Department of Interventional Radiology, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, 3211 Kozukuechou, Kohoku-ku, Yokohama 222-0036, Japan.
Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Tomography. 2024 Nov 7;10(11):1767-1779. doi: 10.3390/tomography10110130.
BACKGROUND/OBJECTIVES: Our aim was to compare the complication rates of different embolization materials (absolute ethanol and gelatin sponges) used for combined transarterial embolization (TAE) and to investigate the impact of tumor size on operative time and cryoneedle use during percutaneous cryoablation (PCA).
We treated 27 patients (9 women and 18 men; mean age, 74 years) with 28 early-stage (T1a) renal cell carcinoma (RCC) lesions using combined TAE and PCA between September 2018 and January 2021. During TAE, 15 lesions in 14 patients were embolized using mixed absolute ethanol and iodized oil. The remaining 13 lesions (in 13 patients) were embolized using a gelatin sponge followed by iodized oil. The PCA was performed within 3 to 21 days of the TAE. We compared complications between the TAE subgroups (i.e., absolute ethanol and gelatin sponge) and assessed potential correlations between tumor size and the operative time of the PCA.
All patients were successfully treated by combined TAE-PCA. Local control was achieved for all patients (monitoring period, 1-48 months; median, 28 months). Although the effect of TAE did not differ between subgroups, a significantly higher number of patients in the absolute ethanol group experienced intraprocedural pain than in the gelatin sponge group ( < 0.05). The operative time of the PCA was significantly correlated with the size of the RCC lesion ( < 0.01). The number of cryoneedles used for the PCA was also correlated with the size of the RCC lesion ( < 0.0001).
For TAE prior to PCA for early-stage RCC, gelatin sponges can replace absolute ethanol to reduce intraprocedural pain. Tumor size correlates with operative time and the number of cryoneedles needed for PCA, which suggests the total medical cost for PCA therefore varies based on the tumor's size.
背景/目的：我们旨在比较不同栓塞材料（绝对乙醇和明胶海绵）在联合经动脉栓塞（TAE）中的并发症发生率，并探讨肿瘤大小对经皮冷冻消融（PCA）手术时间和冷冻探针使用的影响。
我们在 2018 年 9 月至 2021 年 1 月期间，使用联合 TAE 和 PCA 治疗了 27 例（9 名女性和 18 名男性；平均年龄 74 岁）28 个早期（T1a）肾细胞癌（RCC）病变。在 TAE 期间，14 例患者的 15 个病变使用混合的绝对乙醇和碘化油进行栓塞。其余 13 个病变（13 例患者）使用明胶海绵和碘化油进行栓塞。PCA 在 TAE 后 3 至 21 天内进行。我们比较了 TAE 亚组（即绝对乙醇和明胶海绵）之间的并发症，并评估了肿瘤大小与 PCA 手术时间之间的潜在相关性。
所有患者均通过联合 TAE-PCA 成功治疗。所有患者均获得局部控制（监测期 1-48 个月；中位数 28 个月）。尽管 TAE 各组之间的效果无差异，但绝对乙醇组中经历术中疼痛的患者明显多于明胶海绵组（<0.05）。PCA 的手术时间与 RCC 病变的大小显著相关（<0.01）。PCA 所用的冷冻探针数量也与 RCC 病变的大小相关（<0.0001）。
对于早期 RCC 的 PCA 前 TAE，明胶海绵可替代绝对乙醇以减少术中疼痛。肿瘤大小与 PCA 的手术时间和所需冷冻探针数量相关，这表明 PCA 的总医疗费用因肿瘤大小而异。
