Okhunov Zhamshid, Juncal Samuel, Ordon Michael, George Arvin K, Lusch Achim, del Junco Michael, Nguyentat Michael, Lobko Igor I, Kavoussi Louis, Landman Jaime
Department of Urology, University of California, Irvine, Orange, CA.
The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY.
Urology. 2015 Jan;85(1):130-4. doi: 10.1016/j.urology.2014.09.013. Epub 2014 Nov 14.
To compare the efficacy and safety of local anesthesia with conscious sedation (LACS) with general anesthesia (GA) in patients undergoing percutaneous renal cryoablation (PRC) for renal cortical neoplasms.
We performed a retrospective review of patients undergoing PRC between 2003 and 2013. Patient demographics, tumor characteristics, and perioperative and postoperative follow-up data were recorded and analyzed. We compared 3 principal outcomes across the GA and LACS groups: anesthesia-related outcomes, treatment failure, and complications.
A total of 235 patients with available data were included. Of these, 82 underwent PRC under GA and 153 patients under LACS. The 2 groups were similar with regard to age, gender, body mass index, American Society of Anesthesiologists score, tumor features, preoperative serum creatinine level, and hematocrit value. The GA and LACS groups had a similar percentage of patients with biopsy-proven renal cell carcinoma (68.5% and 64.2%, respectively; P = .62). The mean follow-up time for GA and LACS was 37 and 21 months, respectively (P <.0001). The mean procedure time for GA was significantly longer compared with LACS (133 vs 102 minutes; P <.001), and the mean hospital stay was shorter under LACS (1.08 vs 1.95 days; P <.0001). There was no difference in immediate failure (0% and 1.9%; P = .051) or recurrences (11% and 3.9%, respectively; P = .051) between GA and LACS groups. There was no difference in intraoperative and postoperative treatment-related complications between the 2 groups.
PRC for small renal masses under LACS is effective and safe. PRC with LACS has the advantage of decreased procedure time and a shorter hospital stay.
比较局部麻醉联合清醒镇静（LACS）与全身麻醉（GA）用于肾皮质肿瘤经皮肾冷冻消融术（PRC）患者的疗效和安全性。
我们对2003年至2013年间接受PRC的患者进行了回顾性研究。记录并分析患者的人口统计学资料、肿瘤特征以及围手术期和术后随访数据。我们比较了GA组和LACS组的3项主要结局：麻醉相关结局、治疗失败和并发症。
共纳入235例有可用数据的患者。其中，82例在GA下接受PRC，153例在LACS下接受PRC。两组在年龄、性别、体重指数、美国麻醉医师协会评分、肿瘤特征、术前血清肌酐水平和血细胞比容值方面相似。GA组和LACS组经活检证实为肾细胞癌的患者比例相似（分别为68.5%和64.2%；P = 0.62）。GA组和LACS组的平均随访时间分别为37个月和21个月（P < 0.0001）。GA组的平均手术时间明显长于LACS组（133分钟对102分钟；P < 0.001），LACS组的平均住院时间更短（1.08天对1.95天；P < 0.0001）。GA组和LACS组在即刻失败（0%和1.9%；P = 0.051）或复发（分别为11%和3.9%；P = 0.051）方面无差异。两组在术中及术后与治疗相关的并发症方面无差异。
LACS下对小肾肿块进行PRC是有效且安全的。LACS下的PRC具有手术时间缩短和住院时间缩短的优势。
