Yao Dongwei, Qu Feng, Zheng Jinyu, Lian Huibo, Zhang Gutian, Li Xiaogong, Gan Weidong, Guo Hongqian
Department of Urology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
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Zhonghua Wai Ke Za Zhi. 2015 Jun 1;53(6):446-9.
To study the safety and effectiveness of laparoscopic radiofrequency ablation for centrally located renal tumors.
From January 2009 to April 2013, thirteen patients who diagnosed as centrally located renal tumors were treated with laparoscopic radiofrequency ablation in the Department of Urology of Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School. All of the cases were T1aN0M0 stage, 9 patients were male, 4 were female, the mean age was 56 years (range, 38-73 years). All tumors were unilateral, eight lesions were in the left kidney and five in the right kidney. Intraoperative real-time ultrasound and temperature probes were used to guide the range of radiofrequency ablation. Ice saline was injected through ureteral catheter for cooling the collecting system. The postoperative serum creatinine and glomerular filtration rate (GFR) data were collected,all patients were followed up with enhanced CT or MRI.The pre- and post-operative date were compared by paired t test.
All patients underwent laparoscopic radiofrequency ablation successfully. The mean operation time was (113±13) minutes and the mean blood loss was (99±23) ml. The mean pre- and post-operative serum creatinine was (71±11) µmol/L and (74±11) µmol/L, the mean pre- and post-operative GFR was (49±8) ml/min and (45±7) ml/min. There was no significant statistic difference between pre-operation and post-operation (t=-1.371 and 1.986, P>0.05). The mean follow-up was 37 months, range 12-63 months. No evidence of local recurrence or distant metastasis was found.
Laparoscopic radiofrequency ablation for T1aN0M0 centrally located renal tumors could be performed safely with good outcomes. Intraoperative real-time ultrasound and temperature probes are helpful to control the range of radiofrequency ablation. Physical cooling of renal collecting system could reduce the occurrence of postoperative hydronephrosis and leakage of urine.
研究腹腔镜下射频消融治疗肾中央型肿瘤的安全性和有效性。
2009年1月至2013年4月，南京大学医学院附属南京鼓楼医院泌尿外科对13例诊断为肾中央型肿瘤的患者实施了腹腔镜下射频消融治疗。所有病例均为T1aN0M0期，男性9例，女性4例，平均年龄56岁（范围38 - 73岁）。所有肿瘤均为单侧，8个病灶位于左肾，5个位于右肾。术中采用实时超声和温度探头引导射频消融范围。通过输尿管导管注入冰盐水以冷却集合系统。收集术后血清肌酐和肾小球滤过率（GFR）数据，所有患者均接受增强CT或MRI随访。术前和术后数据采用配对t检验进行比较。
所有患者均成功接受腹腔镜下射频消融治疗。平均手术时间为（113±13）分钟，平均失血量为（99±23）ml。术前和术后血清肌酐平均值分别为（71±11）μmol/L和（74±11）μmol/L，术前和术后GFR平均值分别为（49±8）ml/min和（45±7）ml/min。术前和术后比较差异无统计学意义（t = -1.371和1.986，P>0.05）。平均随访37个月，范围12 - 63个月。未发现局部复发或远处转移迹象。
腹腔镜下射频消融治疗T1aN0M0期肾中央型肿瘤安全有效。术中实时超声和温度探头有助于控制射频消融范围。对肾集合系统进行物理降温可减少术后肾积水和尿漏的发生。
