超声引导单极冷循环射频消融治疗孤独肾癌的研究  

Study on ultrasound-guided unipolar cold circulation radiofrequency ablation for the treatment of solitary renal cancer

作　　者：李丹丹[1] 王春光[1] 王沈阳[1] 高振森[1] 颜云[1] LI Dandan;WANG Chunguang;WANG Shenyang;GAO Zhensen;YAN Yun(Department of Ultrasonography,Weifang People's Hospital,Weifang 261041,China)

机构地区：[1]潍坊市人民医院超声科,山东潍坊261041

出　　处：《潍坊医学院学报》2023年第4期267-269,共3页Acta Academiae Medicinae Weifang

基　　金：潍坊市卫生计生委科研课题(项目编号:WFWSJK-2022-051)。

摘　　要：目的探讨超声引导冷循环射频消融(RFA)治疗孤独肾癌的价值。方法对60例不能行手术切除的先天性和后天性孤独肾患者的60个肾肿瘤,在超声引导下行肿瘤RFA治疗,其中后天性孤立肾肿瘤58例,先天性孤立肾肿瘤2例,伴有肾功能不全20例。左肾肿瘤28例,右肾肿瘤32例,肿瘤直径1.0~4.8(3.2±0.3)cm。全麻后,在超声引导下将射频针穿刺至肿瘤底部行RFA治疗,对彩色超声显示肿瘤有供血动脉及血供丰富的肿瘤,先选择高温模式封闭肿瘤供血动脉及肿瘤内血供丰富区,再行RFA,直至消融气化范围超过肿瘤为止,治疗结束后选择高温模式封闭针道,防止出血或肿瘤沿针道种植。治疗后1,3,6,12个月行对比增强CT复查,评估疗效,如发现肿瘤残留再行追加治疗。结果60个肾肿瘤均顺利行RFA治疗,治疗后1~3个月增强CT复查,肿瘤无强化占88.33%,肿瘤部分强化占11.67%;治疗后9~24个月肿瘤局部进展7例(11.67%),对肿瘤残留及进展患者均行再次RFA治疗。结论超声引导RFA治疗肾癌具有微创和高度保留肾单位的优点,可实时监视进针方向,穿刺成功率高,操作方便,并发症少,为孤独肾癌患者的治疗提供了一种安全有效的方法。Objective To investigate the value of ultrasound-guided cold circulation radiofrequency ablation(RFA)in the treatment of solitary renal carcinoma.Methods Sixty cases of unresectable congenital and acquired solitary kidney tumors were treated with RFA under ultrasound guidance,including 58 cases of acquired solitary kidney tumors,2 cases of congenital solitary kidney tumors and 20 cases of renal insufficiency.There were 28 cases of left kidney tumor and 32 cases of right kidney tumor,with tumor diameter of 1.0~4.8(3.2±0.3)cm.After general anesthesia,radiofrequency needle was punctured into the bottom of the tumor under the guidance of ultrasound for RFA treatment.For tumors with blood supply arteries and rich blood supply shown by color ultrasound,high temperature mode was first selected to block the blood supply arteries of the tumor and the rich blood supply areas in the tumor,then RFA was performed until the ablation and gas range exceeded the tumor.After treatment,high temperature mode was selected to block the needle path to prevent bleeding or tumor planting along the needle path.After 1,3,6,and 12 months of treatment,contrast-enhanced CT scans were performed to evaluate the efficacy,if residual tumors were found,additional treatment was performed.Results All patients were treated with RFA successfully.After 1~3 months of treatment,enhanced CT examination showed that 88.33%of the tumors had no enhancement,while 11.67%had partial enhancement.After 9~24 months of treatment,there were 7 cases(11.67%)of local tumor progression,patients with residual and advanced tumors were treated with RFA again.Conclusion Ultrasound guided RFA treatment of renal cancer has the advantages of minimally invasive and high nephron retention,real-time monitoring the direction,high puncture success rate,convenient operation,and few complications,which provides a new safe and effective treatment method for solitary renal cancer.

关 键 词：超声引导 射频消融 肾细胞肿瘤 孤独肾肿瘤 对比增强CT 

分 类 号：R737.11[医药卫生—肿瘤]