实时超声造影技术在腹腔镜下肾肿瘤射频消融术中监测的应用研究

Real time monitoring laparoscopic radiofrequency in the treatment of renal lesions by contrast-enhanced ultrasonography

目的 探讨实时超声造影技术在肾肿瘤腹腔镜下射频消融术（laparoscopic radiofrequency ablation,LRFA）中监测的应用价值. 方法 2008年3月至2011年8月诊断符合肾肿瘤行LRFA的患者61例,随机分为2组.常规组31例,术中使用二维超声评判消融效果；超声造影组30例,术中使用超声造影判断消融效果.术后1、3、6个月及其后每6个月常规复查增强CT,评判LRFA术后肿瘤残留和复发情况. 结果 超声造影组31个病灶中有2个使用常规方法评判认为无肿瘤残留,实时超声造影显示有肿瘤残留行再次消融.术后1个月增强CT检查显示,超声造影组31个病灶完全消融（100％）,而常规组32个病灶完全消融31个（97％）.中位随访时间16个月中,超声造影组未发现肿瘤残留或者复发,常规组发现肿瘤残留1例、肿瘤复发1例,两组局部肿瘤控制率分别为100％ （30/30）及94％（29/31）. 结论 超声造影可以用于LRFA术中实时监测,有望提高肾肿瘤的完全消融率和局部肿瘤控制率.

Objective To evaluate the value of real-time contrast-enhanced uhrasonography （CEUS） in determining the endpoint of laparoscopic radiofrequeney ablation （LRFA） in the treatment of re- nal lesions and its clinical outcome. Methods From Mar. 2008 to Aug. 2011, 61 consecutive renal tumor patients meeting inclusion criteria were recruited and randomized to a pilot, open label, randomized study. There were CEUS group （LRFA performed under the real time CEUS monitoring） and conventional group （ LRFA performed under a combination of ultrasound and laparoscopie monitoring）. Contrasted CT was per- formed 1, 3, 6 months postoperatively and every six months thereafter in both groups to evaluate the ablation efficacy and recurrence rates. Results Two tumors （2/31, 6% ） needed additional ablation after second CEUS during the procedure in CEUS group. On the one-month post-RFA CT imaging, 31 of 31 tumors （100%） and 31 of 32 tumors （97%） were successfully ablated in CEUS group and conventional group re- spectively. Within median 16 months follow-up period, one incomplete ablation and one local recurrence were found in conventional group while none in CEUS group. The local tumor control rate was 94% （29/31） in conventional group versus 100% （30/30） in CEUS group, P=0.492. Conclusions CEUS seems to be a useful imaging technique in monitoring LRFA in the treatment of renal tumors. This novel imaging modality may allow more effective renal tumor ablation and thus increase local tumor control rate.