Gore John L, Kim Hyung L, Schulam Peter
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA.
J Endourol. 2005 May;19(4):480-3. doi: 10.1089/end.2005.19.480.
Laparoscopic renal cryoablation is a feasible therapeutic option for small renal tumors. Advances in cryoablation technology have produced smaller cryoprobes. We review our initial experience with laparoscopic cryoablation utilizing 17-gauge cryoneedles.
Four patients aged 21 to 78 years underwent laparoscopy-assisted percutaneous cryotherapy between May 2003 and March 2004. The tumor size ranged from 1.5 to 2.5 cm. The procedure involved transperitoneal exposure of the tumor utilizing three 5- or 10-mm ports. The cryoprobes were placed percutaneously, without the need for tract dilation. Two freeze-thaw cycles were performed with cooling to below -70 degrees C.
In all patients, the procedure was completed without complication. The mean operative time was 125 minutes. The mean blood loss was 29 mL. No perioperative complications occurred. In follow-up, one patient with a tumor suspected of being renal-cell carcinoma demonstrated residual enhancement and underwent percutaneous radiofrequency ablation.
Laparoscopy-assisted percutaneous cryotherapy is a feasible treatment option in patients with small renal tumors. Laparoscopy allows mobilization of both anterior and posterior tumors. Direct viewing of the mass may facilitate accurate placement of the cryoneedles. The small size of the cryoneedles minimizes bleeding at the entry site.
腹腔镜肾冷冻消融术是治疗小肾肿瘤的一种可行的治疗选择。冷冻消融技术的进步已产生了更小的冷冻探针。我们回顾了我们使用17号冷冻针进行腹腔镜冷冻消融术的初步经验。
2003年5月至2004年3月期间，4例年龄在21至78岁的患者接受了腹腔镜辅助经皮冷冻治疗。肿瘤大小为1.5至2.5厘米。该手术通过3个5毫米或10毫米的端口经腹膜暴露肿瘤。冷冻探针经皮放置，无需扩张通道。进行了两个冻融循环，冷却至零下70摄氏度以下。
所有患者手术均顺利完成，无并发症。平均手术时间为125分钟。平均失血量为29毫升。未发生围手术期并发症。随访中，1例怀疑为肾细胞癌的患者出现残余强化，接受了经皮射频消融术。
腹腔镜辅助经皮冷冻治疗是小肾肿瘤患者的一种可行的治疗选择。腹腔镜可使前后方肿瘤均易于暴露。直视肿块有助于冷冻针的准确放置。冷冻针尺寸小，可使穿刺部位出血减至最少。
