冷循环射频消融联合肿瘤剜除术治疗巨大肾错构瘤的初步临床观察  

A clinical observation of cool-tip radiofrequency ablation assisted enucleation for giant renal angiomyolipoma

作　　者：张士伟[1] 张立进[1] 赵晓智[1] 纪长威[1] 刘光香[1] 李笑弓[1] 宋剑楠[1] 郭宏骞[1] 

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,210008

出　　处：《中华外科杂志》2016年第2期129-132,共4页Chinese Journal of Surgery

摘　　要：目的初步探讨冷循环射频消融联合肿瘤剜除术治疗窄基、外向型生长的巨大肾错构瘤的临床疗效。方法回顾性分析南京大学医学院附属鼓楼医院泌尿外科2011年7月至2014年10月收治的接受冷循环射频消融联合肾肿瘤剜术的15例巨大、窄基底型肾错构瘤患者资料，男性6例，女性9例，年龄35～71岁，中位年龄49岁。肿瘤位于左肾6例、右肾8例，孤立肾1例。所有诊断均经超声或CT检查结果证实。肿瘤最大径8．5—12．7cm，平均9．7cm。所有肿瘤均呈窄基、外向型生长，无集合系统侵犯。15例患者术前平均血红蛋白为（127±19）g／L、平均血清肌酐为（89±53）μmol／L、患肾平均肾小球滤过率（GFR）为（32±12）ml·min^-1·1．73m^-2。结果15例患者手术均获得成功，平均手术时间（115±31）min，平均出血量（72±21）ml，术后平均住院时间（7±2）d。术中及术后均未输血，术后3d复查血红蛋白为（129±18）g／L，血清肌酐为（92±41）μmol／L，患。肾GFR为（30±15）ml·min^-1·1．73m^-2，与术前相比差异均无统计学意义（P值均〉0．05）。术后病理检查结果证实为肾错构瘤。平均随访19．5个月，术后1、3、6个月复查CT及GFR，均显示无局部复发或肾功能受损。结论冷循环射频消融联合肿瘤剜除可安全有效地治疗窄基、外向型生长的巨大肾错构瘤，短期随访结果显示治疗效果基本达到预期目标。Objective To initially explore the clinical effect of cool-tip radiofrequency ablation combined with enucleation for the giant hamartoma of kidney with narrow base and export-oriented way of growth. Methods The clinical date of 15 patients including 6 male and 9 female with special hamartoma of kidney underwent cool-tip radiofrequency ablation assisted enucleation from July 2011 to October 2014 were reviewed. The median age was 49 years （ranging from 35 to 71 years）. There were 6 cases with left renal tumor,8 cases with right renal tumor and 1 case with solitary kidney tumor. All patients were confirmed by B ultrasound or CT scan ,the mean diameter of hamartoma of kidney was 9.7 cm（ 8.5 - 12.7 ） cm, all tumors were located distant from the collecting system and presents with a special way of growth. The preoperative hemoglobin was （ 129 ± 18） g/L, SCr was （ 92 ± 41 ） μmol/L, glomerular filtration rate （GFR） was （ 32 ± 12）ml · min^-1 · 1.73 m^-2. Results Cool-tip radiofrequency ablation assisted enucleation was technically successful in all patients. The mean operative duration was （ 115 ± 31 ）minutes, and the average intraoperative bleeding was （72 ± 21 ）ml with no blooding transfusion. The postoperative hospital stay was （7 ±2 ）days, and the postoperative hemoglobin was （ 129 ± 18 ） g/L, SCr （ 92 ± 41 ） μmol/L, GFR （ 30 ± 15 ） ml · min^-1 · 1.73 m^-2. No statistic change of hemoglobin and SCr or glomerular filtration rate after operations（ all P 〉 0. 05）. Postoperative pathology showed that all cases were hamartoma of kidney. During a mean follow-up period of 19. 5 months, none of them had local tumor recurrence or chronic renal insufficiency. Confusions Cool-tip radiofrequeney ablation assisted enucleation is both safe and effective in the treatment of huge hamartoma of kidney with a narrow base and export-oriented way of growth. The short-term follow-up shows a satisfactory therapeutic effect.

关 键 词：错构瘤 肾肿瘤 导管消融术 剜除术 

分 类 号：R737.11[医药卫生—肿瘤]