CT导向下经皮无水乙醇消融在复杂性肾癌治疗中的临床应用

目的 探讨CT导向下经皮无水乙醇消融(PEA)在复杂性癌治疗中的临床价值.方法 对7例复杂性肾癌患者,其中孤立肾肾癌2例,单侧肾肾癌5例,病灶数11个,肿瘤直径1.7～8.4 cm,在CT引导、局麻下进行经皮穿刺无水乙醇消融治疗,常规行螺旋CT平扫和增强扫描进行随访评价疗效.结果 患者平均每人2次PEA治疗,随访12～26个月,中位时间15个月.1例孤立肾肾癌患者经2次PEA治疗后,已随访1年9个月未见复发;1例孤立肾多发肾癌患者4次PEA治疗后肾衰死亡;2例肾癌伴腰痛血尿症状经PEA治疗后病灶消融完全,血尿症状缓解;其他3例肾癌患者分别随访1年6个月、2年2个月和1年,1例死于远处转移,其他2例CT复查未见肿瘤进展.全部患者无1例出现尿瘘、出血、肠穿孔或针道转移等并发症.结论 CT导向下无水乙醇消融治疗对复杂性肾癌是一种微创、疗效确切、可供选择的局部治疗方法 ,但对于孤立肾肾癌,PEA治疗须谨慎.

CT-guided percutaneous ethanol ablation for treatment of complicated renal cancers

Objective To study the clinical value of CT-guided pereutaneous ethanol ablation (PEA) in complicated renal cancers. Method Seven cases of complicated renal cancers were recruited in this study. The tumors included 11 lesions with 1.7 cm to 8.4 cm in size, comprising 2 cases of multiple renal cancers in a solitary kidney and 5 of unilateral renal cancers. These patients underwent CT-guided PEA by local anesthesia. Plain and contrast CT scan was adopted to evaluate clinical effects and for follow-up. Results Each patient accepted average 2 treatments with PEA, and was followed up for a mean of 12 to 26 months (median = 15 months), of the two cases with multiple renal cancer in a solitary kidney, one was free of recurrence after 2 PEAs and followed-up for 1 year and 9 mouths, whereas the other died of renal failure after 4 PEAs. Of 2 cases with unilateral cancers, PEA led to complete ablation of the lesions and resolution of hematuria. Of the other 3 cases who were followed up for 18, 26 and 12 months respectively, one died of distant metastasis and 2 were progression-free as shown by CT. No complications including urinary fistula, hemorrage, intestinal perforation and needle track implantation were seen in all the patients. Conclusion CT- guided PEA is a microinvasive, reliable option for local treatment of renal cancers but should be prudently used when selected for eancar in solitary kidney.