Computed Tomography–guided Percutaneous Radiofrequency Ablation of Adrenal Tumours: Five-year Institutional Review on Safety and Technique
CSL Tong, RKL Lee, PSF Lee
Hong Kong J Radiol 2011;14:132-40
Objective: Computed tomography–guided radiofrequency ablation is an emerging minimally invasive therapy for solid organ neoplasms. This study aimed to evaluate our technical and safety experience with this procedure when used for the ablation of adrenal tumours.
Methods: Records of all patients who had computed tomography–guided radiofrequency ablation of adrenal tumours performed in our department between August 2004 and August 2009 were retrospectively reviewed. Individual tumour characteristics, procedural technique, complications, and subsequent management were assessed.
Results: In all, 56 computed tomography–guided radiofrequency ablations of adrenal tumours (59% Conn’s adenomas, 20% Cushing’s adenomas, 21% metastases; mean maximal dimension, 2.5 cm) were performed in 49 patients (24 males, 25 females; mean age, 53 years). Four patients had more than one session of radiofrequency to achieve complete tumour ablation. Most commonly, a prone paraspinal approach was employed in 70%; decubitus paraspinal and transhepatic approaches were used in 21% and 9% of the instances, respectively. In eight (14%) of the instances, an iatrogenic pneumoretroperitoneum was induced or a hydrodissection was performed in order to position the adrenal more favourably for electrode insertion. In three (5%) of the instances, attempted insertion failed. Fourteen (25%) of the procedures resulted in minor complications, which included seven retroperitoneal haematomas (size, 0.5-4 cm) and six small pneumothoraces. One patient endured a hypertensive crisis. The median hospital stay for our patients was two days.
Conclusion: Apart from one patient who had a hypertensive crisis, no other major morbidity or mortality was observed. Computed tomography–guided radiofrequency ablation of adrenal tumours can be technically challenging for those with an unfavourable anatomy. However, compared to currently employed standard forms of open or laparoscopic surgery, it was associated with a lower complication rate and shorter hospital stay, and can therefore be considered a safe procedure in experienced hands.
中文摘要
CT導引下經皮射頻消融術治療腎上腺腫瘤的安全性及技術層面： 五年本地經驗
唐倩儂、李嘉樂、李醒芬
目的：CT導引下經皮射頻燒融術是治療實質器官腫瘤的一種新興微創術。本研究評估此技術治療腎 上腺腫瘤的安全性及技術層面。
方法：回顧2004年8月至2009年8月期間於本院進行CT導引下經皮射頻消融術治療腎上腺腫瘤的病人 紀錄。並分析其腫瘤特徵、技術程序、併發症及其後的跟進。
結果：49名腎上腺腫瘤病人（24男、25女；平均年齡53歲）共進行56次CT導引下經皮射頻消融術， 包括Conn’s腺瘤（59%）、Cushing’s綜合症（20%）、轉移瘤（21%）；腫瘤平均最大徑為2.5 cm。 有4名病人要進行超過一次的消融術來把腫瘤徹底清除。大多數採用俯伏式椎旁切口（70%），其餘 採用臥位椎旁切口（21%）及經肝方法（9%）。為更易把電導管插入腫瘤，8例（14%）進行腹膜後 腔積氣或水分離的方法。3名病人（5%）最終不能把電導管插入。14例（25%）有輕微併發症，包括 7例出現腹膜後血腫（0.5至4 cm大小）及6例出現氣胸，另1例有高血壓危象。病人住院中位數為兩 天。
結論：除了1人有高血壓危象外，其餘病人均無嚴重疾病或死亡。CT導引下經皮射頻消融術治療腎 上腺腫瘤對於一些解剖困難的病人會有技術困難。與傳統標準的開胸或腹腔鏡手術比較，此消融術 有相對較低的併發率及較短的住院期。對於有豐富經驗的醫生來說，此技術是安全的。