肾癌冷冻消融术64例经验总结  

Cryoablation of renal cell carcinoma： six-year experience with 64 cases

作　　者：徐斌[1] 宋尚卿 吴震杰[2] 刘冰[2] 杨庆[3] 肖亮[3] 程亚军 于国鹏[1] 李龙 王忠[1] 王林辉[2] 孙颖浩[3] Xu Bin;Song Shangqing;Wu Zhenjie;Liu Bing;Yang Qing;Xiao Liang;Cheng Yajun;Yu Guopeng;Li Long;Wang Zhong;Wang Linhui;Sun Yinghao(Department of Urology, Shanghai Ninth People＇s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011 , China)

机构地区：[1]上海交通大学医学院附属第九人民医院泌尿外科,200011 [2]上海长征医院泌尿外科 [3]上海长海医院泌尿外科

出　　处：《中华泌尿外科杂志》2018年第6期422-427,共6页Chinese Journal of Urology

基　　金：上海交通大学医学院Ⅳ类高峰学科项目（2017LC002）

摘　　要：目的总结冷冻消融术在肾癌保留肾单位手术中的临床应用经验，分析其适应证及治疗效果。方法回顾性分析2012年3月至2018年3月64例行腹腔镜肾癌冷冻消融术及影像学定位引导下冷冻消融术治疗的T1a期肾癌患者的临床资料，其中上海交通大学医学院附属第九人民医院28例，上海长征医院2例，上海长海医院34例。男44例，女20例。年龄35-81岁，平均66岁，其中≥80岁者5例。体重指数（23.9±2.4）kg/m^2 。肿瘤位于左肾29例，右肾32例，双肾3例；孤立肾肾肿瘤4例。有其他部位肿瘤者5例，伴有肾功能不全3例，伴有重症肝炎或肝硬化失代偿期4例，伴有其他合并症39例。术前血肌酐中位值70 μmol/L（48-222 μmol/L）。对一般状况尚可，不能耐受或不愿接受切除性手术的肾癌患者，可行全麻（单孔或普通）腹腔镜下肾癌冷冻消融术；对于全身状况较差无法承受全麻手术，且肿瘤位于背侧的患者，则采用影像学引导冷冻消融术。评估手术并发症，术后采用CT或MRI定期随访评估肿瘤学效果。结果所有手术均顺利完成，未增加切口。术后输血2例，其余病例出血量50 ml（10-110 ml）。肿瘤最大径（2.6±0.9 ）cm（1.2-4.0 cm），手术时间（96.0±24.5）min，术后住院时间（2.7±1.2）d。术后1例因并发出血行数字减影血管造影栓塞止血，其余病例均未出现明显术中及术后并发症。术后复查血肌酐中位值71 μmol/L （49-230 μmol/L），与术前比较差异无统计学意义（P＝0.64）。术后第1周复查肾脏CT或MRI平扫示所有病灶区域呈均匀低密度，CT或MRI增强显示低密度病灶完全无增强，提示消融完全，肿瘤已完全消退。64例随访时间4-72个月，中位时间29个月。1例CT引导下冷冻消融术后6个月复查增强CT示肿瘤复发，遂再次予腹腔镜下冷冻消融术，术后随访40个月未见再次复发；另1例未按规定随访�ObjectiveTo summarize our clinical experience of cryoablation for renal cancer and to analyze the therapeutic indication, security, selection of cryoablation and outcomes.MethodsSixty-four patients suffered with T1a renal cell carcinoma were enrolled in this study from March 2012 to March 2018. Among them, 5 cases were senile patients（≥80 years）, 5 cases complicated with other cancers, 3 cases complicated with renal insufficiency, 4 cases complicated with decompensated cirrhosis, 3 cases with bilateral renal cancer, 4 cases with solitary kidney cancer and 39 cases with some other complications. The preoperative serum creatinine level was（80.5±38.2）μmol/L. The patients underwent laparoscopic single-site （LESS） renal cryoablation, conventional laparoscopic renal cryoablation, or percutaneous image-guided cryoablation according to individual situation. Contrast-enhanced CT scan or MRI were used during the procedures and follow-up was performed.ResultsAll operations were completed successfully and technical success was achieved as well in all cases. Blood transfusion was necessary for 2 cases because of hemorrhage.The mean diameter of the mass was （2.6±0.90）cm , the median volume of blood loss was 50ml（10-110 ml）, and the mean operation time was（96.0±24.5）min. The median inpatient hospital stay was 3 d（1-6 d）. In one case, digital subtraction angiography（DSA ）embolization was performed due to hemorrhage after surgery. None of the other cases had intraoperative or postoperative complications. The serum creatinine level after surgery was not significantly decreased [postoperative （83.8±42.1） μmol/L, P=0.64]. The contrast-enhanced CT or MRI of the kidneys one week postoperatively showed uniform low density in all lesion areas, which represented complete ablation and regression of the tumor. All cases were followed up regularly. One case showed relapse at the 6th month follow-up and underwent cryoablation again. Another case, who was not regularly followed up, relapsed at 69th

关 键 词：癌 肾细胞 冷冻消融 腹腔镜 影像学引导 

分 类 号：R737.11[医药卫生—肿瘤]