CT引导下经皮穿刺氩氦刀冷冻消融术治疗肾癌的临床应用研究

Clinical application of CT-guided percutaneous cryoablation for renal neoplasms

目的探讨CT引导监测,经皮穿刺氩氦刀冷冻消融术治疗肾癌的技术方法、安全性及临床疗效。方法选取2008年9月至2011年1月于我院就诊的肾肿瘤患者27例,采用CT引导氩氦刀冷冻消融疗法,对治疗后局部靶病灶变化、术后肾功能变化、中位生存时间及生存率进行动态随访观察,并记录并发症情况。结果本组27例患者,术后即刻CT扫描显示冰球覆盖率均为100%。术后3个月复查CT示靶病灶密度减低,瘤体不同程度缩小,按实体瘤评价标准,其中完全缓解(CR)23例,部分缓解(PR)2例,病灶稳定(SD)2例,缓解率(CR+PR)为92.6%。术后第3～4天复查肾功能(尿素氮、尿酸和肌酐等),与术前相比均未见明显变化。本组术后无严重并发症(包括皮肤冻伤、感染、穿刺种植转移等)发生,6例于术后1d出现发热(38℃左右),对症治疗后3～5d消退,8例出现局部轻度疼痛,服用止痛药后缓解;2例出现术后出血,应用凝血酶后迅速止血。结论 CT引导监测,经皮穿刺氩氦刀冷冻消融术治疗肾肿瘤近期疗效肯定,是一种安全可靠、值得推广的微创治疗方法 。

Objective To investigate the safety, efficacy and clinical value of CT-guided eryoablation for renal cellular carcinoma（RCC）. Methods 27 patients with RCC were treated with CT-guided eryoablation from August 2008 to January 2011, CT scan were performed to monitor the dynamic changes at different stages after the eryosurgery. The treatment response and survival rate were tested to evaluated the effieaey of the surgery. Results All the patients underwent pereutaneous conformal eryoablation, the immediate CT scan after cryosurgery showed the lesions of all the patients were completely covered by ieeball. CT scan performed at 1 month, 3 month, 6 month and 1 year after the procedure, the lesions were showed abviously deerease on density, the tumor size decreased,and there was no enhancement. Aeeording to the CT scans, 23 patients had complete ablation, 2 partial ablation,and 2 stable disease. Overall, responding rate （CR ＋ PR）for this group of patients was 92. 6%. Renal function in all patients alter cryosurgery 3 to 4 days showed no significant differences compared with that of preoperation. After eryotherapy, no serious complications, sueh as skin eold injury, infection, implantation metastasis inside the puncture path occurred. Fever appeared in 6 patients, and they all recovered after 3 to 5 days. Pain appeared in 8 patients, and all recovered after treatment. Hemorrhage appeared in 2 patients after cryosurgery and recovered after treated with Thrombin. Conclusions CT-guided percutaneous eonformal cryoablation is a promising treatment for RCC.