White Wesley M, Klein Frederick A, Waters W Bedford
Division of Urologic Surgery, University of Tennessee Medical Center, Knoxville, Tennessee 37920, USA.
J Urol. 2008 Dec;180(6):2343-7. doi: 10.1016/j.juro.2008.08.046. Epub 2008 Oct 18.
We evaluated operative outcomes during nephron sparing surgery using a handheld radio frequency ablation resection device.
Patients with a newly diagnosed renal mass who elected treatment were prospectively enrolled in a comparative trial designed to evaluate the usefulness of the handheld HABIB 4X radio frequency ablation device during open nephron sparing surgery. Preoperative variables were determined and patients subsequently underwent open nephron sparing surgery with (group 1) or without (control group 2) the assistance of the radio frequency ablation device. Data were collected on preoperative and postoperative creatinine and hematocrit, estimated operative blood loss, intraoperative and postoperative complications, and pathological outcomes.
A total of 90 patients underwent open nephron sparing surgery with (45) and without (45) the radio frequency ablation device. Mean pathological tumor size was 3.31 and 3.13 cm in groups 1 and 2, respectively (p = 0.49). Mean estimated blood loss was 133.2 and 417.2 cc in groups 1 and 2, respectively (p <0.001). Mean operative time was 83.5 and 97.2 minutes in groups 1 and 2, respectively (p = 0.012). Ten of 45 group 2 patients underwent hilar clamping with hypothermia, while no patients in group 1 underwent hilar clamping. Margins were positive in 1 patient in group 1 (2.2%) and in 2 in group 2 (4.4%). Group 1 complications included postoperative urine leakage in 1 case, which required stent placement. Group 2 complications included 2 cases of urine leakage requiring stent placement, 4 of blood transfusion, 2 of ureteral lacerations, 2 episodes of clot retention and 1 death.
The handheld radio frequency ablation device can yield a significant benefit during open nephron sparing surgery, namely decreased blood loss and operative time.
我们评估了使用手持式射频消融切除设备进行保留肾单位手术的手术效果。
选择接受治疗的新诊断肾肿块患者前瞻性纳入一项比较试验，旨在评估手持式HABIB 4X射频消融设备在开放性保留肾单位手术中的实用性。确定术前变量，随后患者接受有（第1组）或无（对照组2）射频消融设备辅助的开放性保留肾单位手术。收集术前和术后肌酐、血细胞比容、估计手术失血量、术中和术后并发症以及病理结果的数据。
共有90例患者接受了有（45例）和无（45例）射频消融设备的开放性保留肾单位手术。第1组和第2组的平均病理肿瘤大小分别为3.31 cm和3.13 cm（p = 0.49）。第1组和第2组的平均估计失血量分别为133.2 cc和417.2 cc（p <0.001）。第1组和第2组的平均手术时间分别为83.5分钟和97.2分钟（p = 0.012）。第2组45例患者中有10例接受了低温肾门阻断，而第1组无患者接受肾门阻断。第1组有1例患者（2.2%）切缘阳性，第2组有2例患者（4.4%）切缘阳性。第1组的并发症包括1例术后尿漏，需要放置支架。第2组的并发症包括2例需要放置支架的尿漏、4例输血、2例输尿管撕裂、2次血块潴留和1例死亡。
手持式射频消融设备在开放性保留肾单位手术中可产生显著益处，即减少失血量和手术时间。
