CT导向下无水乙醇消融在复杂性肾脏肿瘤治疗中的临床价值

Clinical value of percutaneous ethanol ablation in complicated renal carcinoma

目的探讨CT导向下无水乙醇消融（PEA）在复杂性肾脏肿瘤治疗中的临床价值。方法中山大学附属肿瘤医院影像介入中心10例复杂性肾脏肿瘤患者，其中肾癌7例，肾错构瘤3例，病灶数16个，肿瘤最大径在1．7～8．4cm，平均3．6cm。在CT引导、局麻下进行经皮穿刺无水乙醇消融治疗，常规行螺旋CT平扫和增强扫描进行随访评价疗效。结果10例患者平均每人2次PEA治疗，随访2～26个月，平均18个月。1例孤立肾肾癌患者经2次PEA治疗后，已随访1年9个月未见复发；1例孤立肾多发肾癌患者4次PEA治疗后。肾衰死亡；2例肾癌伴腰痛血尿症状经PEA治疗后病灶消融完全，血尿症状缓解；其他3例肾癌患者分别随访18个月、26个月和12个月，1例死于远处转移，其他2例CT复查未见肿瘤进展。2例错构瘤患者均1次PEA治疗后病灶内出血症状消失，分别随访12个月年和22个月病情稳定。1例肾错构瘤患者2次PEA治疗后未再继续治疗。全部患者无一例出现尿瘘、出血、肠穿孔或针道转移等并发症。结论CT导向下无水乙醇消融治疗对复杂性肾脏肿瘤是一种微创、疗效确切、可供选择的局部治疗方法，但对于孤立肾肾癌，PEA治疗须谨慎。

Objective To probe clinical value of percutaneous ethanol ablation （PEA） in complicated renal carcinoma. Methods 10 cases complicated renal carcinoma patients with 16 lesions ranged from 1.7-8.4 cm totally, renal cancer in 7 cases, renal hamartoma in 3 cases, enderwent CT guided pereutaneous ethanol ablation（PEA） by local anesthesia. Plain and contrast CT scan was adopted to evaluate clinical effect and make follow-up. Results Each patient accepted 2 times PEA in average with follow-up time ranged from 2 to 26 months averaged in 18 months. No recurrence was seen in 1 case isolated renal patient unfortunately with renal cancer through 1 year and 9 months follow-up after 2 times PEA. The other isolated renal cancer patient died of acute renal failure after 4 times PEA. Lesions were fully ablated in 2 cases renal cancer patients with low back pain and blood urine and symptoms disappeared after PEA accordingly. Other 3 cases renal cancer patients went through 1 year and 6 months,2 years and 2 months, and I year follow-up respectively. 1 ease died of distant metastasis and 2 cases kept stabilization evaluated by CT scan. Hemorrhage within lesions disappeared in 2 cases renal hamartoma after just one time PEA ,which kept stabilization through lyear, 1 year and 10 months follow-up respactively. 1 case hamartoma patient gave up treatment after 2 times PEA. No complications including urinary fistula, hemorrage, intestinal perforation and needle track implantation were seen in all patients. Conclusion CT guided PEA is a mieroinvasive, positive curative effect and faculative method in treating complicated renal carcinomas. But for isolated renal patient with renal cancer, PEA should be performed cautiously.