局麻下超声/CT双重引导经皮射频消融治疗肾肿瘤的疗效分析  

Percutaneous radiofrequency ablation of renal tumor under local anesthesia guided by ultrasound and CT

作　　者：杨文锦 王啸峰 黄海锋 张帆[1] 张胜捷 刘光香 纪长威 郭宏骞 Yang Wenjin;Wang Xiaofeng;Huang Haifeng;Zhang Fan;Zhang Shengjie;Liu Guangxiang;Ji Changwei;Guo Hongqian(Department of Urology,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine,Nanjing Drum Tower Hospital,The Afiliated Hospital of Nanjing University Medical School,Institute of Urology Nanjing University,Nanjing 210008,China)

机构地区：[1]南京中医药大学鼓楼临床医学院、南京鼓楼医院、南京大学医学院附属鼓楼医院泌尿外科、南京大学泌尿外科研究所,南京210008

出　　处：《中华泌尿外科杂志》2024年第5期360-365,共6页Chinese Journal of Urology

摘　　要：目的探讨局麻下超声/CT双重引导经皮射频消融治疗肾肿瘤的有效性和安全性。方法回顾性分析2018年1月至2022年12月南京鼓楼医院在局麻下使用超声/CT双重引导射频消融治疗40例肾肿瘤患者的临床资料。男33例,女7例;年龄(61.5±11.9)岁;体质量指数(24.79±3.37)kg/m^(2)。肿瘤位于左肾20例,右肾16例,双侧肾肿瘤4例。40例共44个肿瘤,肿瘤最大径(2.3±0.7)cm(1.0~4.0cm);肾上极15例,中极21例,下极8例;外生性肿瘤23例,内生性5例,混合性16例。术前有多发转移患者2例(其中1例为双侧肾肿瘤患者)。术前血肌酐值68.0(56.5,87.5)μmol/L,估算肾小球滤过率(eCFR)114.2(79.6,132.4)ml/(min·1.73m^(2))。所有患者行射频消融术前/术中均行肾穿刺检查。所有患者的经皮射频消融手术均采用超声/CT双重引导,术中均双定位确认肿瘤完全损毁。双侧肿瘤患者,分两次手术,两次手术间隔时间为1个月。术后密切观察患者生命体征情况,并进行长期随访,记录复发及转移情况。结果本组40例(44侧)手术均于局麻下顺利完成。射频时间(9.5±3.6)min。无输血病例,无中转开放手术,无围手术期死亡病例。肿瘤以外生性为主(23例,52.3%),距集合系统>7mm者31例(70.5%),位于后方者28例(63.6%),完全位于极线以外者13例(29.5%),R.E.N.A.L.评分为(6.1±0.2)分。36例单侧肾肿瘤患者病理结果:透明细胞癌28例,乳头状肾细胞癌2例,未分型肾细胞癌4例,良性肾肿瘤2例。4例双侧肾肿瘤患者病理结果:2例双侧肾肿瘤患者的一侧为良性肾肿瘤,另一侧为透明细胞癌;另两例双侧肾肿瘤均为透明细胞癌。40例中38例(共40个肿瘤)为肾癌,均为CT。期。40例术后1d血肌酐值71.5(59.0,94.3)μmol/L,与术前相比差异无统计学意义(P>0.05);eCFR107.4(79.7132.2)ml/(min·1.73m^(2)),与术前相比差异无统计学意义(P>0.05)。术后无Clavien-Dindo分级≥Ⅱ级的并发症。术后疼痛评分示重度疼痛(7~10分)仅1�Objective To explore the effectiveness and safety of percutaneous radiofrequency ablation for renal tumors,guided by both ultrasound and CT,under local anesthesia.Methods A retrospective analysis was conducted on the clinical data of 40 patients with renal tumors admitted to Nanjing Drum Tower Hospital between January 2018 and December 2022.This treatment involved ultrasound/CT dual-guided radiofrequency ablation under local anesthesia.The cohort included 33 males and 7 females,with an average age of(61.5±11.9)years old and a body mass index(BMI)of(24.79±3.37)kg/m^(2).The tumors were located in the left kidney in 20 cases and the right kidney in 16 cases,with 4 cases involving bilateral renal tumors.There were 44 tumors in 40 patients,with the maximum tumor diameter ranging from 1.0 to 4.0 cm[mean(2.3±0.7)cm].Distribution by kidney pole was as follows:15 cases at the upper pole,21 at the middle pole,and 8 at the lower pole.Of the tumors,23 were exophytic,5 were endophytic,and 16 exhibited mixed features.There were 2 patients with multiple metastases before surgery(including 1 patient with bilateral renal tumor).Preoperative serum creatinine level was 68.0(56.5,87.5)μmol/L,and the estimated glomerular filtration rate(eCFR)was 114.2(79.6,132.4)ml/(min·1.73 m^(2)).All patients underwent renal biopsy before or during radiofrequency ablation.Percutaneous radiofrequency ablation surgery was performed using ultrasound and CT dual guidance on all patients,ensuring complete tumor destruction during the procedure as confirmed by dual positioning.Patients with bilateral tumors underwent two separate surgeries,spaced one month apart.Postoperatively,closely monitor the patient's vital signs and conduct long-term follow-ups to record any recurrence and metastasis.Results In this series,all 40 procedures(involving 44 renal units)were successfully completed under local anesthesia without any need for blood transfusion,conversion to open surgery,or perioperative deaths.The average radiofrequency ablation time was(9.5±3.6)mi

关 键 词：肾肿瘤 超声/CT引导 射频消融 经皮 局部麻醉 

分 类 号：R737.11[医药卫生—肿瘤]