超声引导下经皮肾脏肿瘤射频消融术的早期经验

Ultrasound-guided percutaneous radiofrequency ablation of renal tumors: early clinical experience

目的:探讨超声引导下经皮射频消融(radiofrequency ablation,RFA)技术治疗肾脏肿瘤的有效性及安全性。方法:31例肾肿瘤患者接受RFA治疗,其中3例为姑息治疗,随访观察疗效及并发症。平均随访时间为24.6个月,随访方式以超声造影为主,增强CT或MRI为辅。结果:以肿瘤灭活为目标的28例肿瘤中,27例(96.4%)得到成功治疗,其中22例经1次RFA、4例经2次RFA、1例经3次RFA后达到完全消融。完全消融的27例肾肿瘤中,2例(7.4%)出现局部复发。肿瘤大小是影响RFA成功的重要因素(P=0.017),肿瘤直径≤3.5 cm可作为预测RFA成功的临界值(P=0.021),但肿瘤大小与是否出现局部复发并无明显关联(P=0.129)。此外,患者年龄、性别及肿瘤位置与肿瘤是否能完全消融或是否出现局部复发无明显相关。11例(35.5%)患者在RFA后出现自限性并发症,无严重并发症发生。结论:超声引导下经皮RFA能有效治疗直径≤3.5 cm的肾肿瘤,并发症发生率低,但长期疗效还需进一步观察。

Objective: To investigate the efficacy, safety of ultrasound-guided percutaneous radiofrequency ablation(RFA) for the treatment of renal tumors. Methods: A total of 31 patients with single renal tumor were treated with RFA, of which 3 cases received the palliative care. The efficacy and complications of RFA were observed. The mean follow-up period was 24.6 months. Contrast-enhanced ultrasound(CEUS) was used to identify residues and recurrences after treatment, assisted by contrast-enhanced CT and MRI. Results: Therapeutic success was achieved in 27 of 28 tumors(96.4%): 22 tumors were completely ablated after one therapy, 4 tumors underwent two therapies, and 1 tumor underwent three therapies. 2 of 27(7.4%) complete-ablated tumors had local recurrence. Tumor size was found to be an important factor affecting therapeutic success(P=0.017). The tumor diameter of ≤3.5 cm could be used as the threshold to predict RFA success(P=0.021), but the tumor size was not related to local recurrence(P=0.129). Moreover, patients’ age, gender and tumor location had no correlation with either RFA success rate or local recurrence rate. 11 out of 27(35.5%) patients developed self-limited complications, and no serious complications were observed. Conclusion: Ultrasound-guided percutaneous RFA is safe and effective in the treatment of renal tumors, especially in those with tumor diameter ≤3.5 cm. Nevertheless, further large comparative studies are needed to validate this approach.