腹腔镜下微波消融联合肾部分切除术治疗囊性肾肿物的初步疗效观察  

Laparoscopic microwave ablation combined with partial nephrectomy for the treatment of cystic renal masses:initial experience

作　　者：洪保安 杜鑫 纪永鹏 赵强[1] 曹煜东 刘佳[1] 王硕[1] 杜鹏[1] 杨勇[1] 张宁[1] Hong Baoan;Du Xin;Ji Yongpeng;Zhao Qiang;Cao Yudong;Liu Jia;Wang Shuo;Du Peng;Yang Yong;Zhang Ning(Department of Urology,Peking University Cancer Hospital&Institute,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所泌尿外科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华泌尿外科杂志》2021年第10期721-724,共4页Chinese Journal of Urology

基　　金：北京市自然科学基金资助项目(7212010);首都卫生发展科研专项(2020-2-1024)。

摘　　要：目的探讨腹腔镜下微波消融联合肾部分切除术治疗囊性肾肿物的安全性和有效性。方法回顾性分析2017年11月至2019年12月北京大学肿瘤医院收治的19例行腹腔镜下微波消融联合肾部分切除术治疗的囊性肾肿物患者的临床资料。男13例,女6例。年龄(46.2±13.1)岁;体质指数(25.8±3.1)kg/m^(2),患者ECOG评分均为0分。左肾肿物7例,右肾肿物12例;肿物最大径(2.8±1.3)(1.2~5.0)cm;5例为BosniakⅢ级,14例为BosniakⅣ级。R.E.N.A.L.评分4~6分11例,7~9分7例,10~12分1例。腹腔镜下微波消融囊性肾肿物后行肾部分切除术。观察手术并发症,术后应用CT或MRI定期随访评估。结果手术时间(84.0±20.8)min。术中中位出血量20(10~50)ml。术后中位住院时间3(2~6)d,无出血、感染、肉眼血尿或漏尿等术后并发症。根据术后病理结果的恶性程度分组,术后病理提示囊性肾肿物为良性或生物学行为恶性程度较低者为低危组,病理提示囊性肾肿物恶性程度较高者为高危组。低危组4例,其中乳头状腺瘤1例,肾血管平滑肌脂肪瘤1例,低度恶性潜能多房囊性肾肿瘤1例,肾嫌色细胞癌1例(T_(1a)期)。高危组15例,其中肾透明细胞癌14例[美国癌症分期联合委员会(AJCC)病理分期:T_(1a)期11例,T_(1b)期3例;WHO/国际泌尿病理协会(ISUP)分级:1级7例,2级6例,3级1例];2型乳头状肾细胞癌1例(T_(1b)期,2级)。术后中位随访20(12~37)个月,两组患者均存活,胸腹部影像学复查未见肿瘤复发和种植转移征象;定期复查肾功能基本正常。结论腹腔镜下微波消融联合肾部分切除术治疗囊性肾肿物并发症少,无肿瘤复发或转移,有较好的安全性和疗效,且不影响术后病理诊断,为囊性肾肿物提供了一种安全、有效的治疗选择。Objective To explore the safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy in the treatment of cystic renal masses.Methods The 19 patients with cystic renal masses undergoing laparoscopic microwave ablation combined with partial nephrectomy from November 2017 to December 2019 were retrospectively analyzed.There were 13 males and 6 females.The average age was 46.2 years.The mean body mass index was(25.8±3.1)kg/m^(2).The masses located in the left kidney in 7 cases and the right kidney in 12 cases.The ECOG scores were 0.The mean maximum diameter of the tumors was(2.8±1.3)cm.Five cases were diagnosed with BosniakⅢand 14 cases with BosniakⅣ.According to R.E.N.A.L.scoring,11 cases were of low difficulty(4-6 points),7 cases of medium difficulty(7-9 points)and 1 case of high difficulty(10-12 points).The cystic renal masses were ablated by laparoscopic microwave ablation,then followed by partial nephrectomy.Postoperative complications were observed and the prognosis was assessed by CT or MRI.Results The mean duration of operation was(84.0±20.8)min.The median intraoperative blood loss was 20(10-50)ml.The median duration of postoperative hospitalization was 3(2-6)d,and no complications such as bleeding,infection,gross hematuria or urine leakage were observed.According to the malignant degree of cystic renal masses,the patients were divided into low-risk group and high-risk group.The patients with benign cystic kidney tumors or with low biological malignancy were considered as the low-risk group,while the patients with high malignant pathology were considered as the high-risk group.In the low-risk group,there were 4 patients,including 1 patient with papillary adenoma,1 patient with renal angiomyolipoma,1 patient with low-grade malignant potential multilocular cystic renal tumor,and 1 patient with renal chromophobe carcinoma(stage T_(1a)).In the high-risk group,there were 15 cases,including 14 cases of clear cell renal cell carcinoma(AJCC pathological stage:T_(1a) stage 11 cases,

关 键 词：肾肿瘤 囊性 微波消融 腹腔镜 肾部分切除术 预后 

分 类 号：R737.11[医药卫生—肿瘤]