Finley David S, Beck Shawn, Box Geoffrey, Chu William, Deane Leslie, Vajgrt Duane J, McDougall Elspeth M, Clayman Ralph V
Department of Urology, University of California Irvine Medical Center, Orange, California, USA.
J Urol. 2008 Aug;180(2):492-8; discussion 498. doi: 10.1016/j.juro.2008.04.019. Epub 2008 Jun 11.
PURPOSE: We reviewed our 4-year experience with percutaneous cryoablation and laparoscopy for treating small renal masses. MATERIALS AND METHODS: After institutional review board approval we retrospectively analyzed renal cryoablation procedures performed between March 2003 and October 2007. An in-depth analysis was performed concerning demographics, hospital course and short-term outcome with respect to percutaneous vs laparoscopic cryoablation. RESULTS: A total of 37 patients underwent treatment for 43 renal masses. Of the 37 patients 19 underwent laparoscopic cryoablation (24 tumors) and 18 underwent percutaneous cryoablation (19 tumors) using computerized tomography fluoroscopy. For percutaneous cryoablation a saline instillation was used in 58% of cases to move nonrenal vital structures away from the targeted renal mass. There were 5 cases of hemorrhage requiring transfusion, all of which were associated with the use of multiple cryoprobes. The transfusion rate in the percutaneous and laparoscopic cryoablation groups was 11.1% and 27.8%, respectively. Operative time was significantly longer in the laparoscopic cryoablation group compared to the percutaneous cryoablation group at 147 (range 89 to 209) vs 250.2 (range 151 to 360) minutes, respectively. The overall complication rate (including transfusion) was lower in the percutaneous cryoablation group compared to the laparoscopic cryoablation group (4 of 18 [22.2%] vs 8 of 20 [40%], respectively). Hospital stay was significantly shorter in the percutaneous vs laparoscopic cryoablation group at 1.3 vs 3.1 days, p <0.0001, respectively. Narcotic use in the percutaneous cryoablation group was more than half that used by the laparoscopic cryoablation group (5.1 vs 17.8 mg, p = 0.03, respectively). Among patients with biopsy proven renal cell carcinoma during a median followup of 11.4 and 13.4 months in the percutaneous and laparoscopic cryoablation groups, cancer specific survival was 100% and 100%, respectively, and the treatment failure rate was 5.3% and 4.2%, respectively. CONCLUSIONS: Percutaneous cryoablation is an efficient, minimally morbid method for the treatment of small renal masses and it appears to be superior to the laparoscopic approach. Short-term followup has shown no difference in tumor recurrence or need for re-treatment. Of note, hemorrhage was solely associated with the use of multiple probes.
目的：我们回顾了4年来经皮冷冻消融术和腹腔镜手术治疗小肾肿块的经验。 材料与方法：经机构审查委员会批准后，我们对2003年3月至2007年10月期间进行的肾冷冻消融手术进行了回顾性分析。对经皮与腹腔镜冷冻消融术的人口统计学、住院过程及短期结果进行了深入分析。 结果：共有37例患者接受了43个肾肿块的治疗。37例患者中，19例接受了腹腔镜冷冻消融术（24个肿瘤），18例接受了经皮冷冻消融术（19个肿瘤），采用计算机断层扫描透视技术。经皮冷冻消融术中，58%的病例使用了生理盐水灌注，以将非肾重要结构从目标肾肿块移开。有5例出血需要输血，所有这些均与使用多个冷冻探头有关。经皮和腹腔镜冷冻消融组的输血率分别为11.1%和27.8%。腹腔镜冷冻消融组的手术时间明显长于经皮冷冻消融组，分别为147（范围89至209）分钟和250.2（范围151至360）分钟。经皮冷冻消融组的总体并发症发生率（包括输血）低于腹腔镜冷冻消融组（分别为18例中的4例[22.2%]和20例中的8例[40%]）。经皮冷冻消融组的住院时间明显短于腹腔镜冷冻消融组，分别为1.3天和3.1天，p<0.0001。经皮冷冻消融组的麻醉药物使用量不到腹腔镜冷冻消融组的一半（分别为5.1和17.8毫克，p = 0.03）。在经皮和腹腔镜冷冻消融组中，活检证实为肾细胞癌的患者在中位随访11.4个月和13.4个月期间，癌症特异性生存率分别为100%和100%，治疗失败率分别为5.3%和4.2%。 结论：经皮冷冻消融术是治疗小肾肿块的一种有效、微创的方法，似乎优于腹腔镜手术方法。短期随访显示肿瘤复发或再次治疗需求方面无差异。值得注意的是，出血仅与使用多个探头有关。
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