经皮穿刺冷冻消融治疗肋骨转移性病变

I. Burovik, G. Prokhorov, S. Bagnenko, A. Vasilev
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引用次数: 1

摘要

介绍。微创经皮冷冻消融术用于骨肿瘤病灶的局部控制和疼痛综合征的缓解。在胸骨破坏的情况下,这种手术伴随着胸部和腹部器官以及大血管受损的风险。本文讨论经皮穿刺冷冻消融治疗肋骨转移性病变的特点。目的:分析经皮冷冻消融治疗肋骨转移性病变的方法学,明确穿刺立体定向通路。材料和方法。该手术在11例少转移性骨病变患者中进行。肋骨病变大小从7到55毫米不等。手术在气管内麻醉下于CT手术室进行。硝酸冷冻系统使用可重复使用的探针,直径从1.5到3.0毫米不等。冷冻消融包括两个循环,冷却至目标温度- 190°C,分别暴露10分钟和6分钟。结果和讨论。因此,提出了在肿瘤肋骨破坏中安装冷冻探针的最佳穿刺途径,包括切向和垂直的。在切向通道,冷冻探针可以直接放置在肿瘤病变(骨内变异)和病变水平沿骨的软组织(骨旁变异)。术后随访3 ~ 27个月(11.4±5.6个月)。在3例中,记录了消融病灶水平的病理性骨折的形成。10例患者肿瘤进程得到局部控制,1例术后3个月消融区复发。由于使用了所描述的通道,并实施了旨在防止皮肤冷损的措施,所有病例均成功实现了手术目标,避免了并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Percutaneous Puncture Cryoablation in Patients with Rib Metastatic Lesions
Introduction. The method of mininvasive percutaneous cryoablation is applied in the tumor lesions of bones for the purpose of local control and pain syndrome relief. In the case of chest bone destruction, such procedures are accompanied by a risk of damage to the thoracic and abdominal organs, as well as large vessels. This article discusses the peculiarities of percutaneous puncture cryoablation in patients with rib metastatic lesions.Aim. To analyze the methodological aspects of percutaneous cryoablation in patients with rib metastatic lesions and to clarify puncture stereotactic accesses.Materials and methods. The procedure was performed in 11 patients with oligometastatic bone lesions. The size of rib lesions varied from 7 to 55 mm. Surgery was performed in a CT operating room under endotracheal anesthesia. A nitric cryosystem with reusable probes of a diameter varying from 1.5 to 3.0 mm was used. The cryoablation included two cycles of cooling down to the target temperature of –190 °C with 10- and 6-min exposure, respectively.Results and discussion. As a result, optimum puncture accesses for the installation of cryoprobes in tumoral rib destruction, including tangential and perpendicular ones, were proposed. At the tangential access, the cryoprobe can be placed both directly into the tumor lesion (intraosseous variant) and into soft tissues along the bone at the lesion level (paraosseous variant). The follow-up period after the procedure varied from 3 to 27 months (11.4 ± 5.6 months). In 3 cases, the formation of a pathological fracture at the level of the ablated lesion was recorded. The local control of the tumoral process was achieved in 10 patients, a relapse in the ablation zone was noted in one case 3 months after the procedure.Conclusion. Due to the use of the described accesses, as well as the implementation of measures aimed at preventing cold cutaneous lesions, the surgery goals were successfully achieved and complications were avoided in all cases.
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