摘要目的 探讨CT导向下无水乙醇消融(PEA)在复杂性肾脏肿瘤治疗中的临床价值.方法 中山大学附属肿瘤医院影像介入中心10例复杂性肾脏肿瘤患者,其中肾癌7例,肾错构瘤3例,病灶数16个,肿瘤最大径在1.7～8.4 cm,平均3.6cm.在CT引导、局麻下进行经皮穿刺无水乙醇消融治疗,常规行螺旋CT平扫和增强扫描进行随访评价疗效.结果 10例患者平均每人2次PEA治疗,随访2～26个月,平均18个月.1例孤立肾肾癌患者经2次PEA治疗后,已随访1年9个月未见复发;1例孤立肾多发肾癌患者4次PEA治疗后肾衰死亡;2例肾癌伴腰痛血尿症状经PEA治疗后病灶消融完全,血尿症状缓解;其他3例肾痛患者分别随访18个月、26个月和12个月,1例死于远处转移,其他2例CT复查未见肿瘤进展.2例错构瘤患者均1次PEA治疗后病灶内出血症状消失,分别随访12个月年和22个月病情稳定.1例肾错构瘤患者2次PEA治疗后未再继续治疗.全部患者无一例出现尿瘘、出血、肠穿孔或针道转移等并发症.结论 CT导向下无水乙醇消融治疗对复杂性肾脏肿瘤是一种微创、疗效确切、可供选择的局部治疗方法,但对于孤立肾肾癌,PEA治疗须谨慎.

abstractsObjective To probe clinical value of percutaneous ethanol ablation (PEA) in complicated renal carcinoma. Methods 10 cases complicated renal carcinoma patients with 16 lesions ranged from 1.7-8.4 cm totally, renal cancer in 7 cases, renal hamartoma in 3 cases,enderwent CT guided pereutaneous ethanol ablation(PEA) by local anesthesia. Plain and contrast CT scan was adopted to evaluate clinical effect and make follow-up. Results Each patient accepted 2 times PEA in average with follow-up time ranged from 2 to 26 months averaged in 18 months. No recurrence was seen in 1 ease isolated renal patient unfortunately with renal cancer through 1 year and 9 months follow-up after 2 times PEA. The other isolated renal cancer patient died of acute renal failure after 4 times PEA. Lesions were fully ablated in 2 cases renal cancer patients with low back pain and blood urine and symptoms disappeared after PEA accordingly. Other 3 cases renal cancer patients went through 1 year and 6 months,2 years and 2 months,and 1 year follow-up respectively. 1 case died of distant metastasis and 2 cases kept stabilization evaluated by CT scan. Hemorrhage within lesions disappeared in 2 cases renal hamartoma after just one time PEA, which keptstabilization through lycar, 1 year and 10 months follow-up respactively. 1 case hamartoma patient gave up treatment after 2 times PEA. No complications including urinary fistula, hemorrage, intestinal perforation and needle track implantation were seen in all patients. Conclusion CT guided PEA is a microinvasive, positive curative effect and faculative method in treating complicated renal carcinomas. But for isolated renal pa tientwith renal cancer,PEA should be performed cautiously.