CT引导下直肠癌根治术后局部复发冷冻消融治疗的研究

CT guided cryoablation in local recurrence after radical resection of the rectal carcinoma

背景与目的:结直肠癌的局部复发是接受根治性手术切除的患者治疗失败的主要原因之一。该研究旨在探索直肠癌根治术后局部复发冷冻消融治疗的可行性、安全性及有效性。方法:2013年10月—2015年1月共入组22例直肠癌根治术后局部复发患者,行27次冷冻消融术,术后随访12~32个月。治疗后影像学随访采用盆腔增强CT或MRI。统计技术成功率、并发症发生及处理情况、1年内靶病灶局部控制率,比较术前、术后患者疼痛评分。结果:该组研究技术成功率为100%,主要并发症发生率为18.5%,包括小便困难、患侧肌力下降、脓肿形成、重度组织冻伤。术后1年内靶病灶局部控制率为72.7%,局部病灶进展时间为(11.1±4.3)个月。患者术前与术后第3天进行数字疼痛评分(numerical rating scale,NRS),术前与术后6个月NRS差异有统计学意义(P<0.05);术前与术后12个月NRS差异无统计学意义(P=0.854)。结论:CT引导下冷冻消融作为一种治疗直肠癌根治术后局部复发的新方法,安全可行,靶病灶局控率高,短期内疼痛缓解明显。

Background and purpose： The local recurrence is one of the main causes of treatment failure for rectal carcinomas after radical resection. This study aimed to investigate the feasibility, safety, and efficacy of CT guided cryoablation in local recurrence after radical resection of rectal carcinomas. Methods： From Oct. 2013 to Jan. 2015, a total of 22 patients were enrolled in this study, and a follow-up of 12-32 months were performed. The image follow-up was by contrast-enhanced CT or MRI of pelvic. The technical success rate, complications and managements, and 1-year local control rate were recorded. The degree of pain between preablation and postablation was compared by scores of numerical rating scale （NRS）. Results： The technical success rate was 100%. The main complication rate was 18.5%, including dysuresia, muscle strength decreased of affected side, abscess formation, severe frostbite. The 1-year local control rate was 72.7%, and the time to progression of local lesion were （11.1±4.3） months. Scores of NRS had significant difference between preablation and 3-day postablation, and preablation and 6-month postablation （P〈0.05）. There was no significant difference between preablation and 12-month postablation （P=0.854）. Conclusion： CT-guided cryoablation as a new method for local recurrence after radical resection of rectal carcinomas was safe and feasible, which had high rate of local control, and relieved pain obviously for a period of time.