氩氦刀冷冻消融治疗恶性肾肿瘤23例分析

目的探讨氩氦刀冷冻消融治疗恶性肾肿瘤的临床疗效。方法应用氩氦刀冷冻消融治疗恶性。肾肿瘤患者23例。CT引导下经皮肾穿刺9例，后腹腔镜下9例，开放手术5例。结果术后第1、6个月复查CT或MRI，肾肿瘤冷冻区域呈梗死、无信号增强、逐渐消散等演变过程。23例均未见出血、皮肤冻伤、感染、穿刺道种植转移等严重并发症。随访1．5～48个月，平均28．5个月。21例健康存活，未发现远处转移和复发；死亡2例。开放手术治疗者5例，其中左肾平滑肌肉瘤1例于术后1．5个月因肿瘤广泛转移死亡；CT引导下治疗患者，1例肿瘤直径为8cm者术后10个月因脑血管意外死亡。结论氩氦刀冷冻治疗恶性肾肿瘤技术可靠、创伤小、安全性高，是治疗孤立肾肾肿瘤或无法手术肾肿瘤的一种有效的新手段，对于小的肾肿瘤采用后腹腔镜下氩氦刀冷冻消融治疗是一种值得尝试的新方法。

Clinical analysis of Argon-Helium targeted cryoablation in the treatment of malignant tumor of kidney

Objective To evaluate the clinical efficacy of Argon-Helium （Ar-He） cryoablation for malignant tumor of kidney. Methods 23 patients with malignant tumors of kidney were treated with Ar-He cryoablation. Of them, 9 patients were treated with CT-guided percutaneous puncture, 9 with retroperitoneal laparoscopic cryoablation and 5 with open surgery. Results One month and 6 months respectively after the operation, CT or MRI scan showed infarction in the renal tumor frozen area, no signal enhancement or gradual dissipation was observed. No complications, such as bleeding, cold injury of skin, infection, or metastasis inside the puncture path occurred. During the follow-up of 1.5 to 48 months （average 28.5 months）, 21 patients recovered successfully, and no distant metastases or recurrence was found. Of the 2 patients who died, one receiving open surgery because of left renal leiomyosarcoma died 1.5 months after the surgery due to extensive metastasis. The other pa- tient with tumor diameter of 8 cm died 10 months after the surgery due to cerebrovascular accident. Conclusions Ar-He cryoablation is safe, effective, reliable, and minimally invasive in treating the solitary kidney renal tumor or inoperable renal tumor. Retroperitoneal laparoscopic cryoablation for small renal tumors is a new method worth trying.