Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C.
Anticancer Res. 2023 Apr;43(4):1699-1708. doi: 10.21873/anticanres.16322.
BACKGROUND/AIM: To survey the safety and efficacy of percutaneous cryoablation for renal tumors under local anesthesia and pain control by using the -40°C lethal isotherm of the ice ball to cover the tumor margin as well as the coaxial cryoablation technique.
All procedures were performed between February 2014 and November 2021 with computed tomography (CT) guidance. All tumors were ablated by following the aforementioned plan, according to which tumor margins were covered by the -40°C lethal isotherm. Hydrodissection and coaxial cryoablation were performed in some cases to avoid organ injury and massive bleeding. 2% xylocaine was used for local anesthesia and 50 mg of pethidine (meperidine) was injected intramuscularly for pain control and sedation. The complications were evaluated and the Kaplan-Meier method was used to estimate local recurrence-free survival (LRFS).
Sixty-five tumors [49 renal cell carcinomas (RCC) and 16 angiomyolipomas] were ablated in 55 patients (median Charlson Comorbidity Index=5.0). Local recurrence occurred in three of the 49 RCC cases. Two received a second cryoablation. LRFS at three and five years were both 91%. LRFS at three and five years reached 100% in tumors <3 cm. A large tumor (≥3 cm) was observed in the recurrence group. Hemorrhage was the most common complication (76.9%). Two patients who needed blood transfusion did not receive coaxial cryoablation. Three (4.6%) major complications (Clavien-Dindo grade ≥3) occurred.
By using -40°C as the pre-plan tumor coverage, with the aid of coaxial cryoablation and multiplanar reconstruction method, CT-guided percutaneous renal cryoablation under local anesthesia is a safe and effective procedure in patients with many comorbidities.
背景/目的：调查在局部麻醉和疼痛控制下使用 -40°C 冰球致死等温线覆盖肿瘤边缘以及同轴冷冻消融技术对肾肿瘤进行经皮冷冻消融的安全性和疗效。
所有操作均于 2014 年 2 月至 2021 年 11 月在 CT 引导下进行。所有肿瘤均按照上述方案进行消融，根据该方案，肿瘤边缘由 -40°C 致死等温线覆盖。在某些情况下进行水分离和同轴冷冻消融，以避免器官损伤和大出血。2%的利多卡因用于局部麻醉，50mg 哌替啶（美沙酮）肌肉注射用于止痛和镇静。评估并发症，并使用 Kaplan-Meier 方法估计局部无复发生存率（LRFS）。
55 例患者中有 65 个肿瘤（49 个肾细胞癌[RCC]和 16 个血管平滑肌脂肪瘤）被消融（中位 Charlson 合并症指数=5.0）。49 例 RCC 中有 3 例出现局部复发。其中 2 例接受了第二次冷冻消融。3 年和 5 年的 LRFS 均为 91%。3 年和 5 年的 LRFS 在肿瘤<3cm 时均达到 100%。复发组中观察到一个较大的肿瘤（≥3cm）。出血是最常见的并发症（76.9%）。2 例需要输血的患者未接受同轴冷冻消融。3 例（4.6%）发生严重并发症（Clavien-Dindo 分级≥3）。
在局部麻醉下，通过使用 -40°C 作为预设肿瘤覆盖范围，借助同轴冷冻消融和多平面重建方法，对合并多种疾病的患者进行 CT 引导下经皮肾冷冻消融是一种安全有效的方法。
