微波与射频消融辅助的腹腔镜下肾肿瘤剜除术治疗直径≤4 cm肾肿瘤的比较研究

Comparison of laparoscopic microwave ablation and radio frequency ablation assisted renal tumor enucleation for renal tumor smaller than 4 cm

目的 比较微波消融与射频消融辅助的腹腔镜下肾肿瘤剜除术治疗直径≤4 cm肾肿瘤的优缺点、可行性及临床疗效.方法 回顾性分析2012年3月至2014年3月收治的145例直径≤4 cm肾肿瘤患者的临床资料,男98例,女47例.年龄21-74岁,平均53岁.肿瘤最大径1.0-4.0 cm,平均（2.3 ±0.5） cm.微波消融辅助腹腔镜下肾肿瘤剜除术（laparoscopic microwave ablation assisted renal tumor enucleation,MWA-LRTE）组80例,射频消融辅助腹腔镜下肾肿瘤剜除术（laparoscopic radio frequency ablation assisted renal tumor enucleation,RFA-LRTE）组65例.两组均采用经后腹腔途径,MWA-LRTE组采用KY-2000可控杆温微波消融仪,输出功率60W,每个周期消融时间1-3min,共消融1-3个周期;RFA-LRTE组应用冷循环射频消融仪,输出功率150W,每个周期消融时间8- 12min,共消融1-3个周期.两组均消融结束后再沿肿瘤边缘锐性切除肿瘤.比较两组的手术时间、术中出血量、术后并发症、住院时间及局部疗效等指标.结果 本研究145例手术均顺利完成,无中转开放手术.MWA-LRTE组平均手术时间为（76.2 ±9.0）min,RFA-LRTE组为（81.9±8.8） min;MWA-LRTE组术中平均出血量为（82.3±31.5）ml,RFA-LRTE组术为（97.3土27.2）ml,差异均有统计学意义（P＜0.05）.MWA-LRTE组术中、术后无出血病例,术后出现2例尿漏,1例切口愈合不良,并发症发生率为3.75％.RFA-LRTE组术中出血1例,术后尿漏1例,并发症发生率为3.08％,差异无统计学意义（P＞0.05）.MWA-LRTE组与RFA-LRTE组术后住院时间分别为（3.8±0.8）、（4.0±0.8）d,差异无统计学意义（P＞0.05）.术后随访9-33个月,平均21个月,MWA-LRTE组1例和RFA-LRTE组3例出现局部复发,无肿瘤远处转移病例.结论 微波消融或射频消融辅助的腹腔镜肾下肿瘤剜除术是一种安全有效的保留肾单位的术式.与射频消融相比,微波消融辅助的腹腔镜下肾肿瘤剜除术具有消融效率高、手术时间短、出血量相对少等优点,是一种可供选择的、有效的、相对简单易行的术式,但远期疗效尚需进一步观察随访。

Objective Purpose To compare the advantage, feasibility and surgical outcomes of laparoscopic microwave ablation and radio frequency ablation assisted renal tumor enucleation.Methods 145 patients with renal tumor smaller than 4 cm, treated from March 2012 to March 2014, were retrospectively analyzed.There were 98 males and 47 females with a mean age of 53 （ranging 21-74） years old.The diameter of tumor ranged from 1.0 to 4.0 cm, mean 2.3 ± 0.5 cm.Eighty patients underwent laparoscopic microwave ablation assisted renal tumor enucleation （MWA-LRTE） and 65 patients underwent laparoscopic radio frequency ablation assisted renal tumor enucleation （RFA-LRTE）.All procedures were conducted through retroperitoneal approach.KY-2000 microwave ablation system was used in MWA-LRTE group.A 1-3 min power output of 60 W was designed for 1-3 cycles.A RITA 1500 RF generator was used in RFALRTE group and a 8-12 min power output of 150 W was set for 1-3 cycles.The tumors were excised along the margin after ablation.The differences of estimated blood loss, operative duration, postoperative hospital stay, complications and surgical outcomes between the two groups were compared.Results All patients accepted the successful operation without open surgery conversion.The operative time and blood loss in MWA-LRTE and RFA-LRTE group were 76.2 ±9.0 min and 81.9 ±8.8 min, 82.3 ±31.5 ml and 97.3 ± 27.2 ml, respectively.There was statistical significant difference between two groups.In MWA-LRTE group, the incidence of complication was 3.75%, including urine leakage in 2 cases, poor healing of wound in 1 case.In RFA-LRTE group, the incidence of complication was 3.08%, including bleeding in 1 case, urine leakage in 1 case.No significant difference of complication rate was noticed between two groups.The postoperative hospital stay in two groups were 3.8 ± 0.8d and 4.0 ± 0.8d, respectively.Which didn＆#39;t exhibit the statistical significance.With a mean follow-up of 21 （ranging 9-33） months, there was one case of local tumor recurrence in MWA-LRTE group and 3 cases of local tumor recurrence in RFA-LRTE group.Conclusion Laparoscopic microwave ablation and radio frequency ablation assisted renal tumor enucleation are safe and effective option for selected renal tumor.Compared to laparoscopic radio frequency ablation assisted renal tumor enucleation, laparoscopic microwave ablation assisted renal tumor enucleation can decrease blood loss and operative time, which is more effective in treating the renal tumor smaller than 4 cm.The long-term efficacy of this procedure needs to be further investigated.