The Clinical Study Of CT-guided Percutaneous Conformal Argon-helium Cryoablation For Adrenal Solid Tumors

Research objectiveIn recent years,the technology of cryoablation has been widely applied in the therapies of solid tumors,such as liver cancer,lung cancer and kidney cancer.Due to the physiologically endocrine function of adrenal gland,there is a great challenge for the application of this technique in solid adrenal tumors.For patients who are unable to tolerate surgery or unwilling to accept surgery,image-guided percutaneous cryoablation under local anesthesia shows its incomparable advantages in minimizing their sufferings.The aim of this study was to assess the safety and feasibility of CT-guided percutaneous conformal argon-helium cryoablation for adrenal solid tumors under local anesthesia,to explore various techniques and methods to ensure the successful implementation of the cryoablation,and to analyze the efficacy of this technique in the treatment of adrenal solid tumors according to relevant standards.Research methodIn this study,45 patients with adrenal solid tumors treated by CT-guided percutaneous conformal argon-helium cryoablation under local anesthesia from July 2011 to October 2017 were collected according to inclusion criteria and exclusion criteria.Preoperative diagnosis of adrenal solid tumors was confirmed by two or more imaging methods(CT,ultrasound,MRI,nuclear medicine)and laboratory examination or biopsy pathology.Among 45 cases of adrenal solid tumors,31 cases were metastases,8 cases were pheochromocytomas,3 cases were adenomas and 3 cases were adrenal cortical carcinoma.The image guidance equipment of Philips PQ6000 spiral CT,the Argon-Helium cryoablation equipment of Israel Cryo-HitTM,the refrigerant and heat media of ultra-high pressure argon and helium respectively were used in this study.All operations were performed under the informed permissions of the patients and their clients before operation.In order to ensure the successful implementation of ablation,arterial embolization was used in the treatment of hypervascular tumors before operation.Hydraulic separation was also used in the operation of solid tumors adjacent to important tissues and organs.31 cases of metastatic tumors were followed up until June 2018 or death.Enhanced CT or MRI scanning were performed in 1 month,3 months,6 months and 12 months after operation.Moreover,enhanced CT scannings were reviewed every 6 months to evaluate the survival time and related risk factors of patients with adrenal metastases.8 patients with pheochromocytoma were treated with blockers of a-receptor and dilatation before operation,blood pressure changes were monitored by continuous invasive pressure measurement through radial arteryand blockers of a-receptor and other drugs were used to control paroxysmal hypertension during cryoablation.Research resultsIn this study,the treatment of 45 patients with cryoablation was successfully completed,no operation was terminated and no serious complications related to cryoablation were observed.Moreover,4 patients underwent arterial embolization of tumor supply 1-2 weeks before cryoablation,8 patients underwent the second cryoablation within 3 months after cryoablation because of the large size of the tumor,3 patients underwent hydraulic separation technology before cryoablation because the tumor was adjacent to the small intestine.According to the types of tumors,statistics analysis and discussion were made respectively,the survival rates of 31 patients with adrenal metastatic cancer and cumulative results of 1,3 and 5 years were 83.9%,45.0%and 30.0%,respectively.Continuous intraoperative arterial pressure measurement was successful in 8 patients with pheochromocytoma,intraoperative use of blockers of a-receptorand other drugs was effective in controlling hypertension,and there was significant difference in blood pressure before and after cryotherapy and during rewarming(p<0.05).ConclusionCT-guided percutaneous conformal argon-helium cryoablation under local anesthesia is safe and feasible for the treatment of adrenal solid tumors with minimal trauma.Compared with other surgical treatments and image-guided ablation techniques,it possess definite therapeutic effects,fewer complications,and allows various techniques to simultaneously ensure the success of surgery before and during the operation.This technique is especially suitable for patients who are unsuitable or unwilling to undergo surgery.