Perry Kent, Zisman Amnon, Pantuck Allan J, Janzen Nicolette, Schulam Peter, Belldegrun Arie S
Rev Urol. 2002 Summer;4(3):103-11.
Widespread use of computed tomography, ultrasound, and magnetic resonance imaging has led to an increase in detection of relatively small renal masses, and approaches to managing them have evolved in the last two decades. Indications for nephron-sparing surgery have expanded, and minimally invasive procedures, which can confer advantages over open surgery, are now available. Ablative techniques offer a combination of nephron-sparing and minimally invasive approaches. Ablative techniques include cryoablation, radiofrequency ablation (RFA), and high-intensity focused ultrasound (HIFU). Cryoablation and RFA have been relatively safe. HIFU has been associated with serious side effects in animal models, and is not yet acceptable for use in humans. Ablative techniques require long-term studies to confirm lasting efficacy. The best modality for tumor targeting, monitoring of therapy, and follow-up is still under investigation. Debate exists regarding the best method for ensuring adequate intraoperative tumor cryoablation. For minimally invasive ablative measures to gain a place as nephron-sparing approaches, they should show both equivalent efficacy and reduced morbidity relative to those of open partial nephrectomy. These techniques should currently be reserved for selected patients and should be compared to the evolving modality of laparoscopic partial nephrectomy.
计算机断层扫描、超声和磁共振成像的广泛应用导致相对较小肾肿块的检出率增加，在过去二十年中，处理这些肿块的方法也在不断演变。保留肾单位手术的适应症有所扩大，现在已有比开放手术更具优势的微创手术可供选择。消融技术提供了一种保留肾单位和微创的方法组合。消融技术包括冷冻消融、射频消融（RFA）和高强度聚焦超声（HIFU）。冷冻消融和射频消融相对安全。高强度聚焦超声在动物模型中已出现严重副作用，目前还不能用于人体。消融技术需要长期研究以证实其持久疗效。用于肿瘤靶向、治疗监测和随访的最佳方式仍在研究中。关于确保术中充分冷冻消融肿瘤的最佳方法仍存在争议。为了使微创消融措施能作为保留肾单位的方法得到认可，它们应显示出与开放性部分肾切除术相当的疗效且并发症更少。目前这些技术应仅用于特定患者，并应与不断发展的腹腔镜部分肾切除术方式进行比较。
