CT引导下经皮穿刺射频消融补救性治疗晚期肾癌

doi:10.3877/cma.j.issn.2095-5782.2014.03.013

中华介入放射学电子杂志 ›› 2014, Vol. 02 ›› Issue (03) : 45 -48. doi: 10.3877/cma.j.issn.2095-5782.2014.03.013

所属专题：文献；

非血管介入

CT引导下经皮穿刺射频消融补救性治疗晚期肾癌

顾克峰¹, 潘峰¹, 韩庆涛¹, 高淑萍¹, 李燕¹, 王科学¹, 于海鹏²^,^†(

)

^1. 250200　章丘市人民医院介入科
^2. 300060　天津医科大学肿瘤医院介入治疗科，国家临床医学研究中心，天津市肿瘤防治重点实验室

收稿日期:2013-07-08 出版日期:2014-08-01
通信作者: 于海鹏

CT-guided percutaneous radiofrequency in remedial treatment of advanced renal cell carcinoma

Kefeng Gu¹, Feng Pan¹, Qingtao Han¹, Shuping Gao¹, Yan Li¹, Kexue Wang¹, Haipeng Yu²^,^†()

^1. Department of Interventional Radiology, the People’s Hospital of Zhangqiu, Zhnagqiu 250200, China

Received:2013-07-08 Published:2014-08-01
Corresponding author: Haipeng Yu
About author:
Corresponding author: Yu Haipeng, Email: jieruke@163.com

全文 ( ) 下载PDF ( ) 导出引用

目的

探讨射频消融治疗肾细胞癌（RCC）的有效性及安全性。

方法

收集56例不适宜外科切除治疗的RCC患者。肿瘤直径为2.6～8.6 cm，平均（5.6±1.2）cm。CT引导下行经皮穿刺射频消融术。随访评估临床效果、肾功能和并发症状况。

结果

本组56例患者中，病灶直径<4 cm的35患者射频治疗后1、3、6个月复查时均未见病灶强化，病灶直径>4 cm的21例，在术后3个月复查时13例出现治疗边缘强化，活检证实为复发病灶，再次行射频消融治疗。截止随访时间内，50例存活，6例死于非肿瘤原因。射频治疗前后肾功能变化差异无统计学意义。并发症轻微，无肾脏出血、感染、肾盂损伤等严重并发症。

结论

经皮穿刺射频消融治疗可使无外科手术机会的RCC患者生存获益，并能很好的保护患者肾功能，同时并发症轻微，可作为一种重要的治疗手段。

关键词: 肾肿瘤, 导管消融, 疗效

Objective

To evaluate clinical efficacy and safety of percutaneous radiofrequency ablation (RFA) in treatment of renal cell carcinoma (RCC).

Methods

A total of 56 patients with RCC who were not suitable for surgical resection were analyzed. The longest diameter of the lesions ranged from 2.6 to 8.6 cm with a mean of (5.6±1.2)cm. The oncological outcomes, renal function and complications were observed.

Results

The CT images showed no enhancement of the lesion when evaluated 1, 3, 6 months after RFA for tumors diameter less than 4 cm in 35 cases. For 21 cases with tumors more than 4 cm, 13 cases required a second session of RFA because of recurrence. During follow-up period, 50 patients survived, 6 patients died of non tumor causes. There was no difference between before and after treatment in renal function. Most common complications associated with treatment were minor. No hemorrhage at the probe insertion site, infection and pelvis injury occurred.

Conclusions

Midterm follow-up shows that percutaneous renal RFA is an effective and safe alternative technique for patients with RCC whose condition does not allow surgery and that renal function is preserved and complications is mild.

Key words: Kidney neoplasms, Catheter ablation, Curative effect

表1 56例患者RFA治疗前后肾功能变化

时间	尿素			肌酐
时间	（±SD,mmol/L）	t值	P值	（±SD,mmol/L）	t值	P值
术前	5.53±1.16	?	?	65.50±9.62	?	?
术后1周	5.45±0.98	0.358	0.726	66.19±9.40	1.439	0.174
术后1个月	5.62±0.83	0.710	0.490	66.49±8.78	0.905	0.382
术后3个月	5.49±0.93	0.427	0.676	66.26±8.20	1.996	0.069

表1 56例患者RFA治疗前后肾功能变化

时间	尿素			肌酐
时间	（±SD,mmol/L）	t值	P值	（±SD,mmol/L）	t值	P值
术前	5.53±1.16	?	?	65.50±9.62	?	?
术后1周	5.45±0.98	0.358	0.726	66.19±9.40	1.439	0.174
术后1个月	5.62±0.83	0.710	0.490	66.49±8.78	0.905	0.382
术后3个月	5.49±0.93	0.427	0.676	66.26±8.20	1.996	0.069

1	Gallego VD,Jose PMI,Miralles AJ, et al. Radiofrequency ablation as an alternative treatment for organ confined renal tumor[J]. Actas Urol Esp, 2010,34(10):860-865.
2	Allen BC,Remer EM. Percutaneous cryoablation of renal tumors: patient selection, technique, and postprocedural imaging[J]. Radiographics, 2010,30(4):887-900.
3	Atwell TD,Carter RE,Schmit GD, et al. Complications following 573 percutaneous renal radiofrequency and cryoablation procedures[J]. J Vasc Interv Radiol, 2012,23(1):48-54.
4	Agochukwu N,Shuch B. Clinical management of renal cell carcinoma with venous tumor thrombus[J]. World J Urol, 2014,32(3):581-589.
5	Breda A,Anterasian C,Belldegrun A. Management and outcomes of tumor recurrence after focal ablation renal therapy[J]. J Endourol, 2010,24(5):749-752.
6	Castle S M,Salas N,Leveillee R J. Initial experience using microwave ablation therapy for renal tumor treatment: 18-month follow-up[J]. Urology, 2011,77(4):792-797.
7	Gameiro SR,Higgins JP,Dreher MR, et al. Combination therapy with local radiofrequency ablation and systemic vaccine enhances antitumor immunity and mediates local and distal tumor regression[J]. PLoS One, 2013,8(7):e70417.
8	Mizukoshi E,Yamashita T,Arai K, et al. Enhancement of tumor-associated antigen-specific T cell responses by radiofrequency ablation of hepatocellular carcinoma[J]. Hepatology, 2013,57(4):1448-1457.
9	Passera K,Selvaggi S,Scaramuzza D, et al. Radiofrequency ablation of liver tumors: quantitative assessment of tumor coverage through CT image processing[J]. BMC Med Imaging, 2013,13:3.
10	Salas N,Ramanathan R,Dummett S, et al. Results of radiofrequency kidney tumor ablation: renal function preservation and oncologic efficacy[J]. World J Urol, 2010,28(5):583-591.
11	Georgiades CS,Rodriguez R,Littrup PJ, et al. Development of a research agenda for percutaneous renal tumor ablation: proceedings from a multidisciplinary research consensus panel[J]. J Vasc Interv Radiol, 2010,21(12):1807-1816.
12	Arnoux V,Descotes JL,Sengel C, et al. Perioperative outcomes and mid-term results of radiofrequency ablation and partial nephrectomy in indications of renal tumor treatment and imperative nephron-sparing procedure[J]. Prog Urol, 2013,23(2):99-104.
13	Kurup AN. Percutaneous ablation for small renal masses-complications[J]. Semin Intervent Radiol, 2014,31(1):42-49.

[1]	张妍, 原韶玲, 史泽洪, 郭馨阳, 牛菁华. 小肾肿瘤超声漏诊原因分析新思路[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(05): 500-504.
[2]	王杰, 袁泉, 王玥琦, 乔佳君, 谭春丽, 夏仲元, 刘守尧. 溃疡油在糖尿病足溃疡治疗中的应用效果及安全性观察[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 480-484.
[3]	聂生军, 王钰, 王毅, 鲜小庆, 马生成. 复方倍他米松局部注射联合光动力疗法治疗小型瘢痕疙瘩的临床疗效观察[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(05): 404-410.
[4]	莫淇舟, 苏劲, 黄健, 李健维, 李思宁, 柳建军. 智能控压输尿管软镜碎石吸引取石术在直径10～25 mm上尿路结石中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 497-502.
[5]	谢汶歆, 马乐, 刘晔, 曹晓明, 张万春. 前列腺特异性膜抗原PET/CT在肾癌诊疗中的应用价值[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 514-519.
[6]	李义亮, 苏拉依曼·牙库甫, 麦麦提艾力·麦麦提明, 克力木·阿不都热依木. 机器人与腹腔镜食管裂孔疝修补术联合Nissen 胃底折叠术短期疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 512-517.
[7]	周艳, 李盈, 周小兵, 程发辉, 何恒正. 不同类型补片联合Nissen 胃底折叠术修补食管裂孔疝的疗效及复发潜在危险因素[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 528-533.
[8]	王小琴, 汪丽, 崔建英. 无张力疝修补术治疗慢性肾功能衰竭合并腹股沟疝患者的疗效[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 538-542.
[9]	王亚岚, 倪婧, 余世庆, 陶银花, 张荣. 尼达尼布抗纤维化治疗特发性肺纤维化的耐受性和疗效预测因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 750-755.
[10]	詹济玮, 蔡柳春, 温琼娜, 郭石生, 温春妹, 温鹤明. 布地格福联合噻托溴铵治疗AECOPD 的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 823-826.
[11]	陈杰, 武明胜, 李一金, 李虎, 向源楚, 荣新奇, 彭健. 低位直肠癌冷冻治疗临床初步分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 494-498.
[12]	史彬, 司远. 益气和络方联合缬沙坦治疗气阴两虚兼血瘀证IgA 肾病的疗效观察[J/OL]. 中华肾病研究电子杂志, 2024, 13(06): 306-312.
[13]	韩俊岭, 王刚, 马厉英, 连颖, 徐慧. 维生素D 联合匹维溴铵治疗腹泻型肠易激综合征患者疗效及对肠道屏障功能指标的影响研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 560-564.
[14]	阳跃, 庹晓晔, 崔子豪, 欧阳四民, 林海阳, 胡景宇, 胡银, 李涛, 赵景峰, 郝岱峰, 冯光. 改良“阅读者”皮瓣修复骶尾部压疮的疗效[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 751-755.
[15]	克地尔牙·马合木提, 胡波, 杨琼, 闫素, 胡岚卿, 高沛沛, 姚恩生. 依达拉奉右莰醇对急性脑梗死后认知功能障碍的疗效观察[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 459-466.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

CT-guided percutaneous radiofrequency in remedial treatment of advanced renal cell carcinoma

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

CT-guided percutaneous radiofrequency in remedial treatment of advanced renal cell carcinoma