Klingler H Christoph, Marberger Michael, Mauermann Julian, Remzi Mesut, Susani Martin
Department of Urology, Medical University of Vienna, Vienna, Austria.
BJU Int. 2007 May;99(5):998-1001. doi: 10.1111/j.1464-410X.2007.06769.x.
To evaluate the homogeneity and extent of necrosis obtained with next-generation radiofrequency ablation (RFA) equipment and techniques, as incomplete tumour necrosis, or 'skipping', has been documented after RFA of renal tumours and subsequent partial nephrectomy, but this was assumed to result from insufficient energy deposition with first-generation low-energy generators.
In all, 17 patients with solitary renal tumours of <or=4 cm were treated with RFA under laparoscopic control. A state-of-the-art monopolar RFA generator and 15 G multi-tined needle probes were used. The probe tines were deployed to create an ablation zone>0.5-1.0 cm beyond the sonographically controlled tumour borders. Target temperatures of 105 degrees C were applied in three cycles for 10-30 min at up to 150 W. Tumours were then removed by laparoscopic partial nephrectomy and specimens evaluated by detailed histology.
The mean (range) resected tumour size was 22 (11-40) mm, the mean RFA time was 39 (27-59) min and the mean surgical resection time was 25 (12-45) min. In 13 patients, haemostasis was sufficient to avoid the renal pedicle being clamped. Intraoperative repeated positive margins in one patient required a laparoscopic radical nephrectomy. Thirteen (76%) renal masses showed histologically complete ablation of the entire tumour. Of the four RFA failures, three tumours were >3 cm in diameter, two were highly vascularized and three had a very heterogeneous tissue texture.
Even with state-of-the-art technology, skipping remains a problem with RFA for small renal masses and renders the technique unreliable.
评估新一代射频消融（RFA）设备和技术所获得的坏死均匀性和范围，因为在肾肿瘤RFA及随后的部分肾切除术后，已记录到肿瘤坏死不完全，即“跳跃式”坏死，但这被认为是第一代低能量发生器能量沉积不足所致。
总共17例肾肿瘤直径≤4 cm的患者在腹腔镜控制下接受RFA治疗。使用了最先进的单极RFA发生器和15G多针电极针。电极针展开以在超声控制的肿瘤边界外创建一个>0.5 - 1.0 cm的消融区。在三个周期内以高达150 W的功率施加105℃的目标温度，持续10 - 30分钟。然后通过腹腔镜部分肾切除术切除肿瘤，并通过详细的组织学评估标本。
切除肿瘤的平均（范围）大小为22（11 - 40）mm，平均RFA时间为39（27 - 59）分钟，平均手术切除时间为25（12 - 45）分钟。13例患者中，止血充分，无需夹闭肾蒂。1例患者术中切缘反复阳性，需要行腹腔镜根治性肾切除术。13个（76%）肾肿块在组织学上显示整个肿瘤完全消融。在4例RFA失败病例中，3个肿瘤直径>3 cm，2个血管丰富，3个组织质地非常不均匀。
即使采用最先进的技术，对于小肾肿块，RFA的“跳跃式”坏死仍然是一个问题，使得该技术不可靠。
