Aron Monish, Gill Inderbir S
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, The Cleveland Clinic Foundation, OH 44115, USA.
Curr Opin Urol. 2005 Sep;15(5):298-305. doi: 10.1097/01.mou.0000177684.93531.85.
The management of small renal tumors is changing from radical nephrectomy to nephron-conserving surgery. The aim of this review is to discuss the currently prevailing methods used for nonextirpative renal tumor ablation. The studies published in English during 2004 to May 2005 have been reviewed in this article.
Of the various ablation techniques, cryotherapy and radiofrequency ablation are being increasingly applied clinically. They can be performed either laparoscopically or percutaneously using a combination of fine probes and high-resolution imaging techniques for focusing and monitoring the therapy. Noninvasive tumor ablation by high-intensity focused ultrasound, and other techniques, is still at an experimental stage.
Although the initial outcomes of cryoablation and radiofrequency ablation are encouraging, long-term studies are necessary to confirm their lasting efficacy. The optimal modality for tumor targeting, monitoring therapy, and follow-up remains to be determined. These ablative techniques should be reserved for carefully selected patients, the data should be prospectively accrued, and the results should be compared to that of the reference standard, open or laparoscopic partial nephrectomy.
小肾肿瘤的治疗正从根治性肾切除术转向保留肾单位手术。本综述的目的是讨论目前用于非切除性肾肿瘤消融的流行方法。本文回顾了2004年至2005年5月期间发表的英文研究。
在各种消融技术中，冷冻疗法和射频消融在临床上的应用越来越多。它们可以通过腹腔镜或经皮进行，使用细探针和高分辨率成像技术相结合来聚焦和监测治疗。高强度聚焦超声和其他技术的非侵入性肿瘤消融仍处于实验阶段。
尽管冷冻消融和射频消融的初步结果令人鼓舞，但仍需要长期研究来证实其持久疗效。肿瘤靶向、监测治疗和随访的最佳方式仍有待确定。这些消融技术应保留给精心挑选的患者，数据应前瞻性收集，并将结果与开放或腹腔镜部分肾切除术的参考标准进行比较。
