超声造影引导经皮微波消融治疗肾癌的临床应用

Efficacy of contrast-enhanced ultrasound-guided percutaneous microwave ablation treatment of renal carcinomas

目的评估超声造影引导技术在经皮微波消融治疗肾癌中的临床应用价值。方法回顾性分析2010年6月至2014年8月就诊于解放军总医院介入超声科15例肾癌患者（17个病灶）的治疗及随访资料,年龄46-80岁,平均（65.2±9.4）岁。肿瘤直径1.1-3.9 cm,平均（2.3±0.7）cm。组织穿刺活检病理均诊断为肾癌。所有肿瘤经超声检查无法清晰显示,但在超声造影及增强CT/MRI中清晰显示。所有病灶均行超声造影引导下经皮微波消融治疗。结果 17个病灶在超声造影过程中均能清晰显示其位置、数目、大小、边界、形态,并且均在造影引导下被消融完全。消融时间为5~11分钟,平均（7.2±2.2）分钟。平均治疗次数为（1.1±0.3）次。治疗后对患者进行3-49个月随访（中位随访期17个月）,所有治疗灶均未见复发。整个治疗过程未发生严重并发症。结论超声造影引导微波消融是一种有效、安全的治疗方法,且能为超声下显示不清或邻近重要器官的肾脏肿瘤提供更多治疗机会,具有较大应用价值。

Objective To assess the safety and efficacy of contrast-enhanced ultrasound（CEUS）-guided percutaneous microwave ablation（MWA） treatment of renal carcinomas. Methods Fifteen patients with 17 renal tumors were retrospectively analyze. The patients＇ ages were in the range of 46-80 years（65.2±9.4 years）, the tumor diameters were in the range of 1.1-3.9 cm（2.3±0.7 cm） and biopsy pathological results were renal cell carcinoma. All of the tumors were inconspicuous on conventional ultrasound, while conspicuous on contrast enhanced-computed tomography（CT） or magnetic resonance imaging（MRI）. Seventeen tumors were ablated under the guidance of CEUS. Results All tumors were successfully visualized on CEUS and MWA was performed under CEUS guidance. The durations of energy application for each tumor were in the range of 5-11 min（mean ± SD 7.3±2.2 min）. The mean session of CEUS-guided MWA for each tumor was 1.1±0.3. All patients were followed up for 3-49 months（median, 17 months） to observe the therapeutic effects and complications. There was no local tumor progress and major complication. Conclusion CEUS-guided PMWA is a safety, efficient and feasible therapy for patients with RCC which is inconspicuous on conventional US.