超声引导下经皮射频消融治疗肾透明细胞癌  

Ultrasound-guided percutaneous radiofrequency ablation treatment for renal clear cell carcinoma

作　　者：成向明[1] 甘卫东[1] 徐林锋[1] 姚林方[1] 屈峰[1] 张古田[1] 李笑弓[1] 郭宏骞[1] 

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,210008

出　　处：《中华外科杂志》2014年第11期856-860,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（21377052）;江苏省自然科学基金资助项目（BK20131281）

摘　　要：目的 探讨超声引导下经皮射频消融（USG-RFA）治疗肾脏透明细胞癌的疗效.方法 2009年5月至2014年1月南京大学医学院附属鼓楼医院泌尿外科对共34例肾透明细胞癌患者行USG-RFA治疗.男性28例,女性6例;年龄25 ～ 85岁,平均60.7岁.左肾肿瘤患者16例,右肾肿瘤患者16例,孤立肾患者1例,双侧肾肿瘤患者1位,共35个肾肿瘤.肿瘤最大径1.8 ～ 5.0 cm,平均（2.7±0.3）cm,其中≤4.0 cm肾肿瘤32例,＞4.0～5.0cm肾肿瘤3例.病理诊断由USG-RFA治疗后在B超引导下经皮穿刺肿瘤获得.术中运用肾脏超声造影即时评估疗效,术后运用多层螺旋CT增强扫描和肾脏超声造影进行随访.结果 患者手术均顺利完成,术后住院时间3～5 d,无肾周积液、肾周血肿、周围器官损伤等并发症.术后病理明确为透明细胞癌.术后随访时间3 ～ 59个月,平均（29±6）个月.32个最大径≤4.0 cm肿瘤单次手术达到完全毁损标准,随访中1例于术后1个月发现肿瘤残留;2例分别于术后4和10个月复查时发现肿瘤复发;以上3例患者均再次行USG-RFA治疗,并再次获得经皮穿刺病理证实,治疗后未见复发.3例肿瘤最大径为＞4.0～5.0 cm的患者,其中2例经过2次、1例经过3次USG-RFA达到肿瘤完全毁损标准,随访中无肿瘤残留或复发.结论 USG-RFA治疗小肾脏肿瘤具有较好疗效,且创伤小、并发症少、术后恢复快.Objective To investigate clinical outcomes of ultrasound-guided percutaneous radiofrequency ablation （USG-RFA）in patients with renal clear cell carcinoma.Methods Medical records of 34 patients who underwent USG-RFA of renal clear cell carcinoma at the Department of Urology of the Affiliated Drum Tower Hospital of Medical School of Nanjing University from May 2009 to January 2014 were retrospectively reviewed,including 28 male and 6 female patients aged between 25 and 85 years （mean age 60.7 years）.Of the included cases,16 had tumors located in the left kidney,16 in the right,1 in the solitary kidney,and 1 in the bilateral kidney.There were 35 tumors in this study totally.The maximum diameter of the tumors was 1.8 to 5.0 cm （mean （2.7 ± 0.3） cm）,of which 32 cases of renal tumors were ≤4.0 cm and 3 cases of renal tumors were 〉 4.0 cm to 5.0 cm.Pathological diagnosis were acquired by ultrasound-guided percutaneous biopsy after USG-RFA.Contrast-enhanced ultrasound was used to evaluate tumor outcomes at the time of the surgery,and muhi-slice spiral CT enhanced scan and contrast-enhanced ultrasound were used to identify residues and recurrences after treatment.Results Treatments for all the patients were finished with short postoperative hospital stay about 3-5 days.No complications related to USG-RFA were encountered in any of the cases,such as perirenal fluid collection,perirenal hematoma,and peripheral organ damage.All the cases were diagnosed as clear cell carcinoma according to pathological results.The mean follow-up period was 29 ± 6 （range 3-59）months.Of the 35 USG-RFA-treated subjects,32 tumors ≤4 cm reached the standard of complete treatment after one tumor was found with residue after the first month follow-up,and two tumors were noted recurrence at the 4 and 10 months follow-up after USG-RFA.Nonetheless,no residue or recurrence occurred after secondary treatment for these 3 tumors where pathological diagnosis were acquired again.The other 3 cases with tumors 〉 4.0 cm to 5.0 cm u

关 键 词：肾透明细胞癌 超声 射频消融 

分 类 号：R737.11[医药卫生—肿瘤]