影像引导经皮不可逆电穿孔消融治疗肾细胞癌4例

Image-guided percutaneous irreversible electroporation ablation for the treatment of renal cell carcinoma: report of 4 patients

目的探讨经皮穿刺不可逆电穿孔(IRE)消融术治疗肾细胞癌的初步临床效果及安全性。方法临床经穿刺病理证实的4例无手术适应证的肾细胞癌患者的5个病灶,经术前评估后,在全身麻醉下行IRE消融治疗。术后采用2000年新修订的实体瘤疗效评价标准评价治疗的有效性,并观察并发症。结果 4例患者均顺利完成治疗。病灶大小0.9~40.8 cm^3,平均(16.84±16.45)cm^3,消融时间42~88 min,平均(76.40±19.40)min,消融6~8次,平均(7.0±0.7)次,总脉冲数750~2 240次,平均(1 706.0±587.8)次。术中、术后均无明显并发症。术后即刻及1、3个月行增强CT和/或增强MR复查,病灶消融区均呈低密度/低信号改变,增强扫描未见异常强化区,肿瘤周围组织形态、密度(信号)未见异常。术后3个月复查评价疗效,5个病灶均完全缓解。结论 CT引导下经皮IRE消融术治疗肾癌安全、有效,近期疗效显著,是临床上无手术适应证肾癌患者可选择的治疗方法。

Objective To preliminarily investigate the clinical effect and safety of irreversible electroporation（IRE） ablation in treating renal cell carcinoma（clear-cell carcinoma）. Methods After preoperative evaluation of the clinical condition, 4 patients with inoperable and pathologically-proved renal cell carcinoma（5 lesions in total） underwent IRE ablation therapy under general anesthesia. The therapeutic efficacy was evaluated according to modified response evaluation criteria in solid tumors（m RECIST） of WHO（newly revised in 2000）. Results Successful IRE ablation was accomplished in all 4 patients. The tumor volume was（0.9-40.8） cm^3, with a mean of（16.84±16.45） cm^3. The ablation time was（42-88） minutes,with a mean of（76.40±19.40） minutes. The number of ablation treatments was 6-8 times, with a mean of（7.00±0.71） times. The total number of pulses used in IRE ablation was（750-2240） times, with a mean of（1706.00 ±587.78） times. No severe complications occurred during and after IRE procedure. Enhanced CT and/or MR scans performed immediately after as well as one and 3 months after IRE ablation revealed that the ablated areas showed low density and low signal changes, no abnormal enhancement area was observed on enhancement scan images, and the peritumoral tissue morphology, density（signal） were normal. The curative effect was evaluated at 3 months after operation, and all 5 lesions were completely relieved.Conclusion For the treatment of renal cell carcinoma, CT-guided percutaneous IRE ablation is safe and effective. This therapy has satisfactory short-term curative effect. Therefore, it is an alternative therapy for inoperable renal cell carcinoma.