CT引导下经皮射频消融治疗T1bNxM0期孤立肾肿瘤的中长期随访观察
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摘要
目的评价CT引导下经皮射频消融治疗T1b期孤立肾肿瘤的中长期效果。方法回顾性分析2007年4月至2010年1月在南京总医院就诊的生理性或功能性孤立肾肾肿瘤17例患者的临床资料,肿瘤均为单发,临床分期均为T1bNxM0期,术前经超声、CT及MRI等影像学检查明确诊断肾脏占位,行CT引导下经皮射频消融治疗。术后定期随访患者,复查CT观察复发情况,复查血肌酐计算肾小球滤过率(GFR)以判断肾功能,同时通过随访术后生存率及复发率评估治疗效果。结果所有患者均顺利进行手术,平均手术时间(74±11) min,术中与术后未见严重并发症,无输血病例。术后1周复查CT提示14例肿瘤病灶完全消融,3例局部仍有增强信号,提示肿瘤残留;二次治疗后肿瘤消融完全。2例在术后6个月出现复发,1例在术后12个月出现复发,未再进行治疗,继续随访,其中1例在术后27个月时因肿瘤复发转移死亡。本组患者3年肿瘤相关生存率为94.12%,3年肿瘤复发率为17.65%。存活患者术后3年平均e GFR为(67.6±7.4) mL/(min·1.73m2),与术前比较差异无统计学意义(P>0.05)。结论 CT引导下经皮射频消融治疗T1bNxM0期肾肿瘤安全有效,对肾脏功能影响小,有一定的肿瘤复发风险,但对于孤立肾患者,可以作为姑息性治疗的良好选择。
Objective To evaluate the effect of CT guided percutaneous radiofrequency ablation of T1b stage renal cell tumor with mid-long term follow-up.Methods All the 17 patients with a solitary kidney underwent surgery from April 2007 to January2009.Renal tumor was diagnosed by ultrasonography,CT or MRI.All of the cases were T1bNxM0 stage.By CT positioning,percutaneous radiofrequency ablation were performed on the renal tumor.The patients were followed up regularly after operation.The recurrence rate was observed by CT,the glomerular filtration rate(GFR) was calculated by serum creatinine for judging the renal function.The therapeutic effect was evaluated by following up the survival rate and recurrence rate.Results All patients underwent percutaneous radiofrequency ablation surgery successfully.The mean operation time was(74±11) minutes.No blood transfusion occurred and no severe complication were observed during and post operation.During postoperative follow-up,enhanced CT revealed complete ablation in 14 cases,and 3 residue tumor was confirmed by enhanced CT 7 days post operation.After re-radiofrequency ablation,these 3 patients' tumor were totally ruined.3 cases of recurrence were confirmed by enhanced CT in 6-12 months after operation.1 patient succumbed to tumor metastasis in 27th month after surgery.The 3-year recurrence rate was 17.65%.3-year cancer specific survival rate was 94.12%.The mean e GFR was(67.6±7.4) mL/(min·1.73 m~2) in 3 years after surgery.There were no significant difference between pre-and post-operation(P>0.05).Conclusion Mid-long term follow-up results show the effectiveness and safety of CT guided percutaneous radiofrequency ablation in the treatment for T1b stage renal cell tumor in patients with solitary kidney patients and have no negative influence on the renal function.
Objective To evaluate the effect of CT guided percutaneous radiofrequency ablation of T1b stage renal cell tumor with mid-long term follow-up.Methods All the 17 patients with a solitary kidney underwent surgery from April 2007 to January2009.Renal tumor was diagnosed by ultrasonography,CT or MRI.All of the cases were T1bNxM0 stage.By CT positioning,percutaneous radiofrequency ablation were performed on the renal tumor.The patients were followed up regularly after operation.The recurrence rate was observed by CT,the glomerular filtration rate(GFR) was calculated by serum creatinine for judging the renal function.The therapeutic effect was evaluated by following up the survival rate and recurrence rate.Results All patients underwent percutaneous radiofrequency ablation surgery successfully.The mean operation time was(74±11) minutes.No blood transfusion occurred and no severe complication were observed during and post operation.During postoperative follow-up,enhanced CT revealed complete ablation in 14 cases,and 3 residue tumor was confirmed by enhanced CT 7 days post operation.After re-radiofrequency ablation,these 3 patients' tumor were totally ruined.3 cases of recurrence were confirmed by enhanced CT in 6-12 months after operation.1 patient succumbed to tumor metastasis in 27th month after surgery.The 3-year recurrence rate was 17.65%.3-year cancer specific survival rate was 94.12%.The mean e GFR was(67.6±7.4) mL/(min·1.73 m~2) in 3 years after surgery.There were no significant difference between pre-and post-operation(P>0.05).Conclusion Mid-long term follow-up results show the effectiveness and safety of CT guided percutaneous radiofrequency ablation in the treatment for T1b stage renal cell tumor in patients with solitary kidney patients and have no negative influence on the renal function.
引文
[1]马建辉,李鸣,张思维,等.中国部分市县肾癌及泌尿系其他恶性肿瘤发病趋势比较研究[J].中华泌尿外科杂志,2009,30(8):511-514.
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[4]Fu D,Li P,Xu F,et al.Ultrasound-guided open nephron sparing surgery without renal artery occlusion for central renal tumors[J].J Huazhong Univ Sci Technolog Med Sci,2016,36(1):118-120.
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[6]宋剑楠,赵晓智,连惠波,等.腹腔镜射频消融治疗T1aN0M0期肾癌的中期随访分析[J].中华外科杂志,2013,51(4):320-322.
[7]刘光香,郭宏骞,李笑弓,等.射频消融治疗功能性孤立肾肾细胞癌的临床分析[J].中华泌尿外科杂志,2010,31(11):748-751.
[8]Panumatrassamee K,Autorino R,Laydner H,et al.Robotic versus laparoscopic partial nephrectomy for tumor in a solitary kidney:a single institution comparative analysis[J].Int J Urol,2013,20(5):484-491.
[9]Chang X,Liu T,Zhang F,et al.Radiofrequency ablation versus partial nephrectomy for clinical T1a renal-cell carcinoma:longterm clinical and oncologic outcomes based on a propensity score analysis[J].J Endourol,2015,29(5):518-525.
[10]Lorber G,Glamore M,Doshi M,et al.Long-term oncologic outcomes following radiofrequency ablation with real-time temperature monitoring for T1a renal cell cancer[J].Urol Oncol,2014,32(7):1017-1023.
[11]Su MZ,Memon F,Lau HM,et al.Safety,efficacy and predictors of local recurrence after percutaneous radiofrequency ablation of biopsy-proven renal cell carcinoma[J].Int Urol Nephrol,2016,48(10):1609-1616.
[12]Cooper CJ,Teleb M,Dwivedi A,et al.Comparative Outcome of Computed Tomography-guided Percutaneous Radiofrequency Ablation,Partial Nephrectomy or Radical Nephrectomy in the Treatment of Stage T1 Renal Cell Carcinoma[J].Rare Tumors,2015,7(1):5583.
[13]刘国安,赖江琼,梁礼平,等.彩色多普勒超声检查对肾癌诊断及分期的临床价值[J].东南国防医药,2015,17(6):613-615,625.
[14]Dai Y,Covarrubias D,Uppot R,et al.Image-Guided Percutaneous Radiofrequency Ablation of Central Renal Cell Carcinoma:Assessment of Clinical Efficacy and Safety in 31 Tumors[J].J Vasc Interv Radiol,2017,28(12):1643-1650.
[15]Gang G,Hongkai Y,Xu Z.Sorafenib combined with radiofrequency ablation in the treatment of a patient with renal cell carcinoma plus primary hepatocellular carcinoma[J].JCancer Res Ther,2015,11(4):1026.
[2]Psutka SP,Feldman AS,Mc Dougal WS,et al.Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma[J].Eur Urol,2013,63(3):486-492.
[3]Levey AS,Stevens LA,Schmid CH,et al.A new equation to estimate glomerular filtration rate[J].Ann Intern Med,2009,150(9):604-612.
[4]Fu D,Li P,Xu F,et al.Ultrasound-guided open nephron sparing surgery without renal artery occlusion for central renal tumors[J].J Huazhong Univ Sci Technolog Med Sci,2016,36(1):118-120.
[5]Mc Govern FJ,Wood BJ,Goldberg SN,et al.Radio frequency ablation of renal cell carcinoma via image guided needle electrodes[J].J Urol,1999,161(2):599-600.
[6]宋剑楠,赵晓智,连惠波,等.腹腔镜射频消融治疗T1aN0M0期肾癌的中期随访分析[J].中华外科杂志,2013,51(4):320-322.
[7]刘光香,郭宏骞,李笑弓,等.射频消融治疗功能性孤立肾肾细胞癌的临床分析[J].中华泌尿外科杂志,2010,31(11):748-751.
[8]Panumatrassamee K,Autorino R,Laydner H,et al.Robotic versus laparoscopic partial nephrectomy for tumor in a solitary kidney:a single institution comparative analysis[J].Int J Urol,2013,20(5):484-491.
[9]Chang X,Liu T,Zhang F,et al.Radiofrequency ablation versus partial nephrectomy for clinical T1a renal-cell carcinoma:longterm clinical and oncologic outcomes based on a propensity score analysis[J].J Endourol,2015,29(5):518-525.
[10]Lorber G,Glamore M,Doshi M,et al.Long-term oncologic outcomes following radiofrequency ablation with real-time temperature monitoring for T1a renal cell cancer[J].Urol Oncol,2014,32(7):1017-1023.
[11]Su MZ,Memon F,Lau HM,et al.Safety,efficacy and predictors of local recurrence after percutaneous radiofrequency ablation of biopsy-proven renal cell carcinoma[J].Int Urol Nephrol,2016,48(10):1609-1616.
[12]Cooper CJ,Teleb M,Dwivedi A,et al.Comparative Outcome of Computed Tomography-guided Percutaneous Radiofrequency Ablation,Partial Nephrectomy or Radical Nephrectomy in the Treatment of Stage T1 Renal Cell Carcinoma[J].Rare Tumors,2015,7(1):5583.
[13]刘国安,赖江琼,梁礼平,等.彩色多普勒超声检查对肾癌诊断及分期的临床价值[J].东南国防医药,2015,17(6):613-615,625.
[14]Dai Y,Covarrubias D,Uppot R,et al.Image-Guided Percutaneous Radiofrequency Ablation of Central Renal Cell Carcinoma:Assessment of Clinical Efficacy and Safety in 31 Tumors[J].J Vasc Interv Radiol,2017,28(12):1643-1650.
[15]Gang G,Hongkai Y,Xu Z.Sorafenib combined with radiofrequency ablation in the treatment of a patient with renal cell carcinoma plus primary hepatocellular carcinoma[J].JCancer Res Ther,2015,11(4):1026.