腹腔镜下冷循环射频消融和肾部分切除术治疗肾癌的临床疗效比较

目的 比较腹腔镜下冷循环射频消融和肾部分切除术治疗肾癌的临床疗效.方法 2005年4月至2008年5月先后采用腹腔镜下冷循环射频消融和肾部分切除术治疗肾细胞癌66例.射频消融组37例,治疗39次.男30例,女7例,平均年龄62岁.肿瘤位于左肾13例,右肾22例,双肾2例.肿瘤最大径2.1～8.5 cm.其中T_1N_0M_032例,T2N0M07例.肾部分切除组29例.男19例,女10例,平均年龄61岁.肿瘤最大径2.0～4.5 cm,平均2.8 cm.统计学比较2组手术前后Hb、红细胞沉降率、SCr、患侧GFR及手术时间、术中平均出血量、术后住院时间、术后并发症发生率等指标.结果 68例次手术均获成功,无中转开放者.射频消融组和肾部分切除组Hb、红细胞沉降率、SCr、患侧GFR与术前比较差异均无统计学意义(P＞0.05).2组手术时间分别为(87±22)、(146±45)min,术中出血量分别为(46±27)、(274±269)ml,术后住院时间分别为(5±1)、(10±2)d,组间比较差异均有统计学意义(P＜0.01).射频消融组术后无明显腹腔镜相关并发症,术后6周39个肾癌病灶完全消融37个(94.9%),消融不全2个;肾部分切除组术后出现漏尿1例,2周后自行愈合.66例术后平均随访20(3～36)个月,无复发及死亡者.结论 腹腔镜下冷循环射频消融治疗肾癌安全有效.在手术时间、术中出血量和术后恢复等方面优于腹腔镜下肾部分切除术.

Comparison of clinical efficacy in the treatment of renal cell carcinoma: laparoscopic cool-tip radiofrequency ablation vs partial nephrectomy

Objective To compare the clinical outcomes of laparoscopic cool-tip radiofrequency ablation(LCRFA)and partial nephrectomy(LPN)in the treatment of renal eell carcinoma. Methods The LCRFA group included 37 selected primary renal eell carcinoma cases(30 males and 7 females with mean age Of 62 years).There were 1 3 tumors located in the left，22 located in the right and 2 lo-cated bilaterally.The maximum diameter of tumors was 2.1-8.5 cm.Of which,32 cases were in T1 N0 Mo and 7 were in T_2 N_0 Mo.The LPN group included 29 renal tumors patients(1 9 males and 10 females with mean age of 61 years).The ma~mum diameter of the tumors in this group was 2.0-4.5 em.Changes of Hb.ESR.SCr and ECT-GFR after operations were compared between LCRFA group and LPN group.The operative time，average estimated blood loss.postoperative hospital stay,and postoperative complication rates of the 2 groups were compared and analyzed. Results The 2 surgical procedures were both successful.There was no significant change of Hb，ESR,SCr and ECT-GFR after operations in LCRFA group and LPN group(P>0.05).The operation time was 87±22 min and 146 ± 45 min in LCRFA group and LPN group，respectively.The average estimated blood loss was 46±27 ml and 274±269 m1.The postoperative hospital stay was 5±1 d and 10±2 d.These differences between the 2 groups were significant(P<0.01).No laparoseopie operative complication was noted in LCRFA group.Of the 39 lesions，complete ablation was achieved in 37 lesions(94.9％) and partial ablation achieved in 2 cases in the evaluation 6 weeks after operation.One patient from LPN group had prolonged urinary leakage lasted for 2 weeks.3-36 months'(mean 20 months)fol- low-up showed no recurrence of tumors in both groups.All of the 66 cases survived during the follow- up period. Conclusion LCRFA for renal eell carcinoma is an accurate and effective intervention with a relatively low complication rates.and is superior to LPN in operative time,estimated blood loss and postoperative recovery.