冷冻消融治疗复发性盆腔和后腹肿瘤的应用

Application of cryoablation in treating recurrent pelvic and retroperitoneal tumors

目的探索CT定位经皮冷冻消融盆腔和后腹膜术后复发性肿瘤的安全性及疗效。方法CT定位、引导经皮冷冻消融盆腔、后腹膜恶性肿瘤患者108例并作总结。结果 (1)100例中9例为完全性冷冻消融,91例为姑息性冷冻消融。随访3~11年,1年生存率87%(87/100),3年生存率17%(17/100),5年生存率9%(9/100)。冷冻后疼痛缓解率84%(70/83)。(2)冷冻后1个月增强CT显示9例完全性消融:肿瘤冷冻区无强化。91例姑息性消融:消融率>90%48例、80%~90%25例、70%~80%12例、60%~70%4例、<60%3例。(3)并发症:术后局部感染3例,抗感染治疗后痊愈;直肠上段肠瘘1例,经肠造瘘后逐渐痊愈;术后短暂排尿困难5例,留置导尿3~5 d恢复;术后发热3~5 d;表皮冻伤3例,对症处理痊愈。结论盆腔和后腹膜肿瘤术后局限性复发,CT引导冷冻消融较为安全,完全冷冻消融后对提升肿瘤局部控制,延长生存期获益明显。

Objective To investigate the safety and curative effect of CT-guided percutaneous cryoablation in treating recurrent tumors in pelvic cavity and retroperitoneal space. Methods A total of 100 patients with recurrent tumors in pelvic cavity or retroperitoneal space were included in this study. CT-guided percutaneous cryoablation treatment was carried out in all patients. Results （1） Of the 100 patients, complete cryoablation treatment was performed in 9 and palliative cryoablation treatment was adopted in 91. The following-up time ranged from 3 years to 11 years. The one-, 3- and 5-year survival rates were 87.0% （87/ 100）, 17% （17/100） and 9% （9/100） respectively. The pain relief rate after cryoablation treatment was 84.0% （70/83）. （2） Contrast-enhanced CT scan performed one month after cryoablation treatment showed that complete cryoablation was seen in 9 patients, presenting as no enhancement in the tumor frozen area on CT image; palliative cryoablation was seen in 91 patients, the ablation extent 〉190% was obtained in 48 patients, the ablation extent of 80-90% in 25 patients, the ablation extent of 70-80% in 12 patients, the ablation extent of 60-70% in 4 patients, and the ablation extent 〈60% in 3 patients. （3） Postoperative complications included local infection （n=3）, which was cured after anti-infective therapy; intestinal fistula at upper rectum （n=1）, which was gradually healed after enterostomy; transient dysuresia （n=5）, which was recovered through retention catheterization for 3-5 days; fever lasting 3-5 days; and skin frostbite （n=3）, which was cured after symptomatic treatment. Conclusion For the treatment of recurrent tumors in pelvic cavity and retroperitoneal space, CT-guided percutaneous cryoablation is quite safe. Complete cryoablation is very helpful for improving local tumor control and prolonging survival time.