腹腔镜下冷循环射频消融治疗肾细胞癌

目的 探讨腹腔镜下冷循环射频消融治疗肾细胞癌的可行性. 方法对12例肾癌患者选择性实施腹腔镜下冷循环射频消融治疗13次.肿瘤位于左肾4例,右肾7例,双肾1例.肿瘤最大径2.1～8.5 cm,其中T1N0M0 11例,T2N0M0 2例.术后采用CT、超声造影定期随访. 结果 平均手术时间(92±24)min,平均出血量(50±2)ml,术中均末输血.未见腹腔镜手术相关并发症.术后6周13个肾癌病灶,完全消融12个、消融不全1个,完全消融率92.3%(12/13).血红蛋白、红细胞沉降率、血肌酐、患侧肾小球滤过率较术前无明显变化(P>0.05).术后3个月10例患者复查CT,病灶完全坏死9例、部分坏死1例.随访时间1～16个月,中位数7.8个月,12例均生存.无局部及远处复发病例. 结论 腹腔镜下冷循环射频消融是一种安全有效治疗肾癌的新方法,比超声引导下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.

Laparoscopic cool-tip radiofrequency ablation for renal cell carcinoma

Objective To evaluate the clinical feasibility of laparoscopic cool-tip radiofrequency ablation (LCRFA)for renal cell carcinoma. Methods Twelve selected cases of primary renal, ceil carcinoma underwent LCRFA. Of them, 4 cases of left renal carcinomas, 7 cases had right renal carci-nomas and 1 case had bilateral renal carcinomas. The maximum diameter of the tumors was 2.1-8. 5 era. Eleven cases were T, No M0 and the other one was T2 N0 M0. Results The mean operation time was 92±24 min, and the mean blood loss was 50±29 ml. None of the cases need blood transfusion post-operation. No laparoscopic operative complications were observed. Six weeks after operation, complete ablation was achieved in 12 lesions and partial ablation in 1, with a complete ablation rate of 92.3%(12/13). There was no statistic change of Hb. ESR. SCr and GFR after operations (P>0.05). Ten cases underwent CT examination 3 months after the treatment ,9 cases showed complete necrosis of tumor,1 case showed partial necrosis. No recurrence was found. All of the 12 cases remained sur-vived during the follow-up for 1-16 months(median,7.8 months). Conelusions LCRFA for renal cell carcinoma is an accurate and effective intervention with a low incidence of complications, and is more accurate than ultrasound-guided pereutaneous radiofrequency ablation.