CT导向下冷冻消融术治疗儿童骨样骨瘤  

CT-guided percutaneous cryoablation of osteoid osteoma

作　　者：张肖[1] 肖越勇[1] 杨杰[1] 吴斌[1] 马旭阳[1] 刘士榕[1] 任超[1] 

机构地区：[1]解放军总医院放射诊断科,北京100853

出　　处：《中华放射学杂志》2011年第11期1045-1048,共4页Chinese Journal of Radiology

摘　　要：目的评估CT导向下冷冻消融术治疗儿童骨样骨瘤的安全性及有效性。方法2007年1月至2010年1月期间，对9例病理证实的骨样骨瘤儿童患者行CT导向下冷冻消融治疗。患者男6例、女3例，年龄10．0～15．0岁，平均（13．0±1．6）岁，手术在局部麻醉下进行，术前均行CT导向下经皮穿刺活检获得病理诊断。手术使用大孔径多层螺旋CT（层厚2mm，120kV，250mAs）。于CT导向下应用8G骨穿针穿刺病灶中央，拔出针芯、经外套针置入17G冷冻探针，冷冻模式采用2次冷-热循环，术中间隔5min扫描冷冻区域，了解冰球大小和形状。术后以VAS疼痛评分评估疗效。手术前后VAS评分比较采用Kruskal-Wallis秩和检验。结果9例患者手术均成功；术后疼痛均明显缓解，VAS评分术前评分（8分1例，7分3例，6分4例，5分1例）与术后1个月（1分4例，0分5例）比较，差异有统计学意义（H=32．838，P〈0．01）。本组患者术前因长期疼痛刺激导致不同程度跛行，术后3d疼痛均明显减轻，无肢体功能障碍。1例患者术后1d发热（37．8℃），对症处理2d后缓解，无其他并发症发生。随访期内所有患者疼痛无复发。结论CT导向下冷冻消融术治疗骨样骨瘤是一种安全、有效的微创手段，值得推广应用。Objective To evaluate the safety and efficacy of the CT-guided percutaneous cryoablation of osteoid osteoma in children. Methods Nine children with osteoid osteoma proved by histopathology were treated with CT-guided cryoablation from January 2007 to January 2010. There were 6 boys and 3 girls. Their mean age was （13.0 ± 1.6） years （ranging from 10.0-15.0 years）. The procedures were performed under local anesthesia. Eight G bone biopsy needles for biopsy and 17 G freezing needles were used in the procedure. CT guidance was used for procedural planning, instrument guidance, and monitoring. Each cryoablation included two freezing-thawing cycles. Follow-up was performed to assess technical and clinical outcome. A visual analog scale （VAS） was used to assess severity of pain pre- and post-procedure, and mean VAS for the group was compared pre- and post-procedure with Kruskal-Wallis rank sum test. Results Biopsy and cryoablation were successfully performed in all children. No major immediate or postponed complications were observed. Significant pain relief （ P 〈 0. 01 ） was observed in all patients after procedure. The VAS of preoperation（8 points 1 case, 7 points 3 cases, 6 points 4 cases, 5 points 1 case） compared with that of one month after operation（ 1 point 4 cases, 0 point 5 cases）, the difference was statistically significant （ H = 32. 838, P 〈 0. 01 ）. These patients were allowed to fully weight-bear and function without limitation 3 days after the procedure. Pain was obviously released. Pain recurrence was not observed in all patients. Moderate fever （37.8 ℃ ） was observed in a patient one day after operation and fully recovered 2 days later. Conclusion CT-guided percutaneous cryoablation is a safe and effective minimally invasive method for the treatment of osteoid osteoma in children.

关 键 词：成骨细胞瘤 冷冻外科手术 儿童 

分 类 号：R738[医药卫生—肿瘤]