小肾肿瘤的冷冻消融治疗  

Cryoablation for small renal masses

作　　者：顾晓[1,2] WONG Carson 

机构地区：[1]扬州大学第一临床医学院泌尿外科,江苏扬州225001 [2]美国俄克拉荷马大学医学中心泌尿外科

出　　处：《临床泌尿外科杂志》2012年第11期814-816,818,共4页Journal of Clinical Urology

摘　　要：目的:回顾分析小肾肿瘤冷冻消融治疗的临床资料并总结经验。方法:2004年8月～2010年11月行腹腔镜下(腹腔镜组,n=7)或经皮穿刺(经皮组,n=24)冷冻消融治疗小肾肿瘤患者30例(31个肿瘤)。31个肿瘤中7个位于肾上极,12个位于肾中极,12个位于肾下极。冷冻治疗前均行肿瘤穿刺活检病理检查,术后定期随访。结果:平均手术时间腹腔镜组(142.1±32.9)min明显长于经皮组(103.8±29.9)min,差异有统计学意义(P=0.009)。中位出血量腹腔镜组为55ml明显多于经皮组的5ml,差异有统计学意义(P<0.001)。病理结果示19个(61.3%)肾细胞癌,4个(12.9%)嗜酸细胞瘤,5个(16.1%)良性肿瘤,3个(9.7%)穿刺标本中未见肿瘤组织。随访3～60(19.2±16.1)个月,术前平均血肌酐浓度141.5μmol/L与术后3个月复查浓度176.8μmol/L差异无统计学意义意义(P=0.212)。1例(3.2%)患者术后出现肉眼血尿,1例(3.2%)肾细胞癌患者术后6个月复发。结论:冷冻消融是治疗小肾肿瘤安全有效的方法,适用于高危患者。Objective：Review our experience with percutaneous and laparoscopic cryoablation for treating small renal masses. Method：We retrospectively analyzed renal cryoablation procedures performed between August 2004 and November 2010. 30 consecutive patients underwent laparoscopic （laparoscopy group, n= 7） or percutaneous （percutaneous group, n=24） cryoablation for 31 tumors. 7, 12 and 12 tumors were located in upper pole, mid pole and lower pole, respectively. Biopsy was taken before cryoablation procedure started. Patients were followed up regularly. Result：Seven tumors were treated by laparoscopic eryoablation and the remaining 24 were treated by percutaneous cryoablation, mean operative time were significantly different （142.1±32.9 vs. 103.8±29.9 mins, P=0. 009）. Median estimated blood loss in laparoscopic group was significantly greater than in percutaneous group （55 vs 5ml, P〈0. 001）. Pathologic results showed 19（61.3%） of renal cell carcinoma, 4（12.9%） of oneo- cytoma, 5（16.1%） of benign tumors and 3（9.7%） of no tumor tissue. Mean follow up interval was 19.2±16.1 （3-60） months. There was no significant difference in serum creatinine level between preoperative and 3 months postoperative （141.5 vs 176.8μmol/L, P=0. 212）. 1（3.2%） patient had post-operative gross hematuria and 1 （3.2 %） patient was found recurrence 6 months after cryoablation. Conclusion：Cryoablation is a safe and effective option for treating small renal mass, feasible for high risk patients with comorbidity.

关 键 词：肾肿瘤 冷冻外科治疗 腹腔镜 经皮穿刺 

分 类 号：R737.11[医药卫生—肿瘤]