CT引导下经皮穿刺化学消融术治疗肾上腺转移瘤的疗效分析

Efficacy of CT guided percutaneous chemoablation of adrenal metastasis tumor

目的探讨CT引导下经皮穿刺化学消融术治疗肾上腺转移瘤的临床疗效及其应用价值。方法回顾性分析CT引导下经皮细针穿刺化学消融术治疗26例肾上腺转移瘤的临床资料,其中原发灶为肺癌14例、乳腺癌6例、肝癌4例、胃癌2例(共31个病灶)。采用22GChiba针穿刺,制备化学消融剂[无水乙醇(18ml)、聚桂醇(2ml)、碘化油(2ml)、洛铂(10mg)、表阿霉素(10mg)按9∶1∶1∶3∶3比例制成混悬液],术后1、3、6、12个月复查增强CT,评价肿瘤体积缩小及坏死情况,随访时间为12个月。结果 26例患者(31个病灶)手术均获得成功,术中及术后无严重不良反应。所有肿瘤均有进行性缩小,治疗前病灶最大径为(3.3±0.9)cm,治疗后12个月病灶最大径为(1.2±0.7)cm(t=9.391,P<0.05)。6例肿瘤治疗后12个月复查CT仅残留少许纤维影。结论CT引导下经皮穿刺化学消融术治疗肾上腺转移瘤是一种经济、微创、操作简便、效果显著的介入方法,其远期疗效和对患者生存期的影响还有待进一步的研究。

Objective To evaluate the efficacy and the application value of CT guided percutaneous chemoablation of adrenal metastasis tumor. Methods Twenty-six cases of adrenal metastasis tumors were treated with CT guided percutaneous chemoablation.Among them,there were 14 cases of lung cancer,6cases of breast cancer,4cases of liver cancer,and 2cases of gastric cancer（amounting to 31lesions）.A 22 GChiba needle was used to puncture.The chemical ablation agents were prepared [ethanol（18ml）,lauromacrogol（2ml）,lipiodol（2ml）,lobaplatin（10mg）,epirubicin（10mg）in a ratio of 9∶1∶1∶3∶3are made into a suspension].All the patients were reexamined by contrast-enhanced CT at 1,3,6and 12 months thereafter to evaluate the volume reduction and necrosis of tumors and were followed up for 12 months.Results The operations for all 26patients（31lesions）were successful without serious complications.The volumes of tumors decreased to varying degrees compared with the preoperative ones.The maximum of the diameters of the lesions was（3.3±0.9）cm before operations,and the maximum of the diameters of the lesions was（1.2±0.7）cm 12 months after operations（t=9.391,P〈0.05）.Among them,there were 6cases in which tumors were nearly disappeared 12 months after operation. Conclusions CT guided percutaneous chemoablation of the adrenal metastasis tumor is an effective,less invasive and easily manipulated procedure,however,its long term efficacy and influence on the survival period of patients should be further investigated.