天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (11): 1176-1180.doi: 10.11958/20181018

• 临床研究 • 上一篇    下一篇

射频消融辅助开放性手术治疗肾透明细胞癌脊柱转移的临床疗效

刘乐乐， 王国文△， 韩秀鑫， 张超， 任志午， 李丽丽， 许尧   

  1. 天津医科大学肿瘤医院骨与软组织肿瘤科， 国家肿瘤临床医学研究中心， 天津市肿瘤防治重点实验室， 天津市恶性肿瘤临床医学研究中心 （邮编300060）
  • 收稿日期:2018-07-03 修回日期:2018-09-17 出版日期:2018-11-15 发布日期:2018-11-20
  • 通讯作者: 王国文 E-mail:wgwhrb@163.com
  • 基金资助:
    国家自然科学基金

Clinical efficacy of radiofrequency ablation assisted open surgery in the treatment of spinal metastases of clear cell renal cell carcinoma

LIU Le-le, WANG Guo-wen△, HAN Xiu-xin, ZHANG Chao, REN Zhi-wu, LI Li-li, XU Yao   

  1. Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin’ s Clinical Research Center for Cancer, Tianjin 300060, China
  • Received:2018-07-03 Revised:2018-09-17 Published:2018-11-15 Online:2018-11-20

PDF (PC)

4169

摘要： 摘要： 目的 探讨射频消融 （RFA） 辅助开放手术治疗肾透明细胞癌脊柱转移的临床疗效。方法 回顾性分析 2009年4月—2013年10月天津医科大学肿瘤医院收治的肾透明细胞癌脊柱转移患者31例， 其中男24例， 女7例， 年龄35~71岁， 平均 （55.3±10.5） 岁。RFA辅助开放手术 （RFA辅助组） 13例， 单纯开放手术 （单纯手术组） 18例。比较2 组术中出血量及手术时间， 应用视觉模拟评分 （VAS） 评估疼痛改善情况， 应用Frankel分级对脊髓损伤进行评估， 应用卡氏 （KPS） 评分系统对功能状态进行评分， 采用EORTC QLQ-C30 （Version 3.0） 问卷调查方法进行生活质量评价。治疗后对患者进行随访并进行生存分析。结果 随访10~50个月， 平均 （26.65±1.96） 个月。RFA辅助组术中平均出血量较单纯手术组明显减少 ［（1 488.46±629.87） mL vs.（2 050.00±726.19） mL， P＜0.05］， 手术时间明显缩短 ［（221.54± 79.04） min vs.（291.11±95.29） min， P＜0.05］； 2组治疗3个月、 6个月后疼痛程度较术前均有明显缓解 （均P＜0.01）； RFA辅助组术后3个月Frankel分级D、 E级比例由术前的53.8%提高到术后的84.6% （P＜0.05）， 单纯手术组由术前的66.7%提高到术后的88.9% （P＜0.01）； RFA辅助组术后3个月KPS评分80~100分的比例较术前提高38.4%， 单纯手术组提高27.8%； 2组治疗后功能状态较术前均有明显改善 （均P＜0.05）。结论 RFA辅助开放手术治疗肾透明细胞癌脊柱转移安全、 有效， RFA辅助下能够明显减少术中出血量， 缩短手术时间。

关键词: 肾肿瘤, 腺癌, 透明细胞, 脊柱, 肿瘤转移, 导管消融术, 外科手术

Abstract: Abstract: Objective To investigate the outcome of the combination of radiofrequency ablation (RFA) and open surgery for treating spinal metastases in clear cell renal cell carcinoma (CCRCC). Methods From April 2009 to October 2013, 31 CCRCC cases with spinal metastases were reviewed retrospectively in the present study, including 24 males and 7 females, with an average age of (55.3±10.5) years (range, 35~71 years). All the patients were divided into two groups based on the received treatment, including combinative treatment group (received the combinative treatment of RFA and surgery, n=13) and surgery group (received surgery without RFA application, n=18). Blood loss and intra-operative time were compared between the two groups. Pain levels were assessed by visual analogue scale (VAS). Neurologic deficit was evaluated by Frankel grade, and function was classified by Karnofsky Score (KPS). The quality of the life was assessed by EORTC QLQ-C30 (Version 3.0) questionnaire. Survival time was also analyzed after treatment. Results The period of follow-up ranged from 10 to 50 months with the average of (26.65±1.96) months. The blood loss was (1 488.46±629.87) mL in combinative treatment group, which was significantly less than that in surgery group (2 050.00±726.19) mL (P＜0.05). The intra-operative time (221.54 ± 79.04) min was significantly reduced in the combinative treatment group than that of surgery group (291.11±95.29 min, P＜0.05). VAS scores significantly decreased 3 months and 6 months after treatment in the two groups (P＜0.01). The proportion of Frankel grade (Grade D and E) increased from 53.8% (pre-operation) to 84.6% (post-operation) in the combinative treatment group (P＜0.05), while surgery group showed the significant change from 66.7% (pre-operation) to 88.9% (post-operation, P＜0.01). Compared with pre-operative KPS score, the proportion of KPS score (80-100) increased by 38.4% and 27.8% 3 months after operation in combinative treatment group and surgery group, respectively. The functional state improved significantly after treatment is both groups (P＜0.05). Conclusion The combination of RFA and surgery is a safe and efficacy treatment strategy for clear cell renal cell carcinoma patients with spinal metastases, which can significantly reduce the blood loss and intra-operative time in surgery.

Key words:  kidney neoplasms, adenocarcinoma, clear cell, spine, neoplasm metastasis, catheter ablation, surgical procedures, operative