冷冻消融治疗复发性盆腔和后腹肿瘤的应用

摘要

目的 探索CT定位经皮冷冻消融盆腔和后腹膜术后复发性肿瘤的安全性及疗效.方法 CT定位、引导经皮冷冻消融盆腔、后腹膜恶性肿瘤患者108例并作总结.结果 ①100例中9例为完全性冷冻消融,91例为姑息性冷冻消融.随访3～11年,1年生存率87％(87/100),3年生存率17％(17/100),5年生存率9％(9/100).冷冻后疼痛缓解率84％(70/83).②冷冻后1个月增强CT显示9例完全性消融:肿瘤冷冻区无强化.91例姑息性消融:消融率＞90％ 48例、80％～90％ 25例、70％～80％ 12例、60％～70％4例、＜60％3例.③并发症:术后局部感染3例,抗感染治疗后痊愈;直肠上段肠瘘1例,经肠造瘘后逐渐痊愈;术后短暂排尿困难5例,留置导尿3～5 d恢复;术后发热3～5 d;表皮冻伤3例,对症处理痊愈.结论 盆腔和后腹膜肿瘤术后局限性复发,CT引导冷冻消融较为安全,完全冷冻消融后对提升肿瘤局部控制,延长生存期获益明显.%Objective To investigate the safety and curative effect of CT-guided percutaneous cryoablation in treating recurrent tumors in pelvic cavity and retroperitoneal space.Methods A total of 100 patients with recurrent tumors in pelvic cavity or retroperitoneal space were included in this study.CT-guided percutaneous cryoablation treatment was carried out in all patients.Results ① Of the 100 patients,complete cryoablation treatment was performed in 9 and palliative cryoablation treatment was adopted in 91.The following-up time ranged from 3 years to 11 years.The one-,3-and 5-year survival rates were 87.0％ (87/100),17％ (17/100) and 9％ (9/100) respectively.The pain relief rate after cryoablation treatment was 84.0％ (70/83).② Contrast-enhanced CT scan performed one month after cryoablation treatment showed that complete cryoablation was seen in 9 patients,presenting as no enhancement in the tumor frozen area on CT image;palliative cryoablation was seen in 91 patients,the ablation extent ≥90％ was obtained in 48 patients,the ablation extent of 80-90％ in 25 patients,the ablation extent of 70-80％ in 12 patients,the ablation extent of 60-70％ in 4 patients,and the ablation extent ＜60％ in 3 patients.③ Postoperative complications included local infection (n=3),which was cured after anti-infective therapy;intestinal fistula at upper rectum (n=1),which was gradually healed after enterostomy;transient dysuresia (n=5),which was recovered through retention catheterization for 3-5 days;fever lasting 3-5 days;and skin frostbite (n=3),which was cured after symptomatic treatment.Conclusion For the treatment of recurrent tumors in pelvic cavity and retroperitoneal space,CT-guided percutaneous cryoablation is quite safe.Complete cryoablation is very helpful for improving local tumor control and prolonging survival time.