Department of Radiology, Division of Abdominal Imaging and Intervention, and the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Obstet Gynecol. 2014 Mar;123(3):500-505. doi: 10.1097/AOG.0000000000000133.
Image-guided percutaneous thermal ablation is a commonly performed therapeutic procedure for various tumors. Thermal ablation is not frequently used in the pelvis as a result of anatomic concerns and the potential risk of nontarget tissue injury.
Percutaneous thermal ablation is a minimally invasive procedure involving special probes inserted through the skin to the target lesion under imaging guidance. Various delivery methods of thermal ablation exist, including radiofrequency ablation, which burns tissue, and cryoablation, which freezes tissue with an ultimate goal to destroy the target tumor while minimizing damage to adjacent structures. Protective measures can be used to provide access and safe treatment delivery such as pyeloperfusion to protect the ureter with the infusion of water using a ureteral stent or hydrodissection to protect adjacent structures by displacing them away with the infusion of water using percutaneously placed needles.
The authors' experience with the technique involves thermal ablation of recurrent pelvic tumor in three patients with various gynecologic malignancies who each had a single focus of pelvic recurrence after surgical resection and radiation treatment. No residual or recurrent disease was seen at the treatment site on follow-up imaging consistent with local tumor control.
Thermal ablation of metastatic or recurrent pelvic tumor is technically feasible and should be considered in selected patients with no treatment alternative.
影像引导经皮热消融是治疗各种肿瘤的常用治疗方法。由于解剖学上的考虑和潜在的非目标组织损伤风险，热消融在骨盆中并不常用。
经皮热消融是一种微创程序，涉及通过皮肤将特殊探针插入到影像引导下的目标病变部位。存在多种热消融的输送方法，包括射频消融，其使组织燃烧，以及冷冻消融，其通过最终目标破坏目标肿瘤，同时最小化对邻近结构的损伤来冷冻组织。可以使用保护措施来提供进入和安全的治疗输送，例如肾盂灌注，通过输尿管支架输注水来保护输尿管，或水分离，通过经皮放置的针将水输注以将相邻结构移位来保护相邻结构。
作者的技术经验涉及三名患有各种妇科恶性肿瘤的患者的复发性盆腔肿瘤的热消融，这些患者在手术切除和放射治疗后均有单一的盆腔复发病灶。在随访影像上，治疗部位未见残留或复发疾病，符合局部肿瘤控制。
对于没有治疗选择的特定患者，转移性或复发性盆腔肿瘤的热消融在技术上是可行的，应予以考虑。
