摘要
目的：初步研究冷冻消融（氩氦刀）联合口服索拉菲尼治疗转移性肾癌的临床效果。方法：回顾性分析我院2010年10月～2012年3月收治的9例肾癌伴远处转移患者的临床资料：男7例，女2例，年龄43～71岁，平均58岁。9例肾癌伴肺部转移患者中，双侧多发肺转移伴右侧肱骨转移1例，左侧肺转移5例，右肺转移3例。所有患者均先行根治性肾切除术，2周后再于局部麻醉下行转移灶冷冻治疗，然后口服索拉菲尼进行治疗。结果：9例患者手术均获得成功。肺部转移病灶完全损毁7例，术后4例出现少量咳血，对症处理后缓解；1例术后1周出现大量胸腔积液，予以放置闭氏引流后积液消失，右肱骨转移灶冷冻术后患肢未见明显异常，2周后恢复正常功能。患者术后口服索拉菲尼，药物耐受性及肿瘤控制均取得较满意效果。9例患者随访6～21个月，平均15个月。1例肾癌伴下腔静脉癌栓，左肺转移患者术后13个月死于肿瘤转移，2例肺部多发转移患者分别于术后12、16个月死于肿瘤进展，其余患者均存活。结论：转移性肾癌愈后差，冷冻治疗转移灶后联合索拉菲尼进行治疗可提高患者的生存时间。但由于病例数较少，仍需积累更多相关例数，进一步随诊观察。
Objective： To preliminarily observe the clinical effect of cryosurgery （argon-helium knife） combined with sorafenib on the patients with metastatic renal cell carcinoma. Method： From October 2010 to March 2012, nine patients including seven males and two females were treated for renal cell carcinoma. The average patients＇ age was 58 （range, 43-71） years old. Of them, one case was found bilateral multiple pulmonary metastasis combined with right side of humerus metastasis, five cases were diagnosed as left lung cancer metastasized from renal cell carcinoma, and right lung cancer metastasized from renal cell carcinoma was found in other three cases. All pa- tients were treated with sorafenib after radical nephreetomy combined with cryoablation for bone and lung metasta- ses under the local anesthesia. Result：Cryoablation was technically successful in all nine patients. The metastatic lesions of pulmonary in seven cases was completely damaged. Four patients had postoperative symptoms of hemop- tysis, and the symptoms disappeared after the symptomatic treatment. One case experienced massive pleural effu- sion at the first week after cryosurgery, and the symptom vanished after the closed chest drainage. The patient with bone metastases returned to normal function after cryoablation in the right humerus for two weeks. All pa- tients were sensitive to sorafenib and showed good clinical effects. All patients were followed up for 6-21 （mean, 15） months. One case of renal cancer accompanied by inferior vena cava tumor thrombus migrating to the left lung and two patients with lung multiple tumor metastasis died 13, 12 and 16 months postoperatively respectively. The rest patients still survived. Cofielusion：The prognosis of metastatic renal cell carcinoma is poor. Cryotherapy com- bined with the treatment of sorafenib for metastatic renal cell carcinoma can increase the survival of patients with advanced cancer. However, more relevant cases are needed to have a further observation.
出处
《临床泌尿外科杂志》
2015年第5期412-415,共4页
Journal of Clinical Urology
关键词
转移性肾癌
冷冻消融
索拉菲尼
metastatic renal cell carcinoma
cryoablatiom
sorafenib
