超声引导下经皮微波消融能有效治疗肾细胞癌
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摘要
为探讨超声引导下经皮微波消融术治疗肾细胞癌的效果,本研究回顾性分析超声引导下经皮微波消融术(microwave ablation, MWA)治疗肾细胞癌的并发症。本研究共选取100例肿瘤患者,均接受超声引导下经皮微波消融术治疗,随访1个月、3个月、6个月,每6个月进行造影增强超声、计算机断层扫描或磁共振成像。本研究发现109个肿瘤中有94个(86.2%)手术获得成功,中位随访时间为25 (1.43～92.52)个月。在109例肿瘤中,发现35例并发症,并发症发生率为32.1%。27.5%的手术发生轻微并发症(Clavien-DindoⅠ和Ⅱ级),严重并发症(Clavien-DindoⅢ级)发生率为4.6%,分别占总并发症的85.7%和14.3%。所有的轻微并发症患者均治愈。3例患者发生胸腔积液,2例发生肠道损伤。3例患有胸腔积液的患者有肝硬化病史,微波消融后通过导管引流进行治疗,肠道损伤患者行手术治疗。在所有患者中,手术前后血清肌酐和尿素氮水平无显著差异。超声引导下的经皮微波消融治疗肾细胞癌是一种有效的治疗方法,然而,如果肾肿瘤靠近肠道,或病人有严重的并发症或接受了腹部手术,则必须更慎重地进行手术。
To investigate the effect of ultrasound-guided percutaneous microwave ablation on renal cell carcinoma,this study retrospectively analyze d the complications of renal cell carcinoma treated by ultrasound-guided microwave ablation(MWA). A total of 100 patients selected with tumors underwent ultrasound-guided percutaneous microwave ablation. The patients were followed up at 1 st month, 3 nd month, and 6 th month, and every 6 months, they underwent contrast-enhanced ultrasound, computed tomography, or magnetic resonance imaging.This study found that 94(86.2%) of 109 tumors were successfully operated. The median follow-up time was 25(1.43～92.52) months. In the 109 tumors, 35 were found to have complications with a complication rate of 32.1%.27.5% had mild complications(Clavien-Dindo Ⅰand Ⅱ) and severe complications(Clavien-Dindo Ⅲ) was 4.6%,accounting for 85.7% and 14.3% of the total complications, respectively. All mild complications were cured. There were 3 cases of pleural effusion and 2 cases of intestinal injury occurred. Three patients with pleural effusion had a history of cirrhosis and were treated by catheter drainage after microwave ablation. The patients with intestinal injury were treated with surgical treatment. In all patients, there was no significant difference in serum creatinine and urea nitrogen levels before and after surgery. Ultrasound-guided percutaneous microwave ablation for renal cell carcinoma might be an effective treatment, however, if the kidney neoplasm is close to the intestine, or if the patient has severe complications or has undergone abdominal surgery, surgery must be performed more carefully.
To investigate the effect of ultrasound-guided percutaneous microwave ablation on renal cell carcinoma,this study retrospectively analyze d the complications of renal cell carcinoma treated by ultrasound-guided microwave ablation(MWA). A total of 100 patients selected with tumors underwent ultrasound-guided percutaneous microwave ablation. The patients were followed up at 1 st month, 3 nd month, and 6 th month, and every 6 months, they underwent contrast-enhanced ultrasound, computed tomography, or magnetic resonance imaging.This study found that 94(86.2%) of 109 tumors were successfully operated. The median follow-up time was 25(1.43～92.52) months. In the 109 tumors, 35 were found to have complications with a complication rate of 32.1%.27.5% had mild complications(Clavien-Dindo Ⅰand Ⅱ) and severe complications(Clavien-Dindo Ⅲ) was 4.6%,accounting for 85.7% and 14.3% of the total complications, respectively. All mild complications were cured. There were 3 cases of pleural effusion and 2 cases of intestinal injury occurred. Three patients with pleural effusion had a history of cirrhosis and were treated by catheter drainage after microwave ablation. The patients with intestinal injury were treated with surgical treatment. In all patients, there was no significant difference in serum creatinine and urea nitrogen levels before and after surgery. Ultrasound-guided percutaneous microwave ablation for renal cell carcinoma might be an effective treatment, however, if the kidney neoplasm is close to the intestine, or if the patient has severe complications or has undergone abdominal surgery, surgery must be performed more carefully.
引文
Brace C.L.,2009,Radiofrequency and microwave ablation of the liver,lung,kidney,and bone:what are the differences?Curr.Probl.Diagn.Radiol.,38(3):135-143
Cai Q.L.,Wang Z.,Dong Q.,Li G.,Ma B.J.,Wang Y.,Zhu S.M.,Wen S.M.,and Quan C.Y.,2017,Experience of retroperitoneal laparoscopic nephron sparing surgery in treatment of endophytic renal tumors,Zhonghua Miniaowaike Zazhi(Chinese Journal of Urology),38(2):84-87(蔡启亮,王准,董茜,李刚,马宝杰,王勇,朱识淼,温思盟,权昌益,2017,后腹腔镜下保留肾单位手术治疗完全内生性肾肿瘤的初步经验,中华泌尿外科杂志,38(2):84-87)
Carrafiello G.,LaganàD.,Ianniello A.,Dionigi G.,Novario R.,Recaldini C.,Mangini M.,Cuffari S.,and Fugazzola C.,2007,Post-radiofrequency ablation syndrome after percutaneous radiofrequency of abdominal tumours:one centre experience and review of published works,Australas.Radiol.,51(6):550-554
Clark T.W.,Malkowicz B.,Stavropoulos S.W.,Sanchez R.,Soulen M.C.,Itkin M.,Patel A.,Mondschein J.I.,and Wein A.J.,2006,Radiofrequency ablation of small renal cell carcinomas using multitined expandable electrodes:preliminary experience,J.Vasc.Interv.Radiol.,17(3):513-519
Dupuy D.E.,and Goldberg S.N.,2001,Image-guided radiofrequency tumor ablation:challenges and opportunities-partⅡ,Journal of Vascular&Interventional Radiology Jvir,12(10):1135-1148
Gazelle G.S.,Goldberg S.N.,Solbiati L.,and Livraghi T.,2000,Tumor ablation with radio-frequency energy,Radiology,217(3):633-646
Georgiades C.,and Rodriguez R.,2013,Renal tumor ablation,Tech.Vasc.Interv.Radiol.,16(4):230-238
Ginat D.T.,Saad W.,Davies M.,Walman D.,and Erturk E.,2009,Bowel displacement for CT-guided tumor radiofrequency ablation:techniques and anatomic considerations,J.Endourol.,23(8):1259-1264
Jin P.,and Sun G.,2016,Research progress of local ablation therapy for hepatocellular carcinoma,Zhonghua Xiaohuabing Yu Yingxiang Zazhi(Dianziban)(Chinese Journal of Digestion and Medical Imageology(Electronic Edition)),6(3):97-102(金鹏,孙钢,2016,肝癌消融治疗的研究进展,中华消化病与影像杂志:电子版,6(3):97-102)
Kam A.W.,Littrup P.J.,Walther M.M.,Hvizda J.,and Wood B.J.,2004,Thermal protection during percutaneous thermal ablation of renal cell carcinoma,J.Vasc.Interv.Radiol.,15(7):753-758
Kim H.L.,Belldegrun A.S.,Freitas D.G.,Bui M.H.,Han K.R.,Dorey F.J.,and Figlin R.A.,2003,Paraneoplastic signs and symptoms of renal cell carcinoma:implications for prognosis,J.Urol.,170(5):1742-1746
Kim S.D.,Yoon S.G.,and Sung G.T.,2012,Radiofrequency ablation of renal tumors:four-year follow-up results in 47 patients,Korean J.Radiol.,13(5):625-633
Li G.X.,and Chen X.M.,2017,Comparative study of radiofrequency ablation and microwave ablation in the treatment of lung tumors,Linchuang Fangshexue Zazhi(Journal of Clinical Radiology),36(5):724-727(李光骁,陈晓明,2017,射频消融与微波消融治疗肺肿瘤的对比研究,临床放射学杂志,36(5):724-727)
Liu F.,Yu X.,Cheng Z.,Han Z.,Sun Y.,Liang P.,and Zhou F.,2017,Comparison of ultrasonography-guided percutaneous microwave ablation for subcapsular and nonsubcapsular hepatocellular carcinoma,Eur.J.Radiol.,91:93-98
Liu G.X.,Guo H.Q.,Li X.G.,Liu T.S.,Zhang S.W.,Gan W.D.,Yan X.,Ji C.W.,Wang W.,and Zeng L.Q.,2010,Radiofrequency ablation for renal cell carcinoma in functional solitary kidney,Zhonghua Miniaowaike Zazhi(Chinese Journal of Urology),31(11):748-751(刘光香,郭宏骞,李笑弓,刘铁石,张士伟,甘卫东,燕翔,纪长威,汪维,曾令奇,2010,射频消融治疗功能性孤立肾肾细胞癌的临床分析,中华泌尿外科杂志,31(11):748-751)
Mir S.A.,Cadeddu J.A.,Sleeper J.P.,and Lotan Y.,2011,Cost comparison of robotic,laparoscopic,and open partial nephrectomy,J.Endourol.,25(3):447-453
Mnatzakanian G.N.,Shinagare A.B.,and Sahni V.A.,2016,Early-stage clear cell tubulopapillary renal cell carcinoma:imaging features and distinction from clear cell and papillary subtypes,Abdominal Radiology,41(11):1-9
Park B.K.,and Chan K.K.,2009,Complications of image-guided radiofrequency ablation of renal cell carcinoma:causes,imaging features and prevention methods,European Radiology,19(9):2180-2190
Rhim H.,Dodd G.D.,Chintapalli K.N.,Wood B.J.,Dupuy D.E.,Hvizda J.L.,Sewell P.E.,and Goldberg S.N.,2004,Radiofrequency thermal ablation of abdominal tumors:lessons learned from complications,Radiographics,24(1):41-52
Salagierski M.,Salagierski M.,Salagierska-Barwińska A.,and Sosnowski M.,2006,Percutaneous ultrasound-guided radiofrequency ablation for kidney tumors in patients with surgical risk,Int.J.Urol.,13(11):1375-1379
Shen Y.Z.,2015,Clinical comparison of nephron sparing surgery and radical nephrectomy in the treatment for patients with focal renal carcinoma,Yixue Zongshu(Medical Recapitulate),(7):1292-1293(沈弋桢,2015,保留肾单位手术和肾癌根治手术治疗局限性肾癌的临床疗效,医学综述,(7):1292-1293)
Simon C.J.,Dupuy D.E.,and Mayo-Smith W.W.,2005,Microwave ablation:principles and applications,Radiographics,25(1):S69-S83
Singer E.A.,Gupta G.N.,Marchalik D.,and Srinivasan R.,2013,Evolving therapeutic targets in renal cell carcinoma,Current Opinion in Oncology,25(3):273-280
Syn N.L.,Teng M.W.,Mok T.S.,and Soo R.A.,2017,De-novo and acquired resistance to immune checkpoint targeting,Lancet Oncology,18(12):e731-e741
Wang H.,Zhou L.,Bian T.C.,Yang N.Q.,Chen W.,Jiang S.,Zhu Y.J.,and Guo J.M.,2015,Mini-flank incision for open partial nephrectomy for renal tumor with Zhongshan score≥8,Zhonghua Miniaowaike Zazhi(Chinese Journal of Urology),(10):732-735(王杭,周林,卞亭长,杨念钦,陈伟,姜帅,朱延军,郭剑明,2015,小切口开放式保留肾单位手术治疗中山评分≥8分肾肿瘤的临床研究,中华泌尿外科杂志,(10):732-735)
Wang Y.,Liang P.,Yu X.,Cheng Z.,Yu J.,and Dong J.,2009,Ultrasound-guided percutaneous microwave ablation of adrenal metastasis:preliminary results,Int.J.Hyperthermia.,25(6):455-461
Wu X.R.,Chen W.,Chen Y.H.,Zhang J.,Huang J.W.,Kong W.,Xue W.,Liu D.M.,and Huang Y.R.,2016,Comparison of laparoscopic microwave ablation and radio frequency ablation assisted renal tumor enucleation for renal tumor smaller than 4 cm,Zhonghua Miniaowaike Zazhi(Chinese Journal of Urology),37(1):12-16(吴小荣,陈伟,陈勇辉,张进,黄吉炜,孔文,薛蔚,刘东明,黄翼然,2016,微波与射频消融辅助的腹腔镜下肾肿瘤剜除术治疗直径≤4 cm肾肿瘤的比较研究,中华泌尿外科杂志,37(1):12-16)
Xiong Y.,Sun Y.L.,Din Q.,and Liu C.,2015,Clinical research of percutaneous ablation in the treatment of kidney neoplasm with the assistance of ultrasonic location,Xiandai Zhongliu Yixue(Journal of Modern Oncology),23(14):2035-2037(熊鹰,孙亚凌,丁千,刘灿,2015,超声定位下经皮消融肾肿瘤的临床研究,现代肿瘤医学,23(14):2035-2037)
Xu Y.,Shen Q.,Wang N.,Liu P.,Sheng Y.H.,Xu Y.Y.,and Qian G.J.,2016,Effect analysis of microwave ablation therapy for early hepatocellular carcinoma in patients over 70 years old,Jieru Fangshexue Zazhi(Journal of Interventional Radiology),25(4):332-336(许贇,沈强,王能,刘沛,盛月红,许芸芸,钱国军,2016,微波消融治疗>70岁早期肝细胞肝癌患者效果分析,介入放射学杂志,25(4):332-336)
Zhang L.P.,Weng Y.,and Fang L.P.,2012,Renal cell carcinoma in patients with a solitary kidney treated with radiofrequency ablation:nursing care of patients,Hulixue Zazhi(Journal of Nursing Science),27(24):35-36(张丽萍,文艳,方莉萍,2012,射频消融治疗功能性孤立肾肾细胞癌患者的护理,护理学杂志,27(24):35-36)
Cai Q.L.,Wang Z.,Dong Q.,Li G.,Ma B.J.,Wang Y.,Zhu S.M.,Wen S.M.,and Quan C.Y.,2017,Experience of retroperitoneal laparoscopic nephron sparing surgery in treatment of endophytic renal tumors,Zhonghua Miniaowaike Zazhi(Chinese Journal of Urology),38(2):84-87(蔡启亮,王准,董茜,李刚,马宝杰,王勇,朱识淼,温思盟,权昌益,2017,后腹腔镜下保留肾单位手术治疗完全内生性肾肿瘤的初步经验,中华泌尿外科杂志,38(2):84-87)
Carrafiello G.,LaganàD.,Ianniello A.,Dionigi G.,Novario R.,Recaldini C.,Mangini M.,Cuffari S.,and Fugazzola C.,2007,Post-radiofrequency ablation syndrome after percutaneous radiofrequency of abdominal tumours:one centre experience and review of published works,Australas.Radiol.,51(6):550-554
Clark T.W.,Malkowicz B.,Stavropoulos S.W.,Sanchez R.,Soulen M.C.,Itkin M.,Patel A.,Mondschein J.I.,and Wein A.J.,2006,Radiofrequency ablation of small renal cell carcinomas using multitined expandable electrodes:preliminary experience,J.Vasc.Interv.Radiol.,17(3):513-519
Dupuy D.E.,and Goldberg S.N.,2001,Image-guided radiofrequency tumor ablation:challenges and opportunities-partⅡ,Journal of Vascular&Interventional Radiology Jvir,12(10):1135-1148
Gazelle G.S.,Goldberg S.N.,Solbiati L.,and Livraghi T.,2000,Tumor ablation with radio-frequency energy,Radiology,217(3):633-646
Georgiades C.,and Rodriguez R.,2013,Renal tumor ablation,Tech.Vasc.Interv.Radiol.,16(4):230-238
Ginat D.T.,Saad W.,Davies M.,Walman D.,and Erturk E.,2009,Bowel displacement for CT-guided tumor radiofrequency ablation:techniques and anatomic considerations,J.Endourol.,23(8):1259-1264
Jin P.,and Sun G.,2016,Research progress of local ablation therapy for hepatocellular carcinoma,Zhonghua Xiaohuabing Yu Yingxiang Zazhi(Dianziban)(Chinese Journal of Digestion and Medical Imageology(Electronic Edition)),6(3):97-102(金鹏,孙钢,2016,肝癌消融治疗的研究进展,中华消化病与影像杂志:电子版,6(3):97-102)
Kam A.W.,Littrup P.J.,Walther M.M.,Hvizda J.,and Wood B.J.,2004,Thermal protection during percutaneous thermal ablation of renal cell carcinoma,J.Vasc.Interv.Radiol.,15(7):753-758
Kim H.L.,Belldegrun A.S.,Freitas D.G.,Bui M.H.,Han K.R.,Dorey F.J.,and Figlin R.A.,2003,Paraneoplastic signs and symptoms of renal cell carcinoma:implications for prognosis,J.Urol.,170(5):1742-1746
Kim S.D.,Yoon S.G.,and Sung G.T.,2012,Radiofrequency ablation of renal tumors:four-year follow-up results in 47 patients,Korean J.Radiol.,13(5):625-633
Li G.X.,and Chen X.M.,2017,Comparative study of radiofrequency ablation and microwave ablation in the treatment of lung tumors,Linchuang Fangshexue Zazhi(Journal of Clinical Radiology),36(5):724-727(李光骁,陈晓明,2017,射频消融与微波消融治疗肺肿瘤的对比研究,临床放射学杂志,36(5):724-727)
Liu F.,Yu X.,Cheng Z.,Han Z.,Sun Y.,Liang P.,and Zhou F.,2017,Comparison of ultrasonography-guided percutaneous microwave ablation for subcapsular and nonsubcapsular hepatocellular carcinoma,Eur.J.Radiol.,91:93-98
Liu G.X.,Guo H.Q.,Li X.G.,Liu T.S.,Zhang S.W.,Gan W.D.,Yan X.,Ji C.W.,Wang W.,and Zeng L.Q.,2010,Radiofrequency ablation for renal cell carcinoma in functional solitary kidney,Zhonghua Miniaowaike Zazhi(Chinese Journal of Urology),31(11):748-751(刘光香,郭宏骞,李笑弓,刘铁石,张士伟,甘卫东,燕翔,纪长威,汪维,曾令奇,2010,射频消融治疗功能性孤立肾肾细胞癌的临床分析,中华泌尿外科杂志,31(11):748-751)
Mir S.A.,Cadeddu J.A.,Sleeper J.P.,and Lotan Y.,2011,Cost comparison of robotic,laparoscopic,and open partial nephrectomy,J.Endourol.,25(3):447-453
Mnatzakanian G.N.,Shinagare A.B.,and Sahni V.A.,2016,Early-stage clear cell tubulopapillary renal cell carcinoma:imaging features and distinction from clear cell and papillary subtypes,Abdominal Radiology,41(11):1-9
Park B.K.,and Chan K.K.,2009,Complications of image-guided radiofrequency ablation of renal cell carcinoma:causes,imaging features and prevention methods,European Radiology,19(9):2180-2190
Rhim H.,Dodd G.D.,Chintapalli K.N.,Wood B.J.,Dupuy D.E.,Hvizda J.L.,Sewell P.E.,and Goldberg S.N.,2004,Radiofrequency thermal ablation of abdominal tumors:lessons learned from complications,Radiographics,24(1):41-52
Salagierski M.,Salagierski M.,Salagierska-Barwińska A.,and Sosnowski M.,2006,Percutaneous ultrasound-guided radiofrequency ablation for kidney tumors in patients with surgical risk,Int.J.Urol.,13(11):1375-1379
Shen Y.Z.,2015,Clinical comparison of nephron sparing surgery and radical nephrectomy in the treatment for patients with focal renal carcinoma,Yixue Zongshu(Medical Recapitulate),(7):1292-1293(沈弋桢,2015,保留肾单位手术和肾癌根治手术治疗局限性肾癌的临床疗效,医学综述,(7):1292-1293)
Simon C.J.,Dupuy D.E.,and Mayo-Smith W.W.,2005,Microwave ablation:principles and applications,Radiographics,25(1):S69-S83
Singer E.A.,Gupta G.N.,Marchalik D.,and Srinivasan R.,2013,Evolving therapeutic targets in renal cell carcinoma,Current Opinion in Oncology,25(3):273-280
Syn N.L.,Teng M.W.,Mok T.S.,and Soo R.A.,2017,De-novo and acquired resistance to immune checkpoint targeting,Lancet Oncology,18(12):e731-e741
Wang H.,Zhou L.,Bian T.C.,Yang N.Q.,Chen W.,Jiang S.,Zhu Y.J.,and Guo J.M.,2015,Mini-flank incision for open partial nephrectomy for renal tumor with Zhongshan score≥8,Zhonghua Miniaowaike Zazhi(Chinese Journal of Urology),(10):732-735(王杭,周林,卞亭长,杨念钦,陈伟,姜帅,朱延军,郭剑明,2015,小切口开放式保留肾单位手术治疗中山评分≥8分肾肿瘤的临床研究,中华泌尿外科杂志,(10):732-735)
Wang Y.,Liang P.,Yu X.,Cheng Z.,Yu J.,and Dong J.,2009,Ultrasound-guided percutaneous microwave ablation of adrenal metastasis:preliminary results,Int.J.Hyperthermia.,25(6):455-461
Wu X.R.,Chen W.,Chen Y.H.,Zhang J.,Huang J.W.,Kong W.,Xue W.,Liu D.M.,and Huang Y.R.,2016,Comparison of laparoscopic microwave ablation and radio frequency ablation assisted renal tumor enucleation for renal tumor smaller than 4 cm,Zhonghua Miniaowaike Zazhi(Chinese Journal of Urology),37(1):12-16(吴小荣,陈伟,陈勇辉,张进,黄吉炜,孔文,薛蔚,刘东明,黄翼然,2016,微波与射频消融辅助的腹腔镜下肾肿瘤剜除术治疗直径≤4 cm肾肿瘤的比较研究,中华泌尿外科杂志,37(1):12-16)
Xiong Y.,Sun Y.L.,Din Q.,and Liu C.,2015,Clinical research of percutaneous ablation in the treatment of kidney neoplasm with the assistance of ultrasonic location,Xiandai Zhongliu Yixue(Journal of Modern Oncology),23(14):2035-2037(熊鹰,孙亚凌,丁千,刘灿,2015,超声定位下经皮消融肾肿瘤的临床研究,现代肿瘤医学,23(14):2035-2037)
Xu Y.,Shen Q.,Wang N.,Liu P.,Sheng Y.H.,Xu Y.Y.,and Qian G.J.,2016,Effect analysis of microwave ablation therapy for early hepatocellular carcinoma in patients over 70 years old,Jieru Fangshexue Zazhi(Journal of Interventional Radiology),25(4):332-336(许贇,沈强,王能,刘沛,盛月红,许芸芸,钱国军,2016,微波消融治疗>70岁早期肝细胞肝癌患者效果分析,介入放射学杂志,25(4):332-336)
Zhang L.P.,Weng Y.,and Fang L.P.,2012,Renal cell carcinoma in patients with a solitary kidney treated with radiofrequency ablation:nursing care of patients,Hulixue Zazhi(Journal of Nursing Science),27(24):35-36(张丽萍,文艳,方莉萍,2012,射频消融治疗功能性孤立肾肾细胞癌患者的护理,护理学杂志,27(24):35-36)