, the doctor performs the necessary medical procedures (catheterization, puncture, prosthetics, etc.), which are often as effective as, and sometimes superior to, surgical interventions, and at the same time have a number of advantages over them. They are more gentle and in most cases do not require general anesthesia; the duration and cost of treatment are significantly reduced; the percentage of complications and mortality are reduced. Interventions can be initial stage preparing severely weakened patients for subsequent operations necessary.

Development of R. and. required the creation of a specialized office within the radiology department. Most often, this is an angiographic room for intracavitary and intravascular studies, serviced by an x-ray surgical team, which includes an x-ray surgeon, an anesthesiologist, and a specialist in ultrasound diagnostics, operating nurse, x-ray technician, nurse, photo lab assistant. Employees of the X-ray surgical team must be proficient in intensive care and resuscitation.

Indications for interventional procedures are very wide, which is associated with the variety of problems that can be solved using interventional radiology methods. General contraindications are serious condition sick, acute infectious diseases, mental disorders, decompensation of functions cordially- vascular system, liver, kidneys, when using iodine-containing radiopaque substances - increased sensitivity to iodine preparations.

Preparing the patient begins with explaining to him the purpose and methodology of the procedure. Depending on the type of intervention, they use different shapes premedication and pain relief. All interventional interventions can be divided into two groups: x-ray endovascular and extravasal.

X-ray endovascular interventions, which have received the greatest recognition, are intravascular diagnostic and therapeutic manipulations carried out under X-ray control. Their main types are x-ray endovascular dilatation, or angioplasty, x-ray endovascular prosthetics and x-ray endovascular occlusion.

X-ray endovascular dilatation is one of the most effective methods for treating limited (usually no more than 10 cm) segmental vascular stenoses. This method is used in approximately 15% of patients requiring surgical treatment occlusive vascular lesions. X-ray endovascular dilatation is performed for atherosclerotic narrowing of the coronary arteries of the heart, stenosis of the brachiocephalic branches of the aortic arch, stenosis of the renal arteries of fibromuscular or atherosclerotic nature, narrowing of the celiac trunk and superior mesenteric artery, occlusive lesions of the common and external iliac arteries and vessels of the lower extremities.

X-ray endovascular dilatation is performed under local anesthesia. First, a radiopaque substance is injected into the affected vessel through an angiographic catheter to accurately determine the location of the stenosis, its degree and nature (Fig. 1). A therapeutic double-lumen catheter, such as a Gruntzig catheter, is then inserted into the lumen of the angiographic catheter. It consists of a main tube with a hole at the end and a polyethylene shell surrounding it, forming a end section balloon-shaped expansion. Thus, there are two lumens in the Gruntzig balloon: one internal and the second between the main catheter and its sheath.

After removal of the angiographic catheter, the therapeutic catheter guide is carefully inserted into the area of ​​stenosis under X-ray television control. Using a syringe equipped with a pressure gauge, a diluted radiopaque substance is poured into the lumen formed by the inner tube and shell, as a result of which the balloon, evenly stretching, exerts pressure on the walls of the narrowed section of the vessel. Dilatation is repeated several times, after which the catheter is removed. During the atherosclerotic process, under the influence of compression, atheromatous plaques are crushed and pressed against the vessel wall. Contraindications are diffuse stenosis, sharp bends and torsion of the arteries, eccentric location of the stenosis site.

X-ray endovascular dilatation may be accompanied by complications, including bleeding at the site of vascular puncture, arterial spasm and (the most dangerous) blood clot formation, as well as embolism from detached atheromatous masses. The disadvantage of X-ray endovascular dilatation is the occurrence of restenosis.

To expand the lumen of the vessel, the use of laser tunneling has begun. A probe equipped with fiberglass optics is inserted into the affected segment of the artery, which serves as a conductor for a laser beam that causes “evaporation” of the atheromatous plaque.

X-ray endovascular prosthetics is the introduction of an endoprosthesis into an enlarged area of ​​a vessel, which allows to avoid restenosis after endovascular dilatation. There are self-expanding and inflating steel prostheses, as well as spiral prostheses made of nitinol, which is an alloy of nickel and titanium. Nitinol has high elasticity and the ability to restore the shape previously given to it under certain conditions. The straightened nitinol wire passed through the catheter, under the influence of blood temperature, takes on the previous spiral shape and serves as a supporting frame, preventing restenosis. The endoprosthesis is gradually covered with fibrin and overgrown with endothelial cells.

X-ray endovascular occlusion is the introduction of any material (embolus) into a blood vessel through a catheter for the purpose of temporary or permanent obstruction of its lumen. It is more often used to stop bleeding (pulmonary, gastric, hepatic, intestinal), the source of which is previously established using endoscopic, radiation and other studies. The introduction and advancement of a catheter made of elastic radiopaque material is carried out according to the Seldinger technique. When the catheter reaches the intended level, angiography is performed, followed by embolization. The material for the embolus is selected in each case individually, taking into account the nature of the embolus. pathological process and artery caliber. Dissolving emboli are introduced for temporary occlusion of the lumen of blood vessels, insoluble ones for permanent occlusion. They use substances that are harmless to the body: gelatin hemostatic sponges, muscle homogenate, blood clots, plastic or metal balls, Teflon threads, silicone and latex tear-off cans. Persistent embolization can be obtained with the Gianturco spiral, which is a coil of elastic steel wire with 4-5 cm long wool and (or) Teflon threads fixed at the end. The proximal end of the spiral has a blind channel for inserting an axial stylet, which allows you to straighten the wire to insert it into catheter. IN blood vessel the spiral again takes its original shape and becomes a framework for thrombus formation. In the area where the spiral adheres to the intima of the vessel, aseptic inflammation occurs, which contributes to the organization of a blood clot.

Most often, X-ray endovascular occlusion is used to treat large hemangiomas in hard-to-reach areas. X-ray endovascular occlusion has gained recognition for lung diseases accompanied by repeated hemoptysis and recurrent pulmonary hemorrhages. Having determined from the data x-ray examination source of hemoptysis, perform catheterization of the bronchial vessel supplying blood to the affected lung department. After clarification using character arteriography pathological changes arteries are embolized. Endovascular embolization is used for thrombosis of aneurysms, separation of congenital and acquired arteriovenous anastomosis, closure of the unclosed ductus arteriosus and defect in the septum of the heart. Endovascular embolization is sometimes used to reduce vascularity malignant neoplasm, incl. before surgery, which can help reduce blood loss during surgery (for example, with a kidney tumor).

A complication of X-ray endovascular occlusion is tissue ischemia, leading to in some cases to the development of a heart attack. The procedure may be accompanied by local temporary pain, nausea, and increased body temperature.

X-ray endovascular interventions include many other manipulations: transcatheter embolectomy, transcatheter removal of foreign bodies (for example, from the pulmonary artery and cardiac cavity), dissolution of blood clots in the lumen of blood vessels. Great success has been achieved in thrombolytic therapy of patients with acute heart attack myocardium, thromboembolism pulmonary arteries, as well as during treatment acute pancreatitis, and in particular pancreatic necrosis, through transcatheter long-term regional infusion of therapeutic drugs. Methods of selective administration of chemotherapeutic drugs and radioactive substances are used in oncology.

One of the areas of X-ray endovascular interventions is transcatheter destruction of the tissues of certain organs (for example, destruction of the adrenal glands during severe course Itsenko-Cushing's disease, spleen in a number of blood diseases). For this purpose, several milliliters of a radiopaque substance are injected into the draining vein of the corresponding organ through a catheter, as a result of which the vessel ruptures and the radiopaque substance exits into the parenchyma. The resulting hematoma causes destruction of organ tissue, which can contribute to quick elimination clinical manifestations of the disease (an effect similar to surgery to remove the adrenal glands and splenectomy).

A common X-ray endovascular intervention is the installation of a special filter in the inferior vena cava (cava filter). This operation is performed on patients who are at risk of pulmonary embolism (in particular, with thrombophlebitis of the deep veins of the pelvis and lower extremities). Having established the presence of thrombosis and its localization using ultrasound and phlebography, catheterization of the vena cava is carried out and a filter is strengthened in the lumen.

Extravasal interventional procedures include endobronchial, endobiliary, endoesophageal, endourinal and other manipulations. X-ray endobronchial interventions include catheterization of the bronchial tree, performed under the control of X-ray television illumination, in order to obtain material for morphological studies from areas inaccessible to the bronchoscope. With progressive strictures of the trachea, with softening of the cartilage of the trachea and bronchi, endoprosthetics is performed using temporary and permanent metal and nitinol prostheses.

Endobiliary X-ray surgical interventions are being improved. In case of obstructive jaundice, through percutaneous puncture and catheterization of the bile ducts, they are decompressed and an outflow of bile is created - external or internal drainage of the bile ducts (Fig. 2). IN biliary tract drugs are administered to dissolve small stones, small stones are removed from the ducts using special instruments, biliodigestive anastomoses are expanded, in particular anastomoses between the common bile duct duodenum when it narrows. In severely weakened patients with acute cholecystitis, transcatheter obliteration of the cystic duct is performed, after which anti-inflammatory therapy is carried out, culminating in crushing and removal of stones. Percutaneous gastrostomy, jejunostomy, and cholecystostomy are increasingly used. To eliminate narrowing of the digestive canal, incl. esophagus, balloon dilatation is performed (Fig. 3).

The basis of x-ray endourinary manipulations is most often percutaneous puncture and catheterization renal pelvis with ureteral obstruction. In this way, manometry and contrast of the pyelocaliceal system are performed (antegrade pyelography), medicinal substances. Through an artificially created nephrostomy, a biopsy is performed, dissection of the ureteral strictures and its balloon expansion. Dilatation and endoprosthetics of the urethra for prostate adenoma and similar manipulations for cervical stricture deserve attention.

Interventional methods for studying the fetus and treating its diseases are coming into practice. Yes, under control ultrasound scanning carry out early amniocentesis, chorion biopsy, fetal skin, blood sampling, and eliminate obstruction of the urinary tract.

Interventional studies are used for puncture of non-palpable formations in the mammary gland identified by mammography. The puncture is performed under the control of X-ray television scanning. After examination, a special needle is left in the gland tissue, which serves as a guide for sectoral resection. Under fluoroscopic control or computed tomography Percutaneous transthoracic punctures of intrapulmonary and mediastinal formations are performed. Likewise, incl. under the control of ultrasound scanning, puncture and biopsy of pathological foci in other tissues and organs are performed. The most common interventional procedures were puncture of cysts and abscesses of various locations with their subsequent drainage. The technique is used for cysts of the thyroid, pancreas, kidneys, liver, etc., abscesses of the lungs, liver, pancreas, and abdominal cavity. The abscess is punctured with a stylet catheter under the control of ultrasound scanning, computed tomography or fluoroscopy. After removing the purulent contents through the catheter, medications are poured into the cavity. The catheter is left in the cavity to repeat the procedure. Using radiation research methods, the dynamics of the process are monitored.

The role of R. and. for diseases of the musculoskeletal system. A biopsy is performed under radiation control synovial membranes, trepanobiopsy, interventional interventions on intervertebral discs, incl. percutaneous lumbar decompression and discectomy, as well as chemonucleosis (introduction of proteolytic enzymes into the nucleus pulposus of the disc followed by removal of fragments of cartilaginous hernia), etc.

Bibliography: Rabkin I.Kh. X-ray endovascular prosthetics. Surgery, No. 6, p. 137, 1988; Rabkin I.Kh., Matevosov A.L. and Getman L.I. X-ray endovascular surgery, M., 1987.

• Percutaneous energy ablation of tumors: principles, technologies, results (DOI:10.31917/1703129)

  P.V. Balakhnin, A.S. Shmelev, E.G. Shachinov

  annotation

  Percutaneous energy ablation is promising minimally invasive method of treating unresectable primary and metastatic tumors various localizations. The paper discusses the basic principles of interventions, as well as existing technologies used for hyperthermic (laser, ultrasound, radiofrequency and microwave ablation), hypothermic (cryoablation) and non-thermal (photodynamic ablation, irreversible electroporation) ablation of tumors. The basic mechanisms of action of various types of energy on tissues, as well as their advantages and disadvantages, are covered. clinical use. The long-term results of treatment of tumors of the liver, kidneys, lungs and tumors of other locations were analyzed. Considered modern ideas about the effect of various types of ablation on immune system body, as well as the potential possibilities of using ablative technologies in combination with various methods cancer immunotherapy.

  Key words: radiofrequency ablation, microwave ablation, cryoablation, irreversible electroporation, laser ablation, ultrasound ablation, cancer immunotherapy, interventional radiology

• Interventional radiology in oncology: history of development and current state of the problem

  B.I. Dolgushin

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  In a relatively short period of existence, interventional radiology has today become an integral component of modern oncology.

  The interventional radiologist's arsenal includes: wide choose highly effective minimally invasive radiological and hybrid technologies of various types, including diagnostic and treatment-diagnostic, special antitumor and accompanying ones, which can be used either independently or combined with other methods of treating cancer patients, often comparable in results to traditional surgery.

  The purpose of this work is to provide an overview of the possibilities of using a complex of IR and hybrid technologies in oncology. A description of the methods and indications for their implementation is given. The nature and frequency of complications, feasibility and priority are considered clinical application IR technologies in various areas practical oncology. Their importance in improving treatment results and optimizing the conditions for rehabilitation of cancer patients, improving economic indicators activities of oncological institutions.

  Key words: interventional radiology, hybrid technologies, vascular/non-vascular IR interventions

• Methods of regional therapy of tumors of various localizations

  P.G. Tarazov

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  The lecture is dedicated to introducing readers to a new promising section clinical oncology– therapeutic X-ray endovascular interventions for malignant tumors of various locations.

  At the beginning of the article, the author substantiates the relevance of the use of regional chemotherapy, focusing on its advantages over existing treatment methods and the possibilities of use as a component combination therapy. The main types of interventions used are listed. The following is a description of the mechanisms and effectiveness of x-ray endovascular procedures for tumors of various locations.

  These procedures are most often used for liver tumors. Literature data and our own results of chemoinfusion, various types of chemoembolization, radioembolization in the treatment of unresectable primary and metastatic cancer liver. The role of pre- and postoperative endovascular procedures is shown.

  The application of interventional radiology methods in the treatment of tumors of other locations: head and neck, lung, breast, organs is presented. gastrointestinal tract, genitourinary system, musculoskeletal system; own treatment results are presented. It is especially emphasized that it is advisable to use them in combination with other methods of antitumor therapy.

  In conclusion, it is noted that regional therapy methods play an important role in the treatment of cancer and should be used more widely. Along with surgery, chemotherapy and radiation, interventional radiology can be considered one of the components of modern clinical oncology.

  Key words: interventional radiology, angiography, chemoinfusion, chemoembolization, radioembolization, combination treatment

• X-ray surgical methods for treating emergency conditions in oncology

  P.V. Balakhnin

  annotation

  Emergency conditions directly or indirectly related to oncological diseases, can be the first manifestation of a malignant tumor in the body, and also develop at all stages of treatment of cancer patients. The purpose of the work is to consider the possibilities of using various x-ray surgical technologies, such as percutaneous drainage, percutaneous and intraluminal stenting, endovascular interventions and local therapy in the treatment of emergency conditions arising in patients with cancer. The work discusses the possibility of using the above treatment methods to eliminate the syndrome of obstruction of hollow organs and tubular structures, perforation of hollow organs and tubular structures, compression of organs in delimited cavities, bleeding, purulent-septic complications, venous thromboembolic complications and severe pain syndrome. It is concluded that X-ray surgery as an independent clinical discipline has a wide range of effective technologies, which can be used to treat emergency conditions that arise in patients on different stages diagnosis and treatment malignant tumors. Information may be useful for doctors departments of X-ray surgical methods of diagnosis and treatment, as well as all specialists taking part in combined and complex treatment cancer patients.

» Interventional surgery- X-ray endovascular surgery

Interventional surgery - X-ray endovascular surgery

Reconstructive heart surgery

Cardiovascular surgery – 2007

TO X-ray endovascular (interventional) methods include surgical treatment methods in which rib cage does not open and open surgery is not produced on the heart. All surgical interventions are performed using gentle methods through vessels and inside vessels.

To see the result surgical intervention inside the vessel, X-ray equipment is used and all the surgeon’s actions are carried out under the control of the image on the screen of the X-ray machine. These surgical treatments include percutaneous intravascular angioplasty. The method allows you to increase the lumen of the artery, which is narrowed and developed in this place.

Percutaneous intravascular angioplasty has been used for more than 20 years. This operation is performed:

• If one or two vessels are affected, and the remaining arteries of the heart are in good condition
• For angina pectoris that is difficult to treat with medication
• If signs of ischemia (lack of blood supply) of the heart are proven during heart studies
• In patients with angina pectoris who high risk major surgery
• Repeated after.

Balloon angioplasty contraindicated if the patient has multiple lesions arteries or atherosclerotic plaque is small and occupies less than 50% of the lumen of the vessel, and also if there is pain in the heart instrumental methods Studies have not proven insufficiency of blood supply to the heart muscle.

When planning an operation, coronary angiography data play an important role. This is a study of the heart vessels using contrast agents. Coronary angiography indicates the exact location of the atherosclerotic plaque and helps determine the tactics of surgical intervention.

There are several types of intravascular angioplasty:

• balloon dilatation (expansion)
• rotablation
• laser destruction of atherosclerotic plaque.

But today it is most often used balloon angioplasty. To perform balloon angioplasty, special balloon catheters with a diameter of 1.5 to 4 mm that can withstand pressure of up to 15 atmospheres are used. The operation is performed through the femoral artery. The cylinder is filling contrast agent so that the position of the balloon and the result of its use can be seen during x-ray control of the operation. Through the femoral artery, a catheter with a balloon is passed under X-ray control to the heart, inserted into the desired artery and inflated at the site of narrowing of the vessel. The balloon inflation time is from 15 seconds to 2 minutes. In this case, the plaque on the vessel wall is compressed and flattened, which leads to an increase in the lumen of the vessel. The electrocardiogram is constantly monitored so that when the balloon is inflated, there is no insufficiency of blood supply in the muscle supplied by this vessel. The balloon can be inflated several times until the lumen of the vessel increases by 70%. If there are several such vessels, the vessel with the greater degree of narrowing is selected.

Before balloon angioplasty, the patient must be prepared. To prevent possible thromboembolic complications, 2-3 weeks before surgery, the patient is prescribed drugs that reduce thrombus formation (aspirin, ticlid, clopidogrev). During the operation, heparin is used for 18-48 hours. From the second day after surgery, aspirin is prescribed at a dose of 325 mg per day, calcium antagonists and beta-blockers.

Complications with balloon angioplasty are few. A rupture of the inner wall of the artery is possible, which can lead to the formation of a blood clot at the site of impact or tearing off parts of the membrane and blocking further arteries with them. In this case, it is necessary to install a stent (special frame) or perform intracoronary thrombolysis (dissolution of a blood clot). Sometimes there may be a spasm of the artery or residual narrowing. This complication is eliminated by medication or repeat balloon angioplasty using a larger balloon. The total number of complications is from 2 to 4% in different clinics. The treatment results are good. Mortality with balloon angioplasty ranges from 0.2 to 1.5%.

If the lumen of the vessel is completely blocked, then apply rotational atherectomy(removal of atherosclerotic plaque) using a rotablator. This is a method using a special drill coated with diamond crystals. With the help of such a drill, the atherosclerotic plaque is destroyed and the lumen of the vessel is restored. The operation is successful in 50-65% of cases. When the lumen of the vessel is completely blocked, the method of intravascular extraction atherectomy is also used. In this case, a special catheter is used from two systems - cutting and aspiration. The latter is associated with a vacuum attachment, which allows the removal of fragments of atherosclerotic plaque.

In addition, various laser technologies . This is the destruction of an atherosclerotic plaque using a pulsating power garnet laser, a combination of balloon angioplasty with simultaneous exposure to laser irradiation on the vessel wall.

Long-term complications of angioplasty methods are the development of repeated narrowing of the artery in 20% of patients during the first 6 months after surgery and in 60% within a year, developing more often after laser methods treatment.