冷冻消融术治疗低位直肠间质瘤的疗效及安全性  

The curative effect and safety of liquid nitrogen cryoablation in the treatment of low rectal stromal tumors

作　　者：蒋学军[1] 吉祖进 雷新益 袁方均[1] JIANG Xuejun;JI Zujin;LEI Xinyi;YUAN Fangjun(Affiliated Sinopharm Dongfeng General Hospital,Hubei University of Medicine,Shiyan,Hubei Province 442008,China)

机构地区：[1]湖北医药学院附属国药东风总医院,湖北十堰442008

出　　处：《介入放射学杂志》2023年第7期680-683,共4页Journal of Interventional Radiology

摘　　要：目的 评价经肛门冷冻消融术在低位直肠间质瘤的疗效及安全性。方法 回顾性分析2012年1月至2021年12月冷冻治疗低位直肠间质瘤36例患者的临床资料。评估3个月后的治疗效果及肛门功能。随访截止日期为2021年12月或者肿瘤出现进展。结果 36例患者冷冻消融术后3个月的局部完全缓解率为94.4%。肿瘤大小与肿瘤的冷冻缓解率有相关关系,肿瘤越大,其局部缓解率越低。36例患者中便血2例,下腹部/肛门直肠不适13例,排便次数增多17例,术后3个月缓解分别为2例、12例、14例。术后并发症采取Clavien-Dindo分级系统,其中Ⅰ级并发症:33例(91.7%)在肿瘤脱落过程中有少量便血;Ⅱ级并发症:5例(13.9%)术后出现痔水肿,1例(2.8%)出现肛周感染,1例(2.8%)出现直肠狭窄;Ⅲ级并发症:1例(2.8%)出现便凝血块,与直肠狭窄为同一病例;无一例患者出现直肠阴道瘘、直肠尿道瘘或直肠穿孔。术前、术后肛门直肠功能评分差异有统计学意义(P<0.05)。术后肿瘤消融后其临床症状可缓解。结论 冷冻消融术治疗低位直肠间质瘤是安全、有效的,在保留肛门的同时可改善肛门直肠功能。Objective To evaluate the curative effect and safety of liquid nitrogen cryoablation in treating low rectal stromal tumors.Methods The clinical date of a total of 36 patients with low rectal stromal tumor,who received cryoablation therapy between January 2012 and December 2021,were retrospectively analyzed.The postoperative 3-month curative effect and anal function were evaluated.The follow-up deadline was December 2021 or at the time when the tumor showed progression.Results The postoperative 3-month local complete remission rate(CRR)in the 36 patients was 94.4%.A negative correlation existed between the tumor size and the frozen remission rate,i.e.the larger the tumor was,the lower the local remission rate would be.Of the 36 patients,hematochezia was seen in 2,lower abdominal or anus-rectal discomfort in 13,and increased frequency of defecation in 17,which were relieved in 2,12 and 14 patients respectively in 3 months after treatment.Based on Clavien-Dindo grading system,postoperative complications of gradeⅠwas observed in 33 patients(91.7%),who had a small amount of hematochezia during tumor abscission;postoperative complications of gradeⅡincluded hemorrhoid edema(n=5,13.9%),perianal infection(n=1,2.8%)and rectal stenosis(n=1,2.8%);and postoperative complication of gradeⅢoccurred in one patient who had fecal blood clot(2.8%,being the same patient with the rectal stenosis).No rectovaginal fistula,rectourethral fistula or rectal perforation occurred in all patients.The difference in the rectal function score between preoperative value and postoperative value was statistically significant(P<0.05).The clinical symptoms were relieved after the ablation of tumor.Conclusion For the treatment of low rectal stromal tumors,cryoablation is clinically safe and effective,it can improve anus-rectal function while preserving the anus.(J Intervent Radiol,2023,32:680-683)

关 键 词：间质瘤 冷冻消融 器官保留 并发症 

分 类 号：R735.2[医药卫生—肿瘤]