肾动脉低温灌注联合机器人辅助冷循环射频消融治疗复杂性肾脏肿瘤
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摘要
目的:总结肾动脉低温灌注联合机器人辅助冷循环射频消融治疗复杂性肾脏肿瘤的手术经验,并初步探讨其安全性和有效性。方法:回顾性分析2016年11月~2018年2月于我院接受肾动脉低温灌注联合机器人辅助冷循环射频消融治疗的12例复杂肾肿瘤患者的临床资料。研究参数包括影像学检查结果、手术前后总肾功能及患肾GFR和相关并发症。结果:12例患者均顺利完成手术,手术成功率为100%。肿瘤大小平均3.2cm,R.E.N.A.L.评分平均8分。术后总肾功能和患肾GFR检查与术前比较无显著改变,影像学检查未见肿瘤残留及复发。结论:该手术方式对于复杂性肾肿瘤是安全可行的,可作为肾部分切除术的一种替代方案,长期效果有待于进一步研究证实。
Objective:To introduce the oncologic and safety outcomes of robot-assisted laparoscopic cool tip radio frequency ablation with renal artery cold perfusion for complex renal tumors.Method:The data of 12 patients with complex renal tumors who underwent robot-assisted laparoscopic radio frequency ablation with renal artery perfusion were analysed from November 2016 to February 2018 in Nanjing Drum Tower Hospital.Routine followup included contrast enhanced CT/MRI and renal function test.Result:Mean diameter and R.E.N.A.L.score of tumors were 3.2 cm and 8.The success rate of the procedure was 100%.There was no significant difference between the pre-and post-operative renal function.No evidences of tumor residual or local recurrence by the imageological examination were found.Conclusion:This procedure is favorable with good renal function preservation and oncologic outcomes.It may be a good alternative to partial nephrectomy for complex renal tumors.
Objective:To introduce the oncologic and safety outcomes of robot-assisted laparoscopic cool tip radio frequency ablation with renal artery cold perfusion for complex renal tumors.Method:The data of 12 patients with complex renal tumors who underwent robot-assisted laparoscopic radio frequency ablation with renal artery perfusion were analysed from November 2016 to February 2018 in Nanjing Drum Tower Hospital.Routine followup included contrast enhanced CT/MRI and renal function test.Result:Mean diameter and R.E.N.A.L.score of tumors were 3.2 cm and 8.The success rate of the procedure was 100%.There was no significant difference between the pre-and post-operative renal function.No evidences of tumor residual or local recurrence by the imageological examination were found.Conclusion:This procedure is favorable with good renal function preservation and oncologic outcomes.It may be a good alternative to partial nephrectomy for complex renal tumors.
引文
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3 阮东丽,张更,李智斌,等.机器人辅助腹腔镜与后腹腔镜肾部分切除术近期临床疗效比较[J].临床泌尿外科杂志,2016,31(6):538-542.
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7 Huang W C,Levey A S,Serio A M,et al.Chronic kidneydisease after nephrectomy in patients with renal corticaltumours:A retrospective cohort study[J].Lancet Oncol,2006,7(9):735-740.
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11 Yang R,Lian H,Zhang G,et al.Laparoscopic radiofrequency ablation with intraoperative contrast-enhanced ultrasonography for T1bN0M0renal tumors:initial functional and oncologicoutcomes[J].J Endourol,2014,28(1):4-9.
12 Chang X,Liu T,Zhang F,et al.Radiofrequency ablation versus partial nephrectomy for clinical T1arenal-cell carcinoma:long-term clinical and oncologic outcomes based on a propensity score analysis[J].J Endourol,2015,29(5):518-525.
13 Gervais D A,McGovern F J,Arellano R S,et al.Radiofrequency ablation of renal cell carcinoma:Part 1,Indications,results,and role in patient managementover a 6-year period and ablation of 100tumors[J].AJR Am J Roentgenol,2005,185(1):64-71.
14 Best S L,Park S K,Youssef R F,et al.Long-term outcomes ofrenal tumor radio frequency ablation stratified by tumordiameter:Size matters[J].J Urol,2012,187(4):1183-1189.
15 Kroeze S G,Agenant M,Jonges G N,et al.Clinical efficacy of bipolar radiofrequency ablation of small renal masses[J].World J Urol,2015,33(10):1535-1540.
16 Kai J,Ming S,Yang L,et al.Complete radio frequency ablation of hepatocellular carcinoma adjacent to the main bile duct and blood vessels between the first and the secondhepatic portal[J].Cell Biochem Biophys,2013,66(2):397-402.
2 Van Poppel H,Becker F,Cadeddu J A,et al.Treatment oflocalised renal cell carcinoma[J].Eur Urol,2011,60(4):662-672.
3 阮东丽,张更,李智斌,等.机器人辅助腹腔镜与后腹腔镜肾部分切除术近期临床疗效比较[J].临床泌尿外科杂志,2016,31(6):538-542.
4 Dai Y,Covarrubias D,Uppot R,et al.Image-Guided Percutaneous Radiofrequency Ablation of Central Renal Cell Carcinoma:Assessment of Clinical Efficacy and Safety in 31Tumors[J].J Vasc Interv Radiol,2017,28(12):1643-1650.
5 Long J A,Bernhard J C,Bigot P,et al.Partial nephrectomy versusablative therapy for the treatment of renal tumors in an imperative setting[J].World J Urol,2017,35(4):649-656.
6 杨阳,赵晓智,姚林方,等.机器人辅助腹腔镜下射频消融术治疗肾肿瘤的临床观察[J].临床泌尿外科杂志,2018,33(2):152-155.
7 Huang W C,Levey A S,Serio A M,et al.Chronic kidneydisease after nephrectomy in patients with renal corticaltumours:A retrospective cohort study[J].Lancet Oncol,2006,7(9):735-740.
8 Gill I S,Kamoi K,Aron M,et al.800Laparoscopicpartial nephrectomies:A single surgeon series[J].J Urol,2010,183(1):34-41.
9 Veeratterapillay R,Addla S K,Jelley C,et al.Early surgical outcomes and oncological results of robot-assisted partial nephrectomy:a multicentre study[J].BJU Int,2017,120(4):550-555.
10 Ji C,Zhao X,Zhang S,et al.Laparoscopic Radiofrequency Ablation versus Partial Nephrectomy for cT1a Renal Tumors:Long-Term Outcome of 179Patients[J].Urol Int,2016,96(3):345-353.
11 Yang R,Lian H,Zhang G,et al.Laparoscopic radiofrequency ablation with intraoperative contrast-enhanced ultrasonography for T1bN0M0renal tumors:initial functional and oncologicoutcomes[J].J Endourol,2014,28(1):4-9.
12 Chang X,Liu T,Zhang F,et al.Radiofrequency ablation versus partial nephrectomy for clinical T1arenal-cell carcinoma:long-term clinical and oncologic outcomes based on a propensity score analysis[J].J Endourol,2015,29(5):518-525.
13 Gervais D A,McGovern F J,Arellano R S,et al.Radiofrequency ablation of renal cell carcinoma:Part 1,Indications,results,and role in patient managementover a 6-year period and ablation of 100tumors[J].AJR Am J Roentgenol,2005,185(1):64-71.
14 Best S L,Park S K,Youssef R F,et al.Long-term outcomes ofrenal tumor radio frequency ablation stratified by tumordiameter:Size matters[J].J Urol,2012,187(4):1183-1189.
15 Kroeze S G,Agenant M,Jonges G N,et al.Clinical efficacy of bipolar radiofrequency ablation of small renal masses[J].World J Urol,2015,33(10):1535-1540.
16 Kai J,Ming S,Yang L,et al.Complete radio frequency ablation of hepatocellular carcinoma adjacent to the main bile duct and blood vessels between the first and the secondhepatic portal[J].Cell Biochem Biophys,2013,66(2):397-402.