虚拟导航辅助超声引导下经皮射频消融治疗直径≤2 cm肾上腺良性肿瘤的疗效研究

Therapeutic effects of ultrasound-guided percutaneous radiofrequency ablation assisted by real-time virtual navigation system for benign adrenal tumors≤2 cm in diameter

目的初步评估虚拟导航辅助超声引导下经皮射频消融治疗直径≤2 cm肾上腺良性肿瘤的安全性与疗效。方法回顾分析2020年1月至2022年5月在中山大学附属第三医院行虚拟导航辅助超声引导下经皮射频消融治疗直径≤2 cm肾上腺良性肿瘤的患者15例(17个病灶)。评估术中及术后的并发症发生情况判断其安全性,分析术前与术后的相关激素水平变化判断其疗效。结果14例(93.3%)患者临床诊断为原发性醛固酮增多症,1例(6.7%)患者临床诊断为亚临床库欣综合征。17个病灶的最大径为5~20(13.3±4.3)mm。15例患者中14例成功实施消融,成功率为93.3%(14/15)。1例(1/14,7.14%)患者出现术中高血压危象。术后轻度并发症发生率为50%(7/14),无严重并发症发生。14例消融成功的患者住院期间术前与术后血压比较,差异无统计学意义(P均>0.05),13例消融成功的原发性醛固酮增多症患者住院期间血清醛固酮术后水平显著低于术前水平(P=0.001),血清钾术后水平显著高于术前水平(P=0.025)。术后随访时长为5(4)个月,所有患者出院后均未出现激素水平再次异常变化,临床有效率为100%(14/14)。结论虚拟导航辅助超声引导下经皮射频消融治疗直径≤2 cm肾上腺良性肿瘤安全有效。

Objective To evaluate the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation assisted by a real-time virtual navigation system for benign adrenal tumors with a diameter≤2 cm.Methods From January 2020 to May 2022,the clinical data of 15 patients(17 lesions)with benign adrenal tumors≤2 cm in diameter who received ultrasound-guided percutaneous radiofrequency ablation assisted by a real-time virtual navigation system at the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed.The complications were recorded to evaluate the safety,and the changes of related hormone levels were detected to evaluate the efficacy.Results Fourteen(93.3%)patients were clinically diagnosed as having primary aldosteronism,and one(6.7%)was clinically diagnosed as having subclinical Cushing syndrome.The maximum diameter of the 17 lesions ranged from 5 to 20(mean 13.3±4.3)mm.The ablation was successful in 14 patients,with a technical success rate of 93.3%(14/15).One(7.14%)patient developed hypertension crisis during ablation.The incidence of postoperative minor complications was 50%(7/14).No postoperative major complications occurred.There was no significant difference in blood pressure changes before and after ablation during hospitalization in the 14 patients with successful ablation(P>0.05).In the 13 patients with primary aldosteronism with successful ablation,the level of aldosterone significantly decreased(P=0.001)and the level of serum K+significantly increased(P=0.025)after ablation.No abnormal changes in hormone levels were found in all patients during a median of 5 months of follow-up(range 1-10 months),and the clinical effective rate was 100%(14/14).Conclusion Ultrasound-guided percutaneous radiofrequency ablation assisted by a real-time virtual navigation system is safe and effective for benign adrenal tumors with a diameter≤2 cm.