Aron Monish, Gill Inderbir S
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, United States.
Eur Urol. 2007 Feb;51(2):348-57. doi: 10.1016/j.eururo.2006.10.033. Epub 2006 Oct 27.
To review the evolution and current status of probe ablative methods of minimally invasive nephron-sparing surgery (MINSS) for renal tumours.
The English language literature of the past 10 yr was reviewed by using the National Library of Medicine database and the following keywords: chemoablation, cryoablation, high-intensity focused ultrasound, kidney, laser interstitial thermotherapy, microwave thermotherapy, nephron-sparing surgery, radiofrequency ablation, radiosurgery, renal, and tumour. Over 300 papers were identified, 50 of which were selected for this review on the basis of their contribution in advancing the field with regards to (1) evolution of concepts, (2) development and refinement of techniques, and (3) intermediate- and long-term clinical outcomes.
Open partial nephrectomy is the reference standard for nephron-sparing surgery against which all MINSS techniques should be measured. Although the initial outcomes of cryoablation and radiofrequency ablation (RFA) are encouraging, long-term studies are necessary to confirm lasting efficacy. The optimal modality for tumour 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 long-term cancer cure rates should be compared with the reference standard.
Promising long-term data are available for cryoablation. RFA is still considered developmental, and instances of incomplete cell kill, despite nonenhancement, are concerning. Other modalities are still experimental.
回顾肾肿瘤微创保留肾单位手术（MINSS）中探针消融方法的发展历程及现状。
通过美国国立医学图书馆数据库检索过去10年的英文文献，使用以下关键词：化学消融、冷冻消融、高强度聚焦超声、肾脏、激光间质热疗、微波热疗、保留肾单位手术、射频消融、放射外科、肾脏、肿瘤。共检索到300多篇论文，基于它们在以下方面对该领域的推动作用，从中选取50篇进行本综述：（1）概念的演变；（2）技术的发展与完善；（3）中期和长期临床结果。
开放性部分肾切除术是保留肾单位手术的参考标准，所有MINSS技术均应与之比较。尽管冷冻消融和射频消融（RFA）的初步结果令人鼓舞，但仍需长期研究以证实其持久疗效。肿瘤靶向、治疗监测及随访的最佳方式仍有待确定。这些消融技术应仅用于精心挑选的患者，数据应前瞻性收集，且长期癌症治愈率应与参考标准进行比较。
冷冻消融有前景良好的长期数据。RFA仍被认为尚在发展阶段，尽管无强化表现，但存在细胞杀灭不完全的情况令人担忧。其他方式仍处于实验阶段。
