Mouraviev Vladimir, Joniau Steven, Van Poppel Hendrik, Polascik Thomas J
Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States.
Eur Urol. 2007 Feb;51(2):328-36. doi: 10.1016/j.eururo.2006.09.024. Epub 2006 Oct 17.
In the current era, minimally invasive surgery using ablative techniques for the treatment of small renal tumours has become a more common and feasible treatment option. In this review, we present recent data regarding the utility of needle ablative techniques in the experimental and clinical settings.
We performed a comprehensive evaluation of available published data from 1997 to 2006 that were identified with PubMed. Official proceedings of internationally known scientific societies held in the same time period were also assessed.
Two main thermoablative techniques, cryoablation (CA) and radiofrequency ablation (RFA), represent the current available minimally invasive treatments for renal cell carcinoma (RCC). CA has been more extensively studied and has gained acceptance from patients and physicians. The procedure is well tolerated by patients even with serious concomitant diseases. RFA is delivered with a monopolar alternating current. Morbidity rates for this modality remain slightly higher than those for cryotherapy. Both techniques are associated with highly successful cancer control rates at short-to-medium follow-up in patients with tumour size <3 cm. Multiple lesions can be treated simultaneously and the procedures can be repeated. However, long-term follow-up data are still lacking.
Minimally invasive ablative approaches seem to represent an attractive alternative to extirpative surgery for the treatment of small renal neoplasms in select patients. Potential developments include concepts to improve the accuracy of thermal ablation using novel imaging modalities with reduction in side-effects and optimised selection and follow-up of patients to provide at least equivalent cancer control to conventional surgery.
在当今时代，采用消融技术的微创手术用于治疗小肾肿瘤已成为一种更常见且可行的治疗选择。在本综述中，我们展示了关于针状消融技术在实验和临床环境中效用的最新数据。
我们对1997年至2006年通过PubMed检索到的已发表可用数据进行了全面评估。同时还评估了同一时期国际知名科学协会的官方会议记录。
两种主要的热消融技术，即冷冻消融（CA）和射频消融（RFA），是目前可用于治疗肾细胞癌（RCC）的微创治疗方法。CA得到了更广泛的研究，并已获得患者和医生的认可。即使患者伴有严重疾病，该手术的耐受性也良好。RFA通过单极交流电进行。这种方式的发病率仍略高于冷冻疗法。对于肿瘤大小<3 cm的患者，在短期至中期随访中，这两种技术的癌症控制率都非常高。可以同时治疗多个病灶，并且手术可以重复进行。然而，仍然缺乏长期随访数据。
对于特定患者，微创消融方法似乎是治疗小肾肿瘤的一种有吸引力的替代根治性手术的方法。潜在的发展包括利用新型成像方式提高热消融准确性的概念，同时减少副作用，并优化患者的选择和随访，以提供至少与传统手术相当的癌症控制效果。
