腹腔镜冷冻消融术与CT引导下经皮冷冻消融术治疗肾肿瘤的单中心比较

Single center comparison of laparoscopic cryoablation and CT-guided percutaneous cryoablation for renal tumors.

作者信息

Derweesh Ithaar H, Malcolm John B, Diblasio Christopher J, Giem Andrew, Rewcastle John C, Wake Robert W, Patterson Anthony L, Gold Robert

机构信息

Department of Urology, Department of Diagnostic Radiology, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.

出版信息

J Endourol. 2008 Nov;22(11):2461-7. doi: 10.1089/end.2008.0196.

DOI:10.1089/end.2008.0196

PMID:18928380

Abstract

BACKGROUND AND PURPOSE

Cryoablation has demonstrated therapeutic effectiveness for selected renal tumors. We compared our perioperative and short-term outcomes of laparoscopic (LAP) v percutaneous (PERC) renal cryoablation.

PATIENTS AND METHODS

Thirty-four patients (18 men/16 women) underwent a LAP and 26 patients (19 men/7 women) underwent a PERC procedure between September1998 and January 2007. LAP cryoablation was performed transperitoneally with ultrasonographic monitoring. PERC cryoablation was performed with CT guidance. Follow-up imaging was obtained at regular intervals.

RESULTS

Mean follow-up was 25 months. Average age (years) was 67.0 for the LAP and 69.7 for the PERC procedure (P = 0.307). Mean body mass index (kg/m(2)) was 29.8 for those undergoing LAP and 28.7 for those undergoing PERC procedures (P = 0.543). Mean tumor size (cm) was 2.9 for LAP patients and 3.1 for PERC patients (P = 0.432). Anterior tumors comprised 61.7% of LAP and 15.4% of PERC procedures (P < 0.001). Posterior tumors comprised 32.4% of LAP and 65.4% of PERC procedures (P = 0.01). Mean procedure time (minutes) was 165.7 for LAP and 106.6 for PERC procedures (P < 0.001). Hospital stay (days) was 2.6 for those undergoing LAP and 1.8 for those undergoing PERC procedures (P < 0.001). Both LAP patients (82.4%) and PERC patients (19.2%) needed postoperative narcotics (P < 0.001). Atelectasis developed in 70.6% of LAP patients and 34.6% of PERC patients (P = 0.005). Residual enhancement was seen in 11.5% of PERC patients and 2.9% of LAP patients (P = 0.192). Complications developed in 14.7% of LAP patients and 26.9% of PERC patients (P = 0.248). 1-year, 2-year, and 3-year disease-specific survival for the two groups was 100%. Tumor size > 4 cm and endophytic location were significantly associated with residual enhancement.

CONCLUSIONS

LAP and PERC renal cryoablation have similar short-term outcomes. Significantly more anterior tumors were approached laparoscopically and significantly more posterior tumors were approached percutaneously. The PERC approach may offer advantages regarding hospital stay, narcotic need, and development of atelectasis. Longer-term data are needed to establish success of this approach.

摘要

背景与目的

冷冻消融已被证明对特定肾肿瘤具有治疗效果。我们比较了腹腔镜（LAP）与经皮（PERC）肾冷冻消融的围手术期及短期结果。

患者与方法

1998年9月至2007年1月期间，34例患者（18例男性/16例女性）接受了腹腔镜手术，26例患者（19例男性/7例女性）接受了经皮手术。腹腔镜冷冻消融在超声监测下经腹腔进行。经皮冷冻消融在CT引导下进行。定期进行随访成像。

结果

平均随访时间为25个月。腹腔镜手术患者的平均年龄（岁）为67.0，经皮手术患者为69.7（P = 0.307）。接受腹腔镜手术患者的平均体重指数（kg/m²）为29.8，接受经皮手术患者为28.7（P = 0.543）。腹腔镜手术患者的平均肿瘤大小（cm）为2.9，经皮手术患者为3.1（P = 0.432）。前部肿瘤在腹腔镜手术中占61.7%，在经皮手术中占15.4%（P < 0.001）。后部肿瘤在腹腔镜手术中占32.4%，在经皮手术中占65.4%（P = 0.01）。腹腔镜手术的平均手术时间（分钟）为165.7，经皮手术为106.6（P < 0.001）。腹腔镜手术患者的住院时间（天）为2.6，经皮手术患者为1.8（P < 0.001）。腹腔镜手术患者（82.4%）和经皮手术患者（19.2%）均需要术后使用麻醉剂（P < 0.001）。70.6%的腹腔镜手术患者和34.6%的经皮手术患者发生肺不张（P = 0.005）。11.5%的经皮手术患者和2.9%的腹腔镜手术患者出现残余强化（P = 0.192）。14.7%的腹腔镜手术患者和26.9%的经皮手术患者发生并发症（P = 0.248）。两组的1年、2年和3年疾病特异性生存率均为100%。肿瘤大小>4 cm和内生性位置与残余强化显著相关。