腹腔镜下射频消融治疗中央型肾肿瘤

Laparoscopic radiofrequency ablation for centrally located renal tumors

目的 探讨腹腔镜下射频消融治疗中央型肾肿瘤的安全性及有效性.方法 2009年1月至2013年4月南京大学医学院附属鼓楼医院泌尿外科采用腹腔镜下射频消融治疗临床分期T1aN0M0中央型肾肿瘤13例,男性9例,女性4例;年龄38 ～ 73岁,平均56岁.所有患者均为单侧发病,左侧8例,右侧5例.术中采用实时超声监测联合温度探针对肾肿瘤射频消融治疗,并通过输尿管导管灌注冰盐水对集合系统物理降温.术后复查血肌酐及肾小球滤过率（GFR）,定期CT、MRI随访.手术前后数据比较采用配对t检验.结果 13例患者均顺利接受手术.手术平均时间（113±13） min,平均出血量（99±23） ml.术前和术后血肌酐平均值分别为（71±11）和（74±11） μmol/L,患侧肾GFR平均值分别为（49±8）和（45±7）ml/min,差异均无统计学意义（t=-1.371 ～ 1.986,P＞0.05）.13例患者随访时间12 ～ 63个月,平均37个月,未出现局部复发或者远处转移病例.结论 腹腔镜下射频消融治疗T1aN0M0中央型肾肿瘤安全有效,术中实时超声监测联合应用温度探针可以控制射频范围,集合系统物理降温可以减少术后肾盂积水和漏尿发生.

Objective To study the safety and effectiveness of laparoscopic radiofrequency ablation for centrally located renal tumors.Methods From January 2009 to April 2013,thirteen patients who diagnosed as centrally located renal tumors were treated with laparoscopic radiofrequency ablation in the Department of Urology of Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School.All of the cases were T1 aN0M0 stage,9 patients were male,4 were female,the mean age was 56 years（range,38-73 years）.All tumors were unilateral,eight lesions were in the left kidney and five in the right kidney.Intraoperative real-time ultrasound and temperature probes were used to guide the range of radiofrequency ablation.Ice saline was injected through ureteral catheter for cooling the collecting system.The postoperative serum creatinine and glomerular filtration rate （GFR） data were collected,all patients were followed up with enhanced CT or MRI.The pre-and post-operative date were compared by paired t test.Results All patients underwent laparoscopic radiofrequency ablation successfully.The mean operation time was （113 ± 13）minutes and the mean blood loss was （99 ± 23）ml.The mean pre-and post-operative serum creatinine was （71 ± 11） p mol/L and （74 ± 11） μmol/L,the mean pre-and post-operative GFR was （49 ± 8） ml/min and（45 ±7）ml/min.There was no significant statistic difference between pre-operation and post-operation （t=-1.371 and 1.986,P 〉0.05）.The mean follow-up was 37 months,range 12-63 months.No evidence of local recurrence or distant metastasis was found.Conclusions Laparoscopic radiofrequency ablation for T1aN0M0 centrally located renal tumors could be performed safely with good outcomes.Intraoperative real-time ultrasound and temperature probes are helpful to control the range of radiofrequency ablation.Physical cooling of renal collecting system could reduce the occurrence of postoperative hydronephrosis and leakage of urine.