超声造影监测下射频联合微波消融治疗淋巴结黑素瘤的尝试

目的:超声造影监测下尝试应用射频消融联合微波热消融治疗1例淋巴结黑素瘤,观察其疗效.方法:受治者为64岁男性右足底黑素瘤患者,首发症状为右腹股沟淋巴结肿大,9个月内先后2次行手术切除.随后的2～7个月间于右侧髂动脉旁和右下肢相继出现20余枚肿大的淋巴结,合并右下肢肿胀.鉴于淋巴结包绕髂动脉、数目甚众故不考虑外科手术,且应用化疗及中药治疗效果不明显,遂在超声造影监测下联合使用CelonLab-ENT单针双极射频消融仪和YWY-2T微波消融仪对转移淋巴结进行热凝固治疗,术后观察疗效并进行随访.结果:术中、术后超声造影及穿刺病理检查证实所有经治淋巴结均丧失血供,凝固性坏死、萎缩,无明显并发症.患者一般情况良好,除右下肢少数转移淋巴结病灶仍接受热消融治疗外,其他各处均未再发现病灶.结论:超声造影监测下射频和微波热消融治疗本例淋巴结黑素瘤取得了稳定的杀灭肿瘤效果,治疗过程未发现明显并发症,可以考虑在临床上推广使用.

Percutaneous radiofrequency ablation combined with microwave coagulation therapy under contrast-enhanced ultrasound guidance for treatment of melanoma metastasis to lymph nodes: a case report

Objective:To introduce our experience on treatment of melanoma metastasis to lymph nodes by percutaneous radiofrequency ablation combined with microwave coagulation therapy under contrast-enhanced ultrasound guidance and to assess the subsequent clinical efficacy. Methods: The 64 years old male patient with right sole melanoma had an enlarged right inguinal lymph node and received surgical resection twice within 9 months. During the following 2-7 months, more than 20 enlarged lymph nodes appeared along the right iliac artery and right lower limb, complicated with lower limb swelling. Surgical resection was ruled out due to the involvement of the iliac artery and the great number of the enlargements. Chemotherapy and Chinese herb medication were proven to be less effective, then a combined thermotherapy by radio frequency ablation (CelonLab-ENT, Germany) and microwave coagulation (YWY-2T, China) was employed percutaneously under the guidance of contrast-enhanced ultrasound for the treatment. The patient was followed up for 6 months. Results: Intra-and post-operation contrast-enhanced ultrasound scanning and biopsy pathology showed avascularity, necrosis, and atrophy in all the treated lymph nodes, with no obvious complications. The general condition of the patient was good and there was no new lesion found in other sites, except a few ones still receiving ablation in the right lower limb. Conclusion: Percutaneous radiofrequency ablation combined with microwave coagulation therapy under the guidance of contrast-enhanced ultrasound shows a stable killing effect for melanoma metastasis to lymph nodes in this patient, without obvious complications, and should be considered for more clinical applications.