动脉栓塞联合氩氦刀序贯治疗小肾癌的临床疗效分析

摘要

目的：探讨动脉栓塞(TAE)联合CT引导经皮氩氦刀序贯治疗小肾癌的安全性和疗效。方法收集2008年2月-2013年7月南京军区南京总医院医学影像科介入病房44例TAE联合CT引导经皮氩氦刀序贯治疗的小肾癌患者,术后1个月复查肾功能,术后1~3个月复查增强CT或增强MRI,采用mRECIST标准评价其疗效,并对患者进行12~46个月随访,平均随访时间28个月。结果44例患者共48个病灶行TAE和氩氦刀序贯治疗,其中病灶完全缓解(CR)38个,部分缓解(PR)6个,病灶稳定(SD)4个,缓解率(CR+PR)为91.7%。所有患者均未发生严重并发症,仅1例患者冷冻过程中出现局限性出血,给予对症处理后好转。患者术后平均住院时间4 d,随访期间3例失访,1例因食管癌相关并发症死亡。40例患者随访期均存活,存活患者中5例于13~22个月后复发,后予以再次联合治疗。结论采用TAE联合CT引导经皮氩氦刀序贯治疗小肾癌微创、安全、有效,尤其是氩氦刀冷冻前进行栓塞可能降低冷冻过程中出血发生率,值得临床推广应用。%Objective To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) combined with argon-helium cryoablation in treating small renal cancers. Methods During the period from February 2008 to July 2013, a total of 44 patients with small renal cancer were treated with TAE and argon-helium cryoablation at The Medical Imaging Department of Nanjing General Hospital of Nanjing Military Area Command. The renal function was reexamined one month after the treatment. Contrast-enhanced CT or MRI was performed in all patients within 1-3 months after the treatment. By using mRECIST, the therapeutic efficacy was evaluated. All patients were followed up for 12-46 months (mean 28 months). Results A total of 48 lesions in the 44 patients were treated with sequential therapy of TAE and argon-helium cryoablation. Of the 48 lesions, complete remission (CR) was achieved in 38, partial remission (PR) in 6 and stable disease (SD) in 4, the remission rate (CR+PR) was 91.7%. No severe complications occurred in all patients, except one who developed localized hemorrhage during the performance of argon-helium cryoablation, which was improved after symptomatic medication. The mean postoperative hospitalization time was 4 days. Three patients were lost to follow-up, one patient died of esophageal cancer-related complication. The remaining patients were survival during the follow-up period, among them recurrence occurred in five within 13-22 months after the treatment, and the sequential therapy of TAE and argon-helium cryoablation had to be carried out once more. Conclusion For the treatment of small renal cancers, the sequential therapy of TAE combined with argon-helium cryoablation is minimally-invasive, safe and effective, and TAE that is performed before argon-helium cryoablation can reduce the incidence of bleeding occurring in the freezing process. Therefore, this technique should be recommended in clinical practice.