Enikeev D V, Glybochko P V, Alyaev Yu G, Rapoport L M, Amosov A V, Alekseeva T M, Enikeev M E, Tsarichenko D G, Chinenov D V, Kozmin L D, Dzhalaev Z K, Taratkin M S
I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Research Institute of Uronephrology and Human Reproductive Health, Moscow, Russia.
Urologiia. 2017 Jul(3):68-73. doi: 10.18565/urol.2017.3.68-73.
Surgery remains the gold-standard curative treatment for localized (T1) renal carcinoma. However, recent medical-technological advances have led to the development of new minimally invasive treatment options, one of which is percutaneous cryoablation.
To assess the effectiveness and safety of ultrasound-guided percutaneous cryoablation of renal tumors.
The study comprised 12 patients aged 52 to 76 years who underwent ultrasound-guided percutaneous cryoablation of renal tumors from 2015 to 2017. In 11 patients, the size of the renal mass was 3.0 cm (T1a), in 1 patient 4.5 cm (T1b). A Doppler ultrasound, contrast-enhanced MSCT and computer 3D modeling were performed in all patients pre-operatively and 6 months after surgery to assess the tumors size and extent and the spatial location of the tumor internal surface to the pelvicalyceal system. In all patients, the tumors were located along the posterior or lateral surface of the kidney, in the lower or middle segment and without sinus invasion. We used a 3rd generation Galil Medicals SeedNet Gold Cryotherapy System and IceSeed and IceRod cryoprobes. Intraoperatively, immediately before cryoablation, the tumor was biopsied. In all patients the diagnosis of renal cell carcinoma was confirmed morphologically.
Mean duration of cryoablation was 60 minutes. Endotracheal, spinal, local and intravenous anesthesia was used in 1, 6, 5 and 1 patients, respectively. Doppler ultrasound at 6 months after surgery showed that in 11 patients (T1a) the tumor size decreased on average by 8 mm, with no blood flow in the tumors. MSCT with 3D modeling also revealed a decrease in tumor size and total absence of contrast agent accumulation, or accumulation gradient not exceeding 10 HU (initially it was about 200 HU). In the patient with T1b stage renal carcinoma, MSCT showed a decrease in tumor size from 4.5 to 3.7 cm, however, there was a mass up to 1.5 cm with a high gradient of contrast agent accumulation. The patient underwent kidney resection. No intra- and postoperative complications were observed.
The accumulated experience allows to confirm the effectiveness and safety of ultrasound-guided percutaneous cryoablation and to consider it a method of choice for patients with stage T1a renal carcinoma located along the posterior or lateral surface of the kidney in the lower or middle segment, without sinus invasion.
手术仍然是局限性（T1）肾癌的金标准治愈性治疗方法。然而，最近的医学技术进步催生了新的微创治疗选择，其中之一是经皮冷冻消融术。
评估超声引导下经皮冷冻消融肾肿瘤的有效性和安全性。
本研究纳入了12例年龄在52至76岁之间的患者，他们在2015年至2017年期间接受了超声引导下经皮冷冻消融肾肿瘤治疗。11例患者的肾肿块大小为3.0 cm（T1a），1例为4.5 cm（T1b）。所有患者在术前和术后6个月均进行了多普勒超声、对比增强MSCT和计算机三维建模，以评估肿瘤大小、范围以及肿瘤内表面与肾盂肾盏系统的空间位置。所有患者的肿瘤均位于肾的后表面或外侧表面，在下部或中部节段，且未侵犯肾窦。我们使用了第三代加利尔医疗公司的SeedNet Gold冷冻治疗系统以及IceSeed和IceRod冷冻探头。术中，在冷冻消融前立即对肿瘤进行活检。所有患者经形态学检查确诊为肾细胞癌。
冷冻消融的平均持续时间为60分钟。分别有1例、6例、5例和1例患者使用了气管内麻醉、脊髓麻醉、局部麻醉和静脉麻醉。术后6个月的多普勒超声显示，11例（T1a）患者的肿瘤大小平均减小了8 mm，肿瘤内无血流信号。带有三维建模的MSCT也显示肿瘤大小减小，且完全没有造影剂积聚，或积聚梯度不超过10 HU（最初约为200 HU）。在T1b期肾癌患者中，MSCT显示肿瘤大小从4.5 cm减小至3.7 cm，然而，有一个大小达1.5 cm的肿块，造影剂积聚梯度较高。该患者接受了肾切除术。未观察到术中及术后并发症。
积累的经验证实了超声引导下经皮冷冻消融的有效性和安全性，并使其成为位于肾下部或中部节段后表面或外侧表面、未侵犯肾窦的T1a期肾癌患者的首选治疗方法。
