CT引导下经皮射频消融治疗肾上腺皮质腺瘤库欣综合征  

CT-guided percutaneous radiofrequency ablation for adrenocortical adenoma with Cushing＇s syndrome

作　　者：屈峰[1] 查振雷[2] 周科峰[3] 连惠波[1] 张古田[1] 汪维[1] 兰厚金[1] 甘卫东[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 [2]江苏省江阴市人民医院泌尿外科,214400 [3]南京大学医学院附属鼓楼医院影像医学科,210008

出　　处：《中华内分泌外科杂志》2015年第6期444-448,共5页Chinese Journal of Endocrine Surgery

基　　金：江苏省自然科学基金面上项目（BK20131281）

摘　　要：目的评价CT引导下经皮射频消融（radiofrequency ablation，RFA）治疗肾上腺皮质腺瘤库欣综合征（Cushing＇s syndrome）的可行性、安全性、疗效和不良反应。方法自2009年1月至2013年12月，采用cT引导下射频消融治疗肾上腺皮质腺瘤库欣综合征患者24例，共24个肿瘤。平均肿瘤直径（2．1±0．7）（1．1—3．9）cm。采用CT实时扫描引导下进行射频消融。术后1周复查增强CT扫描，肿瘤病灶无强化定义为消融成功。术后随访血清皮质醇及促肾上腺皮质激素较术前明显改善，且症状改善定义为临床治愈。射频消融术后肿瘤病灶穿刺活检取病理明确诊断。结果24例手术均获成功，无中转开放。术中患者出现血压波动，未发生高血压危象，6例术后出现腰部轻微疼痛。术后1周CT增强扫描显示24个肿瘤完全消融。24例平均随访18（3—36）个月，血清皮质醇及促肾上腺皮质激素基本恢复到正常水平，库欣综合征相关症状也逐渐改善，随访过程中未见肿瘤复发。病理活检结果均为肾上腺皮质腺瘤。所有患者均无严重并发症发生。结论CT引导下RFA治疗具有库欣综合征的肾上腺皮质腺瘤是一种安全可行、有效、并发症少的微创治疗方法。Objective To evaluate the feasibility, safety, therapeutic effects and adverse reactions of CT-guided radiofrequency ablation（RFA）for adrenocortical adenoma with Cushing＇s syndrome. Methods From Jan. 2009 to Dec. 2013, 24 patients with 24 tumors diagnosed as adrenocortical adenoma with Cushing＇s syn- drome received CT-guided percutaneous RFA. The average tumor size was （2. 1-0. 7） cm （ ranging from 1.1 to 3.9 cm）. RFA was performed under real-time computed tomography guidance. Technical success was defined as disappearance of tumor enhancement on contrast CT imaging 1 week after RFA. Clinical success was defined as improvement in serum cortisol, adreno-cortico-tropic-hormone（ACTH） and symptoms within the follow-up. Patho- logical diagnosis was acquired through the needle biopsy after RFA procedure. Results RFA was technically successful in all the 24 patients. No conversion occured. During operation, patients suffered blood pressure fluc- tuation but no one experienced a hypertensive crisis. Mild postoperative lumbar pain occurred in 6 patients. Tumor enhancement disappeared in CT scan. The mean follow-up was 18 months, ranging from 3 to 36 months. Both serum cortisol and ACTH basically returned to normal levels, and the symptoms related to Cushing＇s syn- drome gradually disappeared. No severe complications occurred during this procedure. Histopathology results showed all were adrenal cortical adenomas. No serious complication occurred to any patient during RFA. Conclu- sion CT-guided RFA for adrenocortical adenoma with Cushing＇s syndrome is a feasible, safe, effective and mini- mally invasive treatment with few complications.

关 键 词：肾上腺腺瘤 皮质腺瘤 射频消融 CT引导 库欣综合征 

分 类 号：R736.6[医药卫生—肿瘤]