超声引导冷循环射频消融治疗肾癌的研究

目的探讨超声引导(UG)冷循环射频消融(RFA)治疗肾癌的价值。方法对46例不能行手术切除的先天或后天性孤立肾及肾功能不全患者的46个肾肿瘤,在UG行肿瘤RFA治疗,其中左肾肿瘤22例,右肾肿瘤24例,肿瘤直径1.5~5.2cm,平均3.6cm。在UG将射频针穿刺至肿瘤底部行RFA治疗,根据肿瘤大小行多针多点、交叉重叠法RFA治疗。对CDFI显示肿瘤有供血动脉及血供丰富者的肿瘤,先选择高温模式封闭肿瘤供血动脉及肿瘤内血供丰富区,再行RFA,直至消融气化范围覆盖全部肿瘤为止,每点治疗时间为6~12min,治疗结束后选择高温模式封闭针道,防止出血或肿瘤沿针道种植。治疗后1、3、6、12个月行对比增强CT (CECT)复查,评估疗效,如发现肿瘤残留再行追加治疗。结果 46例肾肿瘤患者的46个肿瘤均顺利行RFA治疗,治疗后1~3个月CECT复查,肿瘤完全灭活为80.4%(37/46),肿瘤残留19.6%(9/46),对肿瘤残留者均行再次RFA治疗,治疗后9~24个月肿瘤局部进展7例17.4%(7/46),对肿瘤局部进展患者均行再次RFA治疗。结论超声引导RFA治疗肾癌,能实时监视进针方向,穿刺成功率达到100%,选择多针多点立体定位法RFA治疗,经CECT复查肿瘤完全灭活成功率80.4%,且操作方便,并发症少,为不适合手术切除的肾肿瘤患者提供了一种新的安全有效的治疗方法。

The Study of the Treatment of Renal Carcinoma with Cool-tip Radiofrequency Ablation Percutaneously Under Ultrasound-guided

Objective To explore the value of the treatment of renal carcinoma with cool-tip radiofrequency ablation percutaneously under ultrasound-guided.Methods 46 unresectable renal carcinomas from 46 patients with solitary kidney and renal insufficiency were treated by radiofrequency ablation percutaneously under ultrasonic guidance.There was 22 cases left renal tumors and 24 cases right renal tumors,the diameter of tumors was 1.5-5.2 cm,the mean diameter was 3.6 cm.Pierced the needle to the deep tumors under ultrasonic guidance,given to the process of multiple punctures and multiple ablations treatment according to the tumor size,until the tumors were covered completely.If the CDFI showed the tumor was abundant with blood supply before the treatment,used the high-temperature models to burned the blood vessel and the zone which was rich blood supply firstly,then processing the RFA.The ablation extent should be 0.5 cm beyond the edge of the normal tumor tissue and the duration of treatment were 6 to 12 minutes.Closing the needle road use the high-temperature model,in order to prevent bleeding and needle-path tumor implantation.To evaluate the effects by follow-up on CECT after the treatment respectively is 1 month and 3 and 6 and much over 12 months.If did not completely inactivated based on the imaging,the same therapy can be repeated.Results RFA was successfully performed on 46 tumors in 46 patients with renal tumors.After the treatment1-3 months,CECT reexamination showed that the total tumor inactivation was 80.4%(37/46),and tumor residue was 19.6%(9/46).All patients with tumor residue were treated with RFA again,after the treatment 9-24 months,7 patients 17.4%(7/46)with local tumor progression were treated with RFA again.Conclusions Ultrasound-guided RFA treatment for renal cancer can real-time monitor the needle direction,and the puncture success rate was 100%.CECT reexamination showed that the total tumor inactivation is 80.4% in patients with selecting multi-needle and multi-point stereotactic RFA therapy,and the operation method is easy and has less complications.It provides a new safe and effective treatment for renal tunor patients who were not suitable for surgical resection.