CT导引下聚桂醇硬化治疗肾囊肿

CT-guided lauromacrogol sclerotherapy for the treatment of renal cysts

目的 评价CT导引下聚桂醇硬化治疗肾囊肿的临床效果。方法 回顾性分析2019年1月至2021年12月在上海市第六人民医院东院接受CT导引下肾囊肿穿刺硬化治疗的50例(52枚)肾囊肿患者临床资料。术前完善出凝血功能、肝肾功能及增强CT检查,排除禁忌病例,确定治疗体位和聚桂醇用量。术中使用Bard 18 G活检针穿刺抽液,囊液吸净后用0.9%氯化钠溶液40~100 mL冲洗1~2次,注入聚桂醇泡沫硬化剂(氧气和聚桂醇按1∶1配比)。参照WHO实体瘤疗效评价标准评价硬化治疗效果。结果 所有患者肾囊肿穿刺一次成功。囊肿大小范围为4.3~12 cm,抽出囊液40~900 mL,颜色淡黄或清亮。囊肿内注入聚桂醇泡沫剂15~60 mL。抽吸硬化治疗全程顺利,患者均无并发症发生。术后所有患者临床症状明显好转或消失。术后3、6个月随访显示,总显效率、有效率分别为71.15%、98.07%。结论 CT导引下聚桂醇硬化治疗肾囊肿创伤小、操作简单、费用低、住院时间短、效果显著,可替代外科手术治疗。尤其是对肾上极囊肿硬化治疗,CT导引优于超声导引。

Objective To evaluate the clinical efficacy of CT-guided lauromacrogol sclerotherapy in treating renal cysts.Methods The clinical date of 50 patients with renal cyst(52 cysts in total),who received CT-guided lauromacrogol sclerotherapy through renal cyst puncture at the East Branch of Shanghai Sixth People's Hospital of China between January 2019 and December 2021,were retrospectively analyzed.The preoperative coagulation function,liver and kidney function,and contrast-enhanced CT examinations were performed to exclude the patients with contraindications and to determine the body position for treatment and the dose of lauromacrogol.During the operation,a Badr 18G biopsy needle was used to make puncture and aspiration of cystic fluid,and after the cystic fluid was cleaned the normal saline of 40-100 mL was used to flush the cystic cavity for 1-2 times,which was followed by the injection of lauromacrogol foam hardening agent,with the ratio of oxygen and lauromacrogol being 1∶1.The curative effect of sclerotherapy was evaluated according to the modified Response Evaluation Criteria in Solid Tumors(mRECIST) of WHO.Results Successful puncture of renal cyst with single puncturing manipulation was accomplished in all the patients.The size of the cysts ranged from 4.3 cm to 12 cm.The amount of cyst fluid withdrawn was 40-900 mL,which was light-yellow in colour or colourless bright,then,lauromacrogol foam hardening agent of 15-60 mL was injected into the cyst cavity.No complications occurred in all patients.After sclerotherapy,the clinical symptoms were significantly improved or even disappeared in all patients.The patients were followed up for 3-6 months,the overall apparent effect and response effect were 71.15% and 98.07% respectively.Conclusion For the treatment of renal cysts,CT-guided lauromacrogol sclerotherapy carries certain advantages,such as minimally-invasive,simple manipulation,lower medical cost,short hospitalization stay,and satisfactory curative effect,therefore,it can replace the surgical therapy.Moreover,in treating renal cysts located at the upper pole of kidney by using sclerotherapy,the use of CT guidance technique is superior to the use of ultrasound guidance technique.