腹腔镜辅助下冷循环射频消融治疗肾脏肿瘤

Laparoscopic cool-tip radiofrequency ablation for renal tumors

目的探讨腹腔镜下冷循环射频消融(LCRFA)治疗肾脏肿瘤的可行性。方法对21例肾脏肿瘤患者选择性实施LCRFA治疗。其中原发性肾细胞癌18例,嗜酸细胞瘤1例,肾错构瘤2例。肿瘤最大径1.9～4.0 cm。比较手术前后体温、肝肾功能、Hb水平及ESR变化;术后定期观察肾功能、CT,超声造影监测消融灶的改变。结果平均手术时间(92.0±24.5)min,平均出血量(50.0±28.8)ml。21个肿瘤病灶中,术后1个月完全消融20个(95.24%)。Hb、ESR、Cr、患侧ECT-肾小球滤过率(GFR)较术前无明显变化。18例获得6个月后CT随访资料,17例病灶完全坏死,1例病灶部分坏死。无局部及远处复发病例。随访时间1～18个月(平均10.8个月),21例均生存。结论LCRFA是一种安全有效的治疗肾脏肿瘤的新方法,比超声引导下经皮射频治疗定位更加精确,可以应用于不适合超声引导下经皮肾穿刺射频消融的病例。

Objective To evaluate the clinical feasibility of laparoscopic cool-tip radiofrequency ablation（LCRFA）for renal tumors.Methods Of 21 selected cases of small kidney tumors,18 cases were primary renal cell carcinoma,1 case was oncocytoma and 2 cases were hamartoma.The maximum diameters of the tumors were 1.9 to 4.0cm.The changes of tempreture,functions of the liver and kidney,hemoglubin（Hb）,ESR and SCr were compaered before and after LCRFA.The patients were followed up with CT and ultrasonic contrast.Results The mean time of operation was（92.0±24.5）min with a mean blood loss of（50.0±28.8）ml.None of the cases recepted blood transfusion after operation.Complete ablation rate was 95.24%（20/21） in one month after operation.There were no statistical changes found in Hb,ESR,SCr and ECT-GFR after operation.Of 18 cases underwent CT examination 6 months after the treatment,17 cases showed completely necrosis of the tumors,1 case showed partial necrosis.No recurrence was seen by CT and ultrasonic contrast.All 21 cases were survived during 1 to 18 months（median,10.8 months） follow-up.Conclusion LCRFA for renal tumors is an effective intervention with a relatively low incidence of complications,which is more accurate than ultrasound-guide percutaneous radiofrequency ablation.