微波消融治疗肾脏肿瘤的适应证选择(附17例报告及文献复习)

Selection of indications for microwave ablation in renal tumor(Report of 17 cases and literature review)

目的：探讨微波消融治疗肾脏肿瘤的适应证。方法：自2013年4月～2014年7月应用微波消融治疗肾脏肿瘤患者17例，男13例，女4例，平均年龄59．4（42～83）岁。按适应证将患者分为三组，组一6例（高危不耐受常规手术组），组二9例（明确诊断并行微波消融治疗组），组三2例（微波消融姑息治疗组）。所有患者术中均行肿瘤穿刺活检联合微波消融治疗。结果：组一穿刺结果示肾透明细胞癌5例，病理无法明确1例，平均随访（11．5土3．8）（6～16）个月，未见肿瘤复发和转移，合并尿瘘1例。组二穿刺结果示肾透明细胞癌3例，高分化腺癌】例，错构瘤5例，平均随访（5．6±4．2）（1～11）个月，未见肿瘤复发和转移。组三穿刺结果均为肾透明细胞癌，平均随访（9．5士2．1）（8～11）个月，患者术前腰背部VAS疼痛评分为6～8分，术后为O～2分，随访期间1例出现远处转移、肿瘤进展，另1例出现股骨病理性骨折，肾脏复发灶治愈。三组患者平均住院（4．0士1．O）（2～7）d。结论：微波消融可以安全有效地用于高危不耐受常规手术、肿瘤体积较小且术前肿瘤性质不明确以及晚期肾脏肿瘤患者的姑息治疗，联合穿刺活检还可以明确肿瘤性质，帮助患者制定下一步治疗措施，但远期疗效仍需进一步随访观察。

Objective： To evaluate selection of indications for microwave ablation （MWA） in renal tumor. Meth- od：From April 2013 to July 2014, 17 patients （13 males and 4 females ） accepted MWA in our department. The mean age was 59.4 （range, 42-83） years old. According to indications they were divided into three groups. The first group （contraindications of common operation or severity concomitant diseases） included six patients, the sec- ond group （clear diagnosis and treated with MWA） included nine patients, the third group （clear diagnosis and re- ceiving palliative treatment of MWA） included two patients. All patients accepted needle biopsy combined with MWA. Result：There were five clear cell renal cell carcinoma confirmed by pathologist in the first group and one case was not available. The mean follow-up period was （11.5±3.8） months （range, 6-16 months）. One case of urine leakage had been noted, and the others had no complication, recurrence or metastasis. In the second group, three cases were diagnosed as clear cell renal cell carcinoma, one case was diagnosed as high-differentiated adeno- carcinoma, and five cases were confirmed as angiomyolipomas. During the mean follow-up period of （5.6±4.2） months （range, 1 11 months）, there was no complication, recurrence or metastasis. In the third group, two cases were reported as clear cell renal cell carcinoma. The mean follow-up period was （9.5±2.1） months （range, 8-11 months）. The VAS pain score of waist descended from 6-8 point preoperatively to 0-2 point postoperatively. One case had distant metastasis and tumor progression. The other experienced pathologic fracture due to metastasis, whereas the recurrent renal tumor was cured. The mean hospital stay of all the patients was （4.0±1.0） days （range, 2-7 days）. Conclusion： MWA is a safe and feasible method for selected patients, for example patients with contraindications of common operation or severity concomitant diseases, patients with small renal tumors and the pathology unknown, or patients with advanced tumors. Combined with needle biopsy during MWA could clarify the pathological diagnosis. However, the long-term efficacy still needs further following up.