超声引导经皮微波消融治疗肾癌根治术后局部复发5例分析

Ultrasound-guided percutaneous microwave ablation in the treatment of local recurrence after radical nephrectomy for renal cell carcinoma

目的探讨超声引导经皮微波消融治疗肾癌根治性切除术后局部复发的安全性及有效性。方法肾癌根治术后局部复发患者5例:男性4例,女性1例;年龄平均70.4(66~76)岁;发现肿瘤局部复发时间为术后18~156月;复发位置肾窝4例(其中累及腰大肌1例)、肾上腺区1例;复发肿瘤位于左侧2例,右侧3例;肿瘤最大平均直径4.6(2.5~6.8)cm;肿瘤单发4例,局部两处病灶1例。5例患者均行超声引导经皮微波消融治疗,对患者治疗情况、术后并发症以及随访结果进行回顾性分析。结果所有患者都顺利耐受超声引导经皮穿刺微波消融术。4例患者使用2根消融针;1例患者使用1根消融针;每针消融时间为15.8(6~30)min。5例患者均1次微波消融便治疗成功,消融成功率100%。术后平均住院时间2(1~4)d。1例患者术后出现局部皮肤坏死、伤口感染,经换药及抗感染等治疗后愈合。无其他严重并发症出现。术后平均随访时间21(6~36)月:1例患者于治疗术后15月因全身多发转移死亡;其余4例患者均存活,复查均显示局部包块无长大。结论超声引导下经皮微波消融治疗肾癌根治术后局部复发安全有效,为不适宜手术及合并症较多的患者提供了新的治疗选择。

Objective To evaluate the safety and efficacy of ultrasound-guided percutaneous microwave ablation in the treatment of local recurrence after radical nephrectomy for renal cell carcinoma. Methods Ultrasound-guided percutaneous microwave ablation was performed in 5 patients, including 4 males and 1 female, with an average age of 70.4 （66-76） years. The tumors recurred during 18- 156 months after radical surgery, at renal fossa in 4 cases （psoas major was involved in 1 case）, and adrenal region in 1 case. Recurrent tumors were located in the left side in 2 cases and the right side in 3 cases, with an average maximum diameter of 4.6 （2.5-6.8） cm. Of all patients, 4 had solitary tumors and 1 had 2 adjacent local lesions. Treatment outcomes, postoperative complications and follow-up results were analyzed retrospectively. Results All patients tolerated the treatment well. Four patients needed 2 ablation needles and the other 1 patient needed 1 needle. The mean ablation time was 15.8 （6-30） min for each needle. All cases were successfully treated in one session, and the success rate was 100%. The average postoperative hospital stay was 2 （1-4） days. No serious complications occurred except 1 case of local skin necrosis and wound infection, which was cured by dressing changing and anti-infection therapy. During the average follow-up of 21 （6-36） months, 1 patient died of systemic multiple metastases, and the other 4 survived without disease progression. Conclusion Ultrasound-guided percutaneous microwave ablation appears to be a safe and effective approach in the treatment of local recurrence after radical nephrectomy for renal cell carcinoma, which provides a new treatment option for patients with other comorbidities who are inappropriate for surgery.