| ObjectiveTo evaluate the short-term clinical efficacy of ultrasound guided percutaneous microwave ablation in the treatment of renal cell carcinoma and to compare the results of renal tumor ablation with different location,that to analyze the factors that influence the success of the ablation..MethodsProspectively evaluated 35 renal tumors in 30 patients(18 male,12 female;5cases in hibateral kidneys,10 cases metastatic tumor of kidney,7 cases resection one side kidney,2 cases with renal inadequacy,1 case with a bad condition);who were referred to our institution from June 2012 to December 2014 underwent microwave ablation guided by ultrasound.All the patients were performed with conventional ultrasound,contrast-enhanced ultrasound and contrast-enhanced MR or enhanced CT examination,in order to ensure the tumor location and size,making the needle direction and the ablation plan.All patients underwent ultrasound guided biopsy before operation,the pathological results: 10 cases of metastatic renal cell carcinoma,14 cases of patients with renal cell carcinoma,5cases of papillary carcinoma,1 cases of angiomyolipoma.After 15~30min all the ablation lesions should examined exactly by intra-operative CEUS to investigate the treatment effect of microwave ablation,within 24 hours image examination(CEMRI,CECT)CEMR were performed in order to observe the perfusion changes of contrast medium in cortex and parenchyma phase and to evaluate the range of lesion with ablation.The treatment response and technical success were defined by absence of contrast enhancement within the tumor on contrast enhanced MR or contrast-enhanced ultrasound in each phase,and irregularenhancement around or inside the treatment zone demonstrated residual tumor remained,then needs remedies.Monitoring glomerular filtration rate(GFR)and serum creatinine before and after microwave treatment,evaluate renal function,both major and minor complications,the management and outcomes of the complications.Patients should be regularly(1 days,1 months after surgery,3 months,6 months later,inspect every 6 months)for imaging(using enhanced CT or MRI),witch were analysis of patients metastasis-free survival(MSF)and local recurrence free(LRFS).Mul tivariate analysis was used to determine variables associated with major compli cations and also the percentage GFR change after microwave.Results1?In all,35 tumors were microwave ablated with a mean(range)tumor size of2.9(1-5.6)cm and the mean(range)patient age was 67.7(21–88.6)years,with a follow-up period of 1/3/6/12 months.Retrospectively analyzed,the total success rate was 91.3%.2?Regular follow-up of patients,during this period,three patients lost their life(after 8monthes,11 monthes,14monthes),patients metastasis-free survival(MSF)and local recurrence free(LRFS)was93.5% and 87.7%?3?The primary technical and overall technical success rate was 85.7% and 91.4%,respectively.The main factors that influence the success of ablation are the location of tumor growth in multivariate logistic regression analysis.Exogenic renal tumor can increase the success rate of ablation and can reduce the damage of renal function.4?In this 30 patients,major complications included hematuresis(two cases)and postoperative hemorrhage(one case),perirenal hematoma(one case).In all patients,only one person develop slightly renal function deterioration.Conclusions:1.The effects of microwave ablation of renal tumors in different parts of the kidney are the result of microwave ablation.Exogenous tumors is a positive factor for patients prognosis and ablation tumors.2.Image-guided MWA is a safe and effective treatment for patients with renal cell carcinoma,can nephron sparing,with a low rate of recurrence and has good MFS rates. |
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