动脉栓塞联合氩氦刀序贯治疗小肾癌的临床疗效分析  

Sequential therapy of transcatheter arterial embolization combined with percutaneous argon-helium cryoablation for small renal cancers: analysis of clinical effect

作　　者：邵天朋 刘丽[2] 袁磊[2] 卢光明[2] 曹建民[2] 许健[2] 

机构地区：[1]徐州医学院研究生院,徐州221000 [2]南京军区南京总医院医学影像科

出　　处：《介入放射学杂志》2015年第7期597-601,共5页Journal of Interventional Radiology

摘　　要：目的探讨动脉栓塞（TAE）联合CT引导经皮氩氦刀序贯治疗小肾癌的安全性和疗效。方法收集2008年2月—2013年7月南京军区南京总医院医学影像科介入病房44例TAE联合CT引导经皮氩氦刀序贯治疗的小肾癌患者,术后1个月复查肾功能,术后1~3个月复查增强CT或增强MRI,采用m RECIST标准评价其疗效,并对患者进行12~46个月随访,平均随访时间28个月。结果 44例患者共48个病灶行TAE和氩氦刀序贯治疗,其中病灶完全缓解（CR）38个,部分缓解（PR）6个,病灶稳定（SD）4个,缓解率（CR＋PR）为91.7%。所有患者均未发生严重并发症,仅1例患者冷冻过程中出现局限性出血,给予对症处理后好转。患者术后平均住院时间4 d,随访期间3例失访,1例因食管癌相关并发症死亡。40例患者随访期均存活,存活患者中5例于13~22个月后复发,后予以再次联合治疗。结论采用TAE联合CT引导经皮氩氦刀序贯治疗小肾癌微创、安全、有效,尤其是氩氦刀冷冻前进行栓塞可能降低冷冻过程中出血发生率,值得临床推广应用。Objective To evaluate the safety and efficacy of transcatheter arterial embolization（TAE） combined with argon- helium cryoablation in treating small renal cancers. Methods During the period from February 2008 to July 2013, a total of 44 patients with small renal cancer were treated with TAE and argon- helium cryoablation at The Medical Imaging Department of Nanjing General Hospital of Nanjing Military Area Command. The renal function was reexamined one month after the treatment. Contrast- enhanced CT or MRI was performed in all patients within 1-3 months after the treatment. By using m RECIST, the therapeutic efficacy was evaluated. All patients were followed up for 12-46 months（mean 28 months）. Results A total of 48 lesions in the 44 patients were treated with sequential therapy of TAE and argon- helium cryoablation. Of the 48 lesions, complete remission（CR） was achieved in 38, partial remission（PR） in 6 and stable disease（SD） in 4, the remission rate（CR＋PR） was 91.7%. No severe complications occurred in all patients, except one who developed localized hemorrhage during the performance of argon- helium cryoablation, which was improved after symptomatic medication. The mean postoperative hospitalization time was 4 days. Three patients were lost to follow- up, one patient died of esophageal cancer- related complication.The remaining patients were survival during the follow- up period, among them recurrence occurred in five within 13-22 months after the treatment, and the sequential therapy of TAE and argon- helium cryoablation had to be carried out once more. Conclusion For the treatment of small renal cancers, the sequential therapy of TAE combined with argon- helium cryoablation is minimally- invasive, safe and effective, and TAE that is performed before argon- helium cryoablation can reduce the incidence of bleeding occurring in the freezing process. Therefore, this technique should be recommended in clinical practice.

关 键 词：小肾癌 冷冻消融 动脉栓塞 并发症 

分 类 号：R737.11[医药卫生—肿瘤]