[ZHUHAI DAILY] A large surgical incision measured in millimeters: interventional therapy featured by precision, minimal invasiveness, safety, efficiency and reproducible results - THE FIFTH AFFILIATED HOSPITAL,SUN YAT-SEN UNIVERSITY


[ZHUHAI DAILY] A large surgical incision measured in millimeters: interventional therapy featured by precision, minimal invasiveness, safety, efficiency and reproducible results

Source: Zhuhai Daily 12th edition March 4 (there are some changes in the title and content)

Reporter: YIN Bei 


The a 62-year-old Mr. Zu who recently suffered severe headaches and disturbances in consciousness, came to the Fifth Affiliated Hospital of Sun Yat-sen University. The examination results suggested that the patient suffered a sudden cerebral aneurysm rupture and subarachnoid hemorrhage. The imaging also showed a 7 × 10mm aneurysm in his neck, which is known as a large wide-necked aneurysm. As Mr. Zhu is old and had undergone lung resection surgery previously, a surgical craniotomy could be too taxing for his weak constitutions. ZHOU Bin, the director of the Neurology Intervention Department, Intervention Medical Center of the Fifth Affiliated Hospital of Sun Yat-sen University decided to adopt interventional surgical treatment after consultation with Mr. Zhu’s family.


"But this treatment is more complex," Zhou explained. Under normal circumstances, aneurysm intervention requires insertion of a spring coil into an artery in the thigh, which plugs the tumor. But Mr. Zhu’s tumor is different from the small pouch-size aneurysm, as it has a wider caliber. Conventional filling is likely to be flushed into other vascular structures, resulting in a blood embolism. Therefore a stent is also needed, as it can serve as a mesh to block the outflow of the filler.


After two hours of surgery, Mr. Zhu’s ruptured aneurysm was blocked successfully. He regained his consciousness ten minutes after the operation, and in a few days, as the intracranial hemorrhage was gradually absorbed, he could even get out of bed..


So, how dangerous are intracranial aneurysms after all? Zhou pointed out that the intracranial aneurysm mostly occurs in the abnormal bulge of the intracranial arterial walls, which is also the main cause of a subarachnoid hemorrhage, which accounts for 80% of cases. Among all cerebrovascular incidents, intracranial aneurysms follow incidences of cerebral thrombosis and cerebral hemorrhage as the third most common problem. The incidence can happen to any age group but most commonly inflicts persons around forty years of age.  The motive factor behind the formation of the aneurysm is still unclear but most likely relates to hypertension, cerebral arteriosclerosis, vasculitis and the occurrence and aneurysms.


The aneurysm often further develops and expands. Anxiety, tension, excitement, a sudden increase in blood pressure, urination, physical exertion, late pregnancy, childbirth, physical labor, sex etc can all be the trigger for an aneurysm rupture. However, in most cases, bleeding happens suddenly in the absence of obvious incentive. The risk of death in the first bleeding is more than 30%. 40% of the patients with hemorrhaging incur a secondary hemorrhage within three weeks, with a mortality rate as high as 60%. Therefore, once the patient bleeds, a timely surgical treatment is needed.


Intervenient embolism therapy and surgical craniotomy clipping surgery are the two main treatments currently. Interventional embolization involves less trauma, fewer complications and quicker recovery, yet a relatively higher cost and relapse rate; while craniotomy clipping surgery has a relatively lower cost and recurrence rate, but higher risk, more complications and a longer recovery time. Most patients would prefer the intervenient embolism therapy.


In fact, cardiovascular disease has become a first cause of disability and death in China. Reporters learned that Intervention Medical Center of the Fifth Affiliated Hospital of Sun Yat-sen University has been extensively involved in the treatment of cerebral vascular disease, including ischemic and hemorrhagic disease, such as the embolization of cerebral aneurysms, cerebral arteriovenous malformations, neck and brain open and endovascular revascularization stenosis occlusion and cerebral venous thrombosis, malformations. For peripheral vascular disease, there are extremity atherosclerosis and venous thrombosis, splanchnic vascular stenosis and interventional treatment of pseudoaneurysm and other diseases, minimally invasive treatment of varicose veins, and covered stenting in abdominal aortic aneurysm and aortic dissection.


Target lesions, starve cancer cells

"Interventional therapy not only requires the introduction of the most advanced equipment, but also cutting-edge technologies and concepts, so that patients can benefit from interventional therapy in a more interdisciplinary context." SHAN Hong, the vice president of the Fifth Affiliated Hospital of Sun Yat-sen University and director of its Interventional Medical Center, told reporter that he led the clinical and research team from the Third Affiliated Hospital of Sun Yat-sen University and set up the Interventional Medical Center in Zhuhai. A number of its medical technologies and researches are taking the lead in China. The Center has two clinical departments, namely the Tumor Vessels Intervention Department and the Nerve Intervention Department, as well as one interventional operating room able to diagnose and treat solid tumors, neurovascular disease, terminal liver disease, and peripheral vascular disease, etc., thus bridging a number of gaps in medical technology in Zhuhai.


In the past thirty-odd years, various means have been adopted to “treat the underlying causes” of some tumors, but little attention has been directed toward patients’ life quality after treatment. For example, the side effects of radiotherapy and chemotherapy include radiation pneumonitis, radiation esophagitis, loss of appetite, nausea, emesis, diarrhea or constipation, decrease of hemocytes and so on. As an important part of interventional therapies, the comprehensive and the individual treatments for tumors comprise chemoembolization with drug carrying microspheres, traditional chemoembolization with iodinated oil, ablation, implantation of radioactive particles, targeted therapy, biotherapy, immunotherapy and so on. Each interventional therapy can function on its own or through combination with other therapies, all of which can treat patents more effectively while causing less pain.


“Regarding malignant tumors which are difficult to cure, interventional therapies can focus the efficacy of drugs on the cancerous parts, so as to reduce the side effects on other organs and the whole body. In addition, the therapies can be used repeatedly due to the low degree of trauma. According to Shan Hong, because of the various advantages mentioned above, interventional therapies have become a major method used to treat primary and metastatic liver cancer, hemangioma, pelvic malignancy, as well as lung, gastric, esophageal and colorectal cancer.


For example, the process of treating liver cancer with interventional therapies is as described below. First, use minimally-invasive surgery to insert the tailor-made vascular catheter through percutaneous femoral artery puncture to hepatic artery vessels. Next, carry out hepatic angiography and selectively and directly inject a large dose of high concentrated anti-cancer drugs to the feeding artery of tumors. Finally, embolize hepatic artery selectively with a gelatin sponge, thereby starving tumor cells to death. Besides, anti-cancer drugs will be supplement the treatment, directly and effectively kill cancer cells and significantly increasing its efficacy.  .


In addition, interventional therapies also play a special role in the portal hypertension-focused comprehensive treatments and cytology-related treatments for liver diseases, as well as treatments for common complications after liver transplantation.