University of Miami School of Medicine, Department of Urology, Miami, FL 33126, USA.
Nat Rev Urol. 2013 May;10(5):284-91. doi: 10.1038/nrurol.2013.68. Epub 2013 Apr 23.
Improvements in imaging technology have resulted in an increase in detection of small renal masses (SRMs). Minimally invasive ablation modalities, including cryoablation, radiofrequencey ablation, microwave ablation and irreversible electroporation, are currently being used to treat SRMs in select groups of patients. Cryoablation and radiofrequency ablation have been extensively studied. Presently, cryoablation is gaining popularity because the resulting ice ball can be visualized easily using ultrasonography. Tumour size and location are strong predictors of outcome of radiofrequency ablation. One of the main benefits of microwave ablation is that microwaves can propagate through all types of tissue, including desiccated and charred tissue, as well as water vapour, which might be formed during the ablation. Irreversible electroporation has been shown in animal studies to affect only the cell membrane of undesirable target tissues and to spare adjacent structures; however, clinical studies that depict the efficacy and safety of this treatment modality in humans are still sparse. As more experience is gained in the future, ablation modalities might be utilized in all patients with tumours <4 cm in diameter, rather than just as an alternative treatment for high-risk surgical patients.
影像学技术的进步导致了对小肾肿瘤 (SRM) 的检测增加。目前,包括冷冻消融、射频消融、微波消融和不可逆电穿孔在内的微创消融方式被用于治疗特定患者群体的 SRM。冷冻消融和射频消融已经得到了广泛的研究。目前,冷冻消融越来越受欢迎,因为使用超声可以很容易地观察到产生的冰球。肿瘤的大小和位置是射频消融结果的强预测因素。微波消融的主要优势之一是微波可以穿透所有类型的组织,包括干燥和烧焦的组织,以及在消融过程中可能形成的水蒸气。动物研究表明,不可逆电穿孔只会影响到不理想的靶组织的细胞膜,而不会损伤相邻的结构;然而,在人体中描述这种治疗方式的疗效和安全性的临床研究仍然很少。随着未来经验的积累,消融方式可能会用于所有直径 <4 厘米的肿瘤患者,而不仅仅是作为高危手术患者的替代治疗方法。