Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota 55905, USA.
J Urol. 2013 Apr;189(4):1243-8. doi: 10.1016/j.juro.2012.10.066. Epub 2012 Oct 30.
Treatment of locally recurrent or de novo tumors in the ipsilateral kidney after partial nephrectomy represents a management dilemma. Percutaneous renal cryoablation offers a minimally invasive treatment option in such cases. We review our single institution experience with percutaneous cryoablation of renal tumors after partial nephrectomy for technical feasibility, complications and outcomes.
Between March 2003 and January 2012, 48 patients underwent percutaneous cryoablation for the treatment of 68 ipsilateral renal tumors after previous partial nephrectomy. Oncologic outcomes, complications (Clavien-Dindo classification system) and renal function were evaluated.
Median maximal diameter of the treated renal tumors was 2.5 cm (range 1.2 to 5.4). All cryoablation procedures were considered technically successful. Of the 54 biopsy proven or suspected renal cell carcinomas with 3 or more months of computerized tomography/magnetic resonance imaging followup after cryoablation (median 19, range 3 to 61), 5 cases (9.3%) had local tumor recurrence. Major (grade 3 or greater) complications developed after 3 (5.7%) cryoablation procedures and there were no perioperative deaths. Median change in patient estimated glomerular filtration rate after renal cryoablation was -1.5 ml per minute. No patients required dialysis in the perioperative period, while 2 with stage 4 chronic kidney disease at the time of ablation became dialysis dependent at 5 and 23 months after treatment, respectively.
Percutaneous renal cryoablation after ipsilateral partial nephrectomy is technically feasible, has a low rate of major complications, provides relative preservation of renal function and demonstrates acceptable short-term oncologic outcomes in this challenging population.
在部分肾切除术后同侧肾脏局部复发或新发肿瘤的治疗是一个管理难题。经皮肾冷冻消融术为这类病例提供了一种微创治疗选择。我们回顾了我们单中心经皮肾部分切除术后肾肿瘤冷冻消融的经验，包括技术可行性、并发症和结果。
2003 年 3 月至 2012 年 1 月，48 例患者因同侧肾部分切除术后 68 个肾肿瘤而行经皮肾冷冻消融术。评估肿瘤学结果、并发症（Clavien-Dindo 分类系统）和肾功能。
治疗的肾肿瘤的最大直径中位数为 2.5cm（范围 1.2 至 5.4cm）。所有冷冻消融术均被认为是技术上成功的。在 54 例经活检证实或怀疑为肾细胞癌的患者中，有 3 例或更多个月的计算机断层扫描/磁共振成像随访（中位数为 19 个月，范围为 3 至 61 个月），5 例（9.3%）发生局部肿瘤复发。3 例（5.7%）冷冻消融术后出现严重（3 级或以上）并发症，无围手术期死亡。肾冷冻消融术后患者估算肾小球滤过率中位数下降 1.5ml/min。无患者在围手术期需要透析，而 2 例在消融时患有 4 期慢性肾脏病的患者分别在治疗后 5 个月和 23 个月需要透析。
同侧部分肾切除术后经皮肾冷冻消融术在技术上是可行的，严重并发症发生率低，相对保留肾功能，并在这一具有挑战性的人群中提供可接受的短期肿瘤学结果。
