CAJ | 학술논문

目的探讨局麻下冷冻消融治疗具有高手术风险的T1期肾细胞癌的可行性. 方法 2008年4月至2013年4月对19例无法耐受手术风险的T1期单发肾细胞癌患者,在局麻下实施经皮冷冻消融治疗.男11例,女8例.年龄41～ 89岁,平均66岁.其中不稳定性心绞痛患者6例,高龄(＞85岁)且拒绝侵入性手术患者4例,消化道肿瘤接受化疗患者3例,终末期肾病接受血液透析患者3例,扩张型心肌病伴心力衰竭患者2例,血友病A患者1例.肿瘤直径1.2～ 5.5cm.术后采用CT、超声造影定期随访. 结果患者局麻耐受性良好.手术时问(55.7±12.8) min,出血量极少.未见明显手术相关并发症.术后3天CT和超声造影显示所有病灶完全消融,技术成功率100％,消融区域直径(3.5±0.8) cm.术后住院(3.8±1.2)d.19例患者随访(36.4±24.1)个月.术后1年测得肿瘤直径为(1.7±0.7)cm,平均缩小58.5％,术后3年时缩小达80.5％,肿瘤局部复发3例,再次予局麻下冷冻消融治疗后,消融完全,未见再次复发.肿瘤特异性生存率100％. 结论局麻下经皮冷冻消融术治疗T1期肾癌有效、安全,适用于高手术风险的早期肾癌患者.
목적 탐토국마하냉동소융치료구유고수술풍험적T1기신세포암적가행성. 방법 2008년4월지2013년4월대19례무법내수수술풍험적T1기단발신세포암환자,재국마하실시경피냉동소융치료.남11례,녀8례.년령41～ 89세,평균66세.기중불은정성심교통환자6례,고령(＞85세)차거절침입성수술환자4례,소화도종류접수화료환자3례,종말기신병접수혈액투석환자3례,확장형심기병반심력쇠갈환자2례,혈우병A환자1례.종류직경1.2～ 5.5cm.술후채용CT、초성조영정기수방. 결과 환자국마내수성량호.수술시문(55.7±12.8) min,출혈량겁소.미견명현수술상관병발증.술후3천CT화초성조영현시소유병조완전소융,기술성공솔100％,소융구역직경(3.5±0.8) cm.술후주원(3.8±1.2)d.19례환자수방(36.4±24.1)개월.술후1년측득종류직경위(1.7±0.7)cm,평균축소58.5％,술후3년시축소체80.5％,종류국부복발3례,재차여국마하냉동소융치료후,소융완전,미견재차복발.종류특이성생존솔100％. 결론 국마하경피냉동소융술치료T1기신암유효、안전,괄용우고수술풍험적조기신암환자.
Objective To evaluate the feasibility,safety and therapeutic effects of local anesthetic percutaneous renal cryoablation for the patients who suffered from T1 single renal cell carcinoma with high surgical risk.Methods Nineteen patients who were not candidates for surgery underwent primary cryosurgery using third-generation cryotechnol％y with ultrathin crvo-needles.Eleven men and 8 women with mean age of 66 years were included in this study.The diameter of the tumors were 1.2-5.5 cm.CT and ultrasonic contrast were used during the treatments and follow-up processes.Results Local anaesthesia was tolerated well by all patients.The mean time of the operations was (55.7± 12.8) min.No operative or immediate postoperative complications were observed.Technical success was achieved in all cases (100％) and 3 reccurent tumors were seen on followup imaging.The mean diameter of the ice ball was (3.5±0.8) cm on CT on the third postoperative day.After an average followup of (36.4±24.1) months,the size reduction was 58.5％ and 80.5％ at 1 year and 3 years.Cancer-specific survival rate was 100％.Conclusion Percutaneous renal cryoablation under local anesthesia is a feasible,safe therapy for the patients who have unresectable T1 renal cell carcinoma in high surgical risk.