超声造影联合超声监控下冷循环射频消融术治疗T1a期肾癌疗效分析

Efficacy of contrast-enhanced ultrasound combined with ultrasound-guided radiofrequency ablation on T_(1a)renal cancer

目的比较T1a期肾癌患者行超声造影联合超声监控下冷循环射频消融术(RFA)与腹腔镜肾部分切除术(LPN)的疗效及安全性。方法2017年8月—2021年6月新乡医学院第一附属医院诊治T1aN0M0期单发肾癌患者137例,其中行超声造影联合超声监控下冷循环RFA者33例为RFA组,行LPN者104例为LPN组。比较2组年龄、ECOG评分、ASA分级、肿瘤直径、肿瘤类型、肿瘤位置、WHO/ISUF分级、RENAL评分、手术时间、术后住院时间、术中失血量、患肾估算肾小球滤过率(eGFR)损失及手术前、后患肾eGFR;比较2组术后并发症及肿瘤清除率。结果RFA组年龄[75(69,78)岁]大于LPN组[65(59,70)岁](Z=7.308,P<0.001),ECOG评分[1(1,1)分]及ASAⅡ级、中央型、中下极、背侧肿瘤比率(93.94%、15.15%、90.91%、72.73%)均高于LPN组[0(0,0)分、13.46%、2.88%、68.27%、41.35%](P<0.05),肿瘤直径、WHO/ISUF分级、RENAL评分与LPN组比较差异均无统计学意义(P>0.05)。RFA组手术时间[(83.76±19.03)min]、术后住院时间[(3.58±0.61)d]均短于LPN组[(138.41±10.08)min、(6.70±0.55)d](t=-15.318,P<0.001;t=-27.490,P<0.001),术中失血量[(74.55±13.23)mL]、患肾eGFR损失[5(-3,6)mL/(min·1.73 m^(2))]均少于LPN组[(139.92±20.14)mL、6(5,7)mL/(min·1.73 m^(2))](t=-21.550,P<0.001;Z=-5.191,P<0.001)。RFA组术前、术后患肾eGFR[(38.82±5.32)、(36.39±6.06)mL/(min·1.73 m^(2))]均低于LPN组[(43.88±4.80)、(39.18±5.45)mL/(min·1.73 m^(2))](t=-5.131,P<0.001;t=-2.491,P=0.014);LPN组术后患肾eGFR低于术前(t=12.036,P<0.001),RFA组术后患肾eGFR与术前比较差异无统计学意义(t=2.111,P=0.079)。RFA组术后发热、恶心呕吐、血尿、肾区疼痛、肾周血肿发生率及肿瘤清除率与LPN组比较差异均无统计学意义(P>0.05)。结论超声造影联合超声监控下冷循环RFA治疗T1a期肾癌的肿瘤清除率与LPN相近,可有效保护肾功能,不增加并发症发生率,尤其适用于高龄、基础状况较差及中央型、中下极、背侧肾肿瘤患者。

Objective To compare the efficacy and safety of contrast-enhanced ultrasound(CEUS)combined with ultrasound-guided radiofrequency ablation(RFA)versus laparoscopic partial nephrectomy(LPN)in the treatment of T_(1a)renal cancer.Methods Totally 137patients with solitary renal cancer in stage T_(1a)N_0M_0were diagnosed and treated in the First Affiliated Hospital of Xinxiang Medical University from August 2017to June 2021,among whom 33patients age,ECOG score,ASA grade,tumor diameter,tumor type,tumor location,WHO/ISUF grade,RENAL score,operation lasting time,length of postoperative hospital stay,intraoperative blood loss,estimated glomerular filtration rate(eGFR)loss of the affected kidney,eGFR of the affected kidney before and after operation,postoperative complications and tumor clearance rate were compared between two groups.Results The patients were older in RFA group[75(69,78)years]than LPN group[65(59,70)years](Z=7.308,P<0.001).The ECOG scores,and rates of ASAⅡ,central,mid-lower pole and dorsal tumors were higher in RFA group[1(1,1),93.94%,15.15%,90.91%,72.73%]than those in LPN group[0(0,0),13.46%,2.88%,68.27%,41.35%](P<0.05),and there were no significant differences in the tumor diameter,WHO/ISUF grade and RENAL score between two groups(P>0.05).The operation lasting time and postoperative hospital stay were shorter in RFA group[(83.76±19.03)min,(3.58±0.61)d]than those in LPN group[(138.41±10.08)min,(6.70±0.55)d](t=-15.318,P<0.001;t=-27.490,P<0.001),the intraoperative blood loss and eGFR loss of the affected kidney were less in RFA group[(74.55±13.23)mL,5(-3,6)mL/(min·1.73m^(2))]than those in LPN group[(139.92±20.14)mL,6(5,7)mL/(min·1.73m^(2))](t=-21.550,P<0.001;Z=-5.191,P<0.001),the preoperative and postoperative eGFRs of the affected kidney were lower in RFA group[(38.82±5.32),(36.39±6.06)mL/(min·1.73m^(2))]than those in LPN group[(43.88±4.80),(39.18±5.45)mL/(min·1.73m^(2))](t=-5.131,P<0.001;t=-2.491,P=0.014),the postoperative eGFR of the affected kidney was lower than the preoperative eGFR in LPN group(t=12.036,P<0.001),and there was no significant difference in eGFR of the affected kidney before and after operation in RFA group(t=2.111,P=0.079).There were no significant differences in the tumor clearance rate and the incidence rates of postoperative fever,nausea/vomiting,hematuria,renal pain and perirenal hematoma between two groups(P>0.05).Conclusions CEUS combined with ultrasound-guided RFA has a similar tumor clearance rate with LPN in the treatment of T_(1a)renal cancer,which can effectively protect renal function without increasing the incidence of complications.It is particularly suitable for elderly patients with poor basic conditions and central,mid-lower pole and dorsal renal cancer.