局麻下经皮冷冻消融治疗高手术风险T1期肾癌的疗效和安全性分析

Safety and therapeutic effects of local anesthetic percutaneous renal cryoablation for T1 renal cell carcinoma with high surgical risk

目的 探讨局麻下冷冻消融治疗具有高手术风险的T1期肾细胞癌的可行性. 方法 2008年4月至2013年4月对19例无法耐受手术风险的T1期单发肾细胞癌患者,在局麻下实施经皮冷冻消融治疗.男11例,女8例.年龄41～ 89岁,平均66岁.其中不稳定性心绞痛患者6例,高龄（＞85岁）且拒绝侵入性手术患者4例,消化道肿瘤接受化疗患者3例,终末期肾病接受血液透析患者3例,扩张型心肌病伴心力衰竭患者2例,血友病A患者1例.肿瘤直径1.2～ 5.5cm.术后采用CT、超声造影定期随访. 结果 患者局麻耐受性良好.手术时间（55.7±12.8） min,出血量极少.未见明显手术相关并发症.术后3天CT和超声造影显示所有病灶完全消融,技术成功率100％,消融区域直径（3.5±0.8） cm.术后住院（3.8±1.2）d.19例患者随访（36.4±24.1）个月.术后1年测得肿瘤直径为（1.7±0.7）cm,平均缩小58.5％,术后3年时缩小达80.5％,肿瘤局部复发3例,再次予局麻下冷冻消融治疗后,消融完全,未见再次复发.肿瘤特异性生存率100％. 结论 局麻下经皮冷冻消融术治疗T1期肾癌有效、安全,适用于高手术风险的早期肾癌患者.

Objective To evaluate the feasibility,safety and therapeutic effects of local anesthetic percutaneous renal cryoablation for the patients who suffered from T1 single renal cell carcinoma with high surgical risk.Methods Nineteen patients who were not candidates for surgery underwent primary cryosurgery using third-generation cryotechnol%y with ultrathin crvo-needles.Eleven men and 8 women with mean age of 66 years were included in this study.The diameter of the tumors were 1.2-5.5 cm.CT and ultrasonic contrast were used during the treatments and follow-up processes.Results Local anaesthesia was tolerated well by all patients.The mean time of the operations was （55.7± 12.8） min.No operative or immediate postoperative complications were observed.Technical success was achieved in all cases （100%） and 3 reccurent tumors were seen on followup imaging.The mean diameter of the ice ball was （3.5±0.8） cm on CT on the third postoperative day.After an average followup of （36.4±24.1） months,the size reduction was 58.5% and 80.5% at 1 year and 3 years.Cancer-specific survival rate was 100%.Conclusion Percutaneous renal cryoablation under local anesthesia is a feasible,safe therapy for the patients who have unresectable T1 renal cell carcinoma in high surgical risk.