Arima Kiminobu, Yamakado Kouichirou, Suzuki Ryuichi, Matsuura Hiroshi, Nakatsuka Atsuhiro, Takeda Kan, Sugimura Yoshiki
Division of Urology, Mie University Graduate School of Medicine, Tsu, Japan.
Urology. 2007 Sep;70(3):407-11. doi: 10.1016/j.urology.2007.04.032.
To evaluate the feasibility, safety, and therapeutic effects of image-guided radiofrequency (RF) ablation used for the treatment of adrenocortical adenoma with Cushing syndrome.
From February 2003 to May 2005, 4 consecutive patients with adrenocortical adenoma and Cushing syndrome received percutaneous RF ablation. All tumors were in the left adrenal gland, with a mean tumor size of 2.7 +/- 0.6 cm (range 2.0 to 3.5). The RF ablation was performed under real-time computed tomography fluoroscopic guidance. Technical success was defined as disappearance of tumor enhancement on contrast-enhanced computed tomography imaging acquired within 1 week after RF ablation. Clinical success was defined as improvement in serum cortisol and adrenocorticotropic hormone values and symptoms at the end of follow-up.
Tumor enhancement disappeared after initial RF ablation in 3 of 4 patients (technical success rate 75%). The fourth patient underwent a repeat RF ablation session 3 years later, resulting in eradication of tumor enhancement. Both the serum cortisol and adrenocorticotropic hormone levels returned to normal and the symptoms related to Cushing syndrome had disappeared at the end of follow-up (range 20 to 46 months, mean 33) for a clinical success rate of 100%. All tumors showed involution (2.2 +/- 0.3 cm) at the end of the study. No major complications occurred related to the procedures except for pneumothorax requiring chest tube placement for 3 days.
Using RF ablation for adrenocortical adenoma with Cushing syndrome is a feasible, safe, and promising treatment method in selected patients.
评估影像引导下射频（RF）消融治疗库欣综合征肾上腺皮质腺瘤的可行性、安全性及治疗效果。
2003年2月至2005年5月，4例肾上腺皮质腺瘤合并库欣综合征患者接受经皮RF消融治疗。所有肿瘤均位于左肾上腺，平均肿瘤大小为2.7±0.6 cm（范围2.0至3.5 cm）。RF消融在实时计算机断层扫描透视引导下进行。技术成功定义为RF消融后1周内获得的对比增强计算机断层扫描成像上肿瘤强化消失。临床成功定义为随访结束时血清皮质醇和促肾上腺皮质激素值及症状改善。
4例患者中3例在初次RF消融后肿瘤强化消失（技术成功率75%）。第4例患者3年后接受了重复RF消融，肿瘤强化得以消除。随访结束时（范围20至46个月，平均33个月），血清皮质醇和促肾上腺皮质激素水平均恢复正常，与库欣综合征相关的症状消失，临床成功率为100%。研究结束时所有肿瘤均出现缩小（2.2±0.3 cm）。除1例气胸需放置胸腔引流管3天外，未发生与手术相关的严重并发症。
对于库欣综合征肾上腺皮质腺瘤患者，RF消融是一种可行、安全且有前景的治疗方法。
