CT引导下经皮穿刺酒精介入治疗肾上腺良性功能性肿瘤

目的 评价CT引导下经皮穿刺酒精注射疗法对肾上腺良性功能性肿瘤的治疗价值。方法 对20例肾上腺良性功能性肿瘤进行CT引导下经皮穿刺酒精注射治疗,其中嗜铬细胞瘤5例、醛固酮瘤15例,观察治疗前后血压、血醛固酮、血钾及尿儿茶酚胺的变化。行CT平扫和增强扫描,观察肿瘤大小、坏死情况。结果 5例嗜铬细胞瘤经治疗后6－19个月随访,未发生阵发性血压增高,尿儿茶酚胺正常。15例醛固酮瘤治疗后5－7d,血醛固酮降至正常,血钾升至正常。其中1例在首次治疗后7个月时,血醛固酮再次升高,血钾再次降低,经再次治疗后血醛固酮、血钾转为正常。治疗后7－15d,13例血压降至正常;1例需口服小剂量降压药使血压维持正常,1个月后不服任何降压药血压降至正常。另1例醛固酮瘤在治疗后血压有较大幅度下降,但仍需服用小剂量降压药才能使血压维持在正常范围。治疗后7－15d CT复查,15肿瘤全部坏死,5例绝大部分坏死。结论 CT引导下经皮穿刺酒精注射疗法对肾上腺良性功能性肿瘤具有较好的疗效,且简便、安全、创伤小及费用少。     

CT引导下经皮注射醋酸治疗肾上腺醛固酮腺瘤(附9例分析)

目的 :研究CT引导下经皮注射 5 0 %醋酸治疗肾上腺醛固酮腺瘤的可行性。材料和方法 :对 9例肾上腺醛固酮腺瘤患者进行CT引导下经皮注射醋酸治疗 ,观察治疗前后血压、血醛固酮、血钾的变化。CT平扫或增强扫描 ,观察肿瘤大小和坏死情况。结果 :1血醛固酮水平 :1月后复查血醛固酮 ,9例患者均恢复到正常范围内 ,随访 2月～ 3年 ,6例患者血醛固酮均在正常范围内 ,3例未再查血醛固酮。 2血钾水平 :9例患者 1月后复查血钾均恢复到正常范围内 ,随访 2月～ 3年 ,9例患者血钾均在正常范围内。 3血压变化 :术后用降压药维持血压在正常范围内的数量和剂量减少 ,1月后停服所有降压药 ,7例患者血压一直在正常范围内 ;另外 2例患者 ,术后 1月血压邻近正常 ,服小剂量降压药可维持血压在正常范围内 ,降压药数量和剂量较以前明显减少。 4肾上腺CT扫描 :6例患者进行了肾上腺CT扫描复查。CT表现为原肾上腺肿瘤结节消失或残留一些瘢痕组织。结论 :CT引导下经皮注射醋酸治疗肾上腺醛固酮腺瘤是一种具有简便、微创、安全、费用低的有效治疗方法。     

CT导向下经皮细针穿刺化学消融术治疗肾上腺肿瘤

目的探讨CT导向下经皮细针穿刺化学消融术治疗肾上腺肿瘤的价值。方法CT导向下经皮细针穿刺化学消融术治疗37例肾上腺肿瘤，其中无功能性腺瘤11例、皮质醇腺瘤5例、醛固酮腺瘤7例、转移瘤14例(20个病灶)。病灶瘤径小于3cm者注射无水乙醇治疗，大于3cm者注射50％冰醋酸治疗。结果10个瘤径小于3cm的良性肿瘤治疗后仅残留少许纤维影；16个大于3cm的良性肿瘤均有进行性缩小；8个转移瘤灶缩小1／3以上，5个转移瘤灶治疗后瘤径无变化但瘤体内存在大面积低密度坏死区，7个转移瘤灶有增大并合并其他部位多发转移。全部功能性肾上腺肿瘤治疗后血液中激素水平恢复到正常范围。结论CT导向下经皮细针穿刺化学消融术治疗肾上腺肿瘤是1种效果显著、创伤性小、操作简便的介入方法。     

嗜铬细胞瘤CT引导下经皮穿刺乙醇介入治疗

目的：评价CT引导下经皮穿刺乙醇乙醇介入疗法对嗜铬细胞瘤的治疗效果。材料和方法：嗜铬细胞瘤13例,男6例,女7例,年龄31－59岁,平均42岁。良性肾上腺嗜铬细胞瘤12例,左侧5例,右侧7例,均为单发,其中8例经活检证实,4例根据典型的临床症状、体征、实验室检查结果和CT表现作出诊断。右肾上腺恶性嗜铬细胞瘤术后复发1例,在右侧交感神经链上有2个复发灶。13例嗜铬细胞瘤均在CT引导下行乙醇注射消融治疗。结果：治疗后7－20天CT或MRI复查,8例肾上腺良性嗜铬细胞瘤完全消失,4例完全坏死并缩小。1例恶性嗜铬细胞瘤的2个复发灶完全消失。所有病例已随访7－30个月,患者血压一直正常,未再发阵发性头晕、面色苍白、四肢麻木等表现。血、尿儿茶酚胺检查也正常。结论：CT引导下经皮穿刺乙醇消融疗法对良恶性嗜铬细胞瘤具有确切疗效,安全可靠,并发症少,费用低,值得推广应用。     

CT引导下微波消融术治疗肺转移瘤的临床效果

【摘要】 目的 探讨CT引导下MWA治疗肺转移瘤的临床效果。 方法 回顾性分析2014年1月至2017年7月接受CT引导下MWA治疗的60例肺转移瘤患者的临床资料，评估CT引导下MWA治疗肺部肿瘤的安全性及其临床疗效。结果 60例患者100个病灶术后1个月复查98个病灶完全消融，完全消融率为98.0%。术后1个月内无一例因MWA造成的死亡，12例患者发生并发症，其中3例患者发生咯血，1例胸腔积液，9例气胸，对症处理后均好转。 结论 CT引导下经皮穿刺MWA治疗肺转移瘤是一种安全有效的微创治疗方法。     

CT引导下经皮穿刺胸腺乙醇消融疗法治疗重症肌无力

目的：评价CT引导下经皮穿刺胸腺乙醇消融疗法对重症肌无力（MG）的治疗价值。材料和方法：31例MG，男13例，女18例，年龄10－54岁，平均34岁。均根据典型的病史、体征、新斯的明试验和肌电图表现等作出诊断。按Osseerman分型：Ⅰ型19例、Ⅲ型7例、Ⅳ型5例。胸腺增生25例，小胸腺瘤5例，正常胸腺1例，均经穿刺活检证实。取胸骨旁为穿刺点，用22G穿刺针在CT引导下穿入胸腺，分次注射无水乙醇，直到胸腺瘤或整个增生、正常胸腺充满乙醇为止。结果：治疗后即刻CT扫描，示胸腺内充满高密度影（乙醇混含对比剂），3－4 周CT复查，25例胸腺增生和1例正常胸腺坏死，5例小胸腺瘤坏死。31例MG胸腺乙醇消融治疗后3个月CT复查，胸腺上下径、前后径与治疗前比较分别缩小了59．2％，68．6％，73．2％。30例MG于治疗后2天内部见效，其中23例在治疗后眼睑即能明显睁开。治疗后随访4年，显著好转23例，好转7例，无效1例。结论：CT引导下经皮穿刺胸腺乙醇消融疗法对MG具有确切疗效，安全易行，并发症少，是可供选择的微创治疗方法。     

CT引导下射频消融治疗肺部恶性肿瘤的临床应用

目的 探讨CT引导下射频消融(RFA)治疗肺恶性肿瘤的疗效、不良反应和安全性.方法 对21例肺恶性肿瘤患者的31个瘤体进行CT引导下RFA治疗,对其中14个瘤体进行2次以上重复消融.术前常规CT引导下经皮穿刺活检或支气管镜检查获取病理学诊断,10例为非小细胞肺癌,其中鳞癌5例,腺癌4例,未分化癌1例,转移性肺癌11例.瘤体直径<5 cm的肿瘤25个(15例),5～8 cm的肿瘤6个(6例).所有患者术后3、6个月后行增强CT检查评价肿瘤疗效.结果 31个肿瘤均顺利完成RFA治疗.肿瘤疗效评估显示:CR 5个,PR 17个,NC 5个,PD 4个,总有效率(CR+PR)为71.0%.术中并发少量气胸8例,液气胸1例.13例术后见暗红色痰,6例术后疼痛,13例术后轻度发热.全部患者未出现其他严重并发症.平均住院时问为5-7 d.结论 CT引导下经皮穿刺RFA治疗肺部恶性肿瘤,近期疗效确切,是一种安全、有效、并发症较少的微创治疗方法.     

125I放射性粒子植入联合栓塞化疗治疗肾上腺转移瘤临床应用

目的 探讨CT导引下经皮穿刺植入125I放射性粒子联合介入栓塞化疗治疗肾上腺转移瘤的方法及疗效.方法 对12例肾上腺转移瘤患者,应用介入栓塞化疗,2周后复查CT,采用治疗计划系统(TPS)计算剂量和布粒计划,CT定位下行病灶内125I放射性粒子植入术.植入结束后,再次进行CT扫描观察粒子分布情况及有无并发症,评价粒子分布情况.术后2～6个月定期CT随访.结果 术后2、4、6个月随访,12例有效率分别为58.33 %、81.82 %、80.00 %.结论 CT引导下经皮穿刺125I粒子植入联合介入栓塞化疗治疗肾上腺转移瘤安全,损伤小,并发症轻,近期疗效确切,值得推广和应用.     

CT引导下经皮射频消融治疗肾上腺转移性肿瘤的初步疗效

目的 探讨CT引导下经皮射频消融(RFA)治疗肾上腺转移癌的近期疗效、安全性和不良反应.方法 肾上腺转移癌患者共19例,病灶总数24个,肿瘤直径为1.5-7.8 cm,平均直径3.5 cm.19例患者原发灶来源于肺癌6例,肝癌5例,肾癌5例,结肠癌3例.经RFA治疗3个月后行CT增强扫描评价肿瘤治疗效果.结果 上述24个病灶经消融治疗后,CT增强扫描显示20个肿瘤完全消融;其余4个病灶在治疗后仍有部分残留组织强化区,提示有残留肿瘤,未完全消融.5例患者出现血压波动,6例患者术后出现轻微疼痛,2例患者在术后出现一过性血尿.其余患者无严重并发症.结论 CT引导下RFA治疗肾上腺转移癌是一种安全、有效、并发症少的微创治疗方法.     

无水乙醇局部消融治疗术后复发嗜铬细胞瘤

目的 评价CT引导下局部注射无水乙醇对术后复发性嗜铬细胞瘤的治疗效果.方法 5例嗜铬细胞瘤手术治疗后复发,其中右侧3例,左侧1例,双侧1例,手术病理为良性嗜铬细胞瘤,均在CT引导下行局部无水乙醇消融治疗.结果 治疗后30 d CT复查5例肿瘤均有不同程度缩小,所有病例已随访9～42个月,患者血压一直正常,未再发阵发性头晕、头痛及发作性晕厥等症状.尿香草扁桃酸正常.结论 CT引导下局部无水乙醇消融疗法治疗术后复发嗜铬细胞瘤,疗效确切且安全可靠,是非常具有临床价值的治疗手段.     

肾上腺肿瘤经皮乙酸化学灭活

目的：为了判定肾上腺肿瘤乙酸化学灭活的潜在效果,方法：从2000年3月1日－10月1日,6例肾上腺肿瘤在CT引导下,用50％乙酸和非离子造影剂注入肿瘤内,进行灭活治疗,结果：6例中,除局部疼痛外,没有明显的临床并发症发生,PAI后,5例血压恢复正常,1例血压的明显下降,2例低血钾恢复正常,结论：初步结果表明,CT引导下的PAI对于小的或者大的功能型的不可手术切除的肾上腺肿瘤是安全有效的介入治疗方法。     

Aldosteronomas: experience with superselective adrenal arterial embolization in 33 cases

PURPOSE: To evaluate the effectiveness and long-term follow-up results of superselective adrenal arterial embolization (SAAE) of aldosteronomas. MATERIALS AND METHODS: Thirty-three patients with unilateral aldosteronomas were treated with SAAE. A 0.2-7.0-mL dose of high-concentration ethanol (HCE) was selectively infused into the feeding arterial branches of the aldosteronoma through a microcatheter by using a coaxial technique. Hormone, electrolyte, and blood pressure levels were evaluated after SAAE. The influence of background factors on SAAE success rate and the influence of age on hypertension in the patients in whom SAAE was successful were assessed with the Fisher exact test and a logistic regression model. RESULTS: SAAE was successful in 27 (82%) of 33 patients. SAAE success rate was not influenced by sex, age, hypertension duration, family history of hypertension, adenoma site, type of ethanol used, or number of embolized arteries. The destructive effects of SAAE continued for the 6-94-month (mean, 45 months) follow-up period in all patients in whom SAAE was successful. In one patient, aldosteronoma recurred 15 months after SAAE and the second SAAE was successful. Blood pressure decreased in all 11 (100%) patients aged 45 years or younger and in eight (50%) of 16 patients older than 45 years (P =.008). Blood pressure decreased within 4 weeks after SAAE in 15 (79%) of these 19 patients. The rate of blood pressure reduction after SAAE decreased with increasing age, and the correlation was significant (P =.022). None of the 33 patients had severe complications. CONCLUSION: SAAE with HCE is an effective therapy for aldosteronoma.     

Percutaneous CT-guided radiofrequency ablation of symptomatic bilateral adrenal metastases in a single session

Percutaneous computed tomography (CT)-guided radiofrequency (RF) ablation has been used in the palliative treatment of symptomatic bilateral adrenal tumors, often with each tumor addressed separately over the course of multiple treatment sessions. In the present case, a 71-year-old man with a diagnosis of lung cancer and painful bilateral metastases to the adrenal glands underwent percutaneous CT-guided RF thermal ablation of both adrenal masses in a single session (left adrenal mass, 4.7 cm; right adrenal mass, 4.3 cm), without occurrence of blood pressure instability or other acute complications. Measurement of plasma levels of cortisol, adrenocorticotropic hormone (ACTH), and glucose before and after RF ablation revealed transient changes that suggested preservation of endocrine feedback mechanisms. The patient experienced marked relief in pain bilaterally. By 5 days after the procedure, cortisol, ACTH, and glucose levels returned to preprocedural levels. On further follow-up at 6 months, the patient noted a lack of endocrine sequelae and continued pain relief.     

CT引导下经皮穿刺化学消融术治疗腹膜后淋巴结转移瘤的疗效

 目的 探讨CT引导下经皮穿刺化学消融术治疗腹膜后淋巴结转移瘤的疗效。方法 回顾性分析CT引导下经皮细针穿刺化学消融术治疗28例腹膜后淋巴结转移瘤患者的临床资料,其中原发病灶为肝癌12例,胃癌10例,胰腺癌3例,结肠癌3例(共31个病灶)。采用22G Chiba针穿刺,制备化学消融剂[无水乙醇(18 ml)、聚桂醇(2 ml)、碘化油(2 ml)、洛铂(10 mg)、表阿霉素(10 mg)按9∶1∶1∶3∶3比例制成混悬液],术后1、3、6、12个月复查增强CT,评价肿瘤体积缩小及坏死情况,采用VAS评分评价疼痛缓解情况,随访时间为12个月。结果 28例(31个病灶)手术均获得成功,术中及术后无严重不良反应。治疗前VAS评分为(6.3±1.5)分,治疗后1个月VAS评分为(1.3±1.2)分(t=13.773,P<0.05);治疗前病灶最大径为(4.2±0.8)cm,治疗后12个月病灶最大径为(1.7±0.5)cm(t=14.755,P<0.05)。结论 CT引导下经皮穿刺化学消融术治疗腹膜后淋巴结转移瘤是一种效果显著的介入方法,其远期疗效和对患者生存期的影响还有待进一步的研究。     

Technical note: CT-guided paravertebral adrenal biopsy using hydrodissection--a safe and technically easy approach

The adrenal glands are an important site of both primary and secondary disease processes. Image-guided percutaneous biopsy of the adrenal gland is an accurate and safe alternative to surgical biopsy. This procedure is most often performed in patients with a suspicion of metastatic disease where an accurate pathological diagnosis plays an important role in disease staging and defining therapy. There are many different approaches to performing adrenal biopsy under CT guidance such as anterior transhepatic/transpancreatic, lateral transhepatic/transplenic or posterior transpulmonary/transpleural/paravertebral. We describe a technique in which the adrenal gland was biopsied using a CT-guided percutaneous paravertebral approach with the use of a hydrodissection manoeuver. 13 CT-guided adrenal gland percutaneous biopsies using this technique were performed at our institution between April 2009 and July 2010. All biopsies yielded sufficient material for pathological analysis and there were no complications reported after the procedure. Saline injection can expand the posterior paravertebral space and facilitate a posterior extrapleural approach with high accuracy and low complication rates, and we believe that this may be the best approach for adrenal gland biopsy.     

CT-guided interstitial brachytherapy in the local treatment of extrahepatic, extrapulmonary secondary malignancies

The purpose was to evaluate the safety and efficacy of high-dose-rate (HDR) CT-guided interstitial brachytherapy in the treatment of extrahepatic, extrapulmonary, secondary malignancies. Nineteen patients were included in this prospective study. The median age was 66 years (49–77). Underlying primaries comprised colorectal carcinomas in six, renal cell carcinoma in three, pancreatic carcinoma in three, cervical cancer in two, endometrial cancer in two and NSCLC, breast cancer and sarcoma in one patient each. All patients had undergone extensive pretreatments. CT-guided HDR brachytherapy employed a ¹⁹²Iridium source. Dose planning for brachytherapy was performed using 3D CT data acquired after CT-guided percutaneous applicator positioning. MRI follow-up was performed 6 weeks and every 3 months post intervention. Primary endpoints were complications, local tumor control and progression-free survival. The median tumor diameter was 6 cm (2–15 cm). Tumor locations included the hepatoduodenal ligament, mesentery, adrenal gland, mesogastrium and local recurrences after rectal or pancreatic cancer. The minimal median dose in the target volume was 11 Gy (4–18 Gy). Minor complications comprised pain and fever (n=6, 32%). Major complications included one hospital death of unknown causes (n=1; 5%). Median follow-up was 7 months (1–16). Four patients (21%) died during the follow-up period. Local tumor control was 76.5% after 6 months and progression-free survival 47% after 6 months. Minimally invasive CT-guided HDR brachytherapy is safe and effective in the palliative treatment of extrahepatic, extrapulmonary secondary malignancies.     

CT引导下经皮穿刺适形冷冻消融治疗肺癌的临床分析

目的 探讨CT引导监测,经皮穿刺适形冷冻治疗肺癌的安全性、疗效和可行性.方法 研究对象为肺癌患者,纳入标准:(1)肺功能差、年龄大不能耐受开胸者;(2)周围型肺癌累及胸膜及胸壁肿瘤而无法彻底切除者;(3)肺癌通过临床综合治疗病灶缩小稳定,但不能消失者;(4)局限性肺癌,有手术切除适应证,但患者拒绝手术治疗者.排除标准:(1)双侧或单侧多发病灶患者;(2)肿块靠近纵隔大血管,预计穿刺途径不可避免地会伤及大血管者;(3)严重肺功能低下,肺最大通气容积<39%;(4)重度咳嗽,反复出现呼吸困难,不能配合治疗者;(5)肿瘤晚期、明显恶病质及出血倾向者.根据以上标准入选66例共76个病灶进行了冷冻消融,病灶最大径为1.5～16.0 cm,全部病灶按照肿瘤体积行17 G冷冻探针穿刺适形冷冻.肿瘤最大径<3.0 cm者采取双针"夹击"冷冻;肿瘤直径3.0～5.0 cm者采取多针穿刺适形冷冻;肿瘤最大径>5.0 cm者采取瘤内穿刺适形布针,针距<1.5 cm.患者术后随访6个月至2年.疗效评价采用CT增强扫描,观察病灶大小及强化情况.结果 本组18例肿瘤最大径<3.0 cm,术中CT复查显示冷冻范围超过病灶边缘1.0 cm以上,病灶局部密度减低,紧邻病灶周围可见窄带状透亮环绕,其外围肺组织密度增高,呈磨玻璃样环绕病灶形成靶征;术后1、3个月复查显示,病灶及邻近肺组织无强化;6个月后复查,扫描局部可见纤维条索影;7例随访时间达2年,其中5例肿瘤无复发和转移,1例术后1年发现纵隔淋巴结肿大,1例出现肿瘤骨转移.22例肿瘤最大径在3.0～5.0 cm之间,术后即刻CT复查显示,冷冻冰球覆盖全部病灶,病灶边缘的分叶和毛刺等恶性肿瘤征象消失,病灶体积轻度增大;术后1、3个月复查实性病灶逐渐缩小;9例患者随访达2年,其中4例肿瘤无复发,3例肿瘤稳定,2例出现其他部位转移.26例肿瘤最大径>5.0 cm,术中复查,冰球覆盖病灶体积70%～90%,周围肺组织无冷冻损伤改变.26例患者术后进行了放、化疗等综合治疗,随访6个月,9例病灶体积缩小,11例病灶稳定,6例病灶进展伴身体其他部位转移.本组患者术中3例出现咳血;术后26例痰中带血丝,19例出现气胸,其中5例行胸腔闭式引流,气体完全吸收,拔管时间平均为5 d.结论 CT引导监测,经皮穿刺适形冷冻治疗肺癌疗效肯定,是一种可行的微创方法.     

经皮穿刺胆囊引流治疗急性重症胆囊炎的临床疗效

目的：探讨CT引导下经皮穿刺胆囊引流术治疗急性重症胆囊炎的临床疗效。 方法：于2014年月—2016年6月,对我院22例急性重症胆囊炎患者行经皮穿刺胆囊引流术,其中19例经皮经肝穿刺引流,3例经腹腔穿刺引流。 结果：所有22例患者均一次性完成穿刺引流,技术成功率100%。21例患者术后72 h内患者的腹痛、腹胀、高热等症状明显缓解,血常规检查中白细胞及中性粒细胞计数10 d内恢复正常。1例患者合并重症肺炎术后第2天死亡。14例患者术后3～6周拔管,7例患者长期带管生存。 结论：CT引导下经皮穿刺胆囊引流治疗急性重症胆囊炎操作简单、创伤小、安全有效,值得临床推广应用。     

Adrenal neoplasms: CT-guided radiofrequency ablation--preliminary results

PURPOSE: To evaluate initial experience with radiofrequency (RF) ablation of adrenal neoplasms. MATERIALS AND METHODS: Thirteen adrenal masses in 12 patients (bilateral metastases in one patient) were treated with computed tomography (CT)-guided percutaneous RF ablation. Eleven adrenal lesions were metastases (five from lung cancer, four from renal cell carcinoma, and two from melanoma); one lesion was a pheochromocytoma and one was an aldosteronoma. There were 10 men and two women (average age, 58 years; range, 40-77 years) in the study; average adrenal mass diameter was 3.9 cm (range, 1-8 cm). Average number of RF applications per adrenal mass was 2.7 (range, 1-5 applications); average time per application was 7.8 minutes (range, 4-13 minutes). An internally cooled single electrode was used in five sessions; an internally cooled cluster electrode was used in eight sessions. RESULTS: Average follow-up was 11.2 months (range, 1-46 months). Eleven of 13 lesions were treated successfully with RF ablation after one session. Successful treatment was defined as lack of enhancement of the treated region on follow-up CT images and resolution of the biochemical abnormality in two patients. In two patients with large adrenal lesions (4 and 8 cm in diameter), enhancement of residual tissue was observed after one treatment session; this finding was indicative of residual tumor. One patient with thrombocytopenia that resulted from chemotherapy had a small hematoma, but no transfusion was required. No patient developed hypertension during the RF application. No patient with metastases had recurrent tumor at the treated site, and this lack of recurrence indicated effective local control; 11 patients had progression of metastatic disease at extraadrenal sites. CONCLUSION: Preliminary data suggest that CT-guided RF ablation is an effective technique for local control of adrenal neoplasms.