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孤立肾肿瘤的射频消融与部分肾切除术的比较

Comparison of radiofrequency ablation and partial nephrectomy for tumor in a solitary kidney.

作者信息

Xiaobing Wu, Wentao Gong, Guangxiang Liu, Fan Zhang, Weidong Gan, Hongqian Guo, Gutian Zhang

机构信息

Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, 210008, China.

出版信息

BMC Urol. 2017 Sep 6;17(1):79. doi: 10.1186/s12894-017-0269-4.

Abstract

BACKGROUND

To estimate oncologic and functional outcomes for radiofrequency ablation (RFA) versus partial nephrectomy (PN) for tumors in a solitary kidney.

METHODS

Nineteen patients with sporadic renal cell carcinoma in a solitary kidney were treated with RFA, and 21 patients were treated with PN between November 2008 and September 2015. Basic demographic information including age, gender, operative and pathological data, complications, renal function, oncological outcomes, was obtained for each patient. Statistical analysis was done to test for the correlation of clinical and pathological features, renal function outcomes, as well as oncological outcomes of RFA and PN. All statistical tests were 2-sided, and p-value < 0.05 was considered significant. Statistical analyses were performed using SPSS 19.0.

RESULTS

No significant differences were indicated between the RFA and PN with respect to mean patient age, tumor size, as well as intraoperative or postoperative complications. The mean length of hospitalization (P = 0.019) and mean operative time (P = 0.036) was significantly shorter in RFA, with the median estimated blood loss being greater in PN (P = 0.001). The mean serum creatinine level 24 h following operation were significantly higher than preoperative creatinine in PN (P = 0.009), but did not reach statistical significance in RFA. Local recurrence were detected in only 1 patient (5%) in PN and 3 patients (18.75%) in RFA (P = 0.4). One patient developed pulmonary metastasis and one exhibited tumor persistence in RFA, none were present in PN.

CONCLUSIONS

Radiofrequency Ablation and Partial Nephrectomy for Tumors in a Solitary Kidney were all safe and effective, with each method having distinct advantages. It is the decision of the patient and urologist to pick the best approach.

摘要

背景

评估对于孤立肾肿瘤,射频消融(RFA)与部分肾切除术(PN)的肿瘤学及功能预后。

方法

2008年11月至2015年9月期间,19例孤立肾散发性肾细胞癌患者接受了RFA治疗,21例患者接受了PN治疗。获取了每位患者的基本人口统计学信息,包括年龄、性别、手术及病理数据、并发症、肾功能、肿瘤学预后。进行统计分析以检验RFA和PN的临床及病理特征、肾功能预后以及肿瘤学预后之间的相关性。所有统计检验均为双侧检验,p值<0.05被认为具有统计学意义。使用SPSS 19.0进行统计分析。

结果

RFA组和PN组在患者平均年龄、肿瘤大小以及术中或术后并发症方面无显著差异。RFA组的平均住院时间(P = 0.019)和平均手术时间(P = 0.036)显著更短,PN组的估计中位失血量更大(P = 0.001)。PN组术后24小时的平均血清肌酐水平显著高于术前肌酐水平(P = 0.009),但RFA组未达到统计学意义。PN组仅1例患者(5%)出现局部复发,RFA组有3例患者(18.75%)出现局部复发(P = 0.4)。RFA组有1例患者发生肺转移,1例患者肿瘤持续存在,PN组均未出现。

结论

孤立肾肿瘤的射频消融和部分肾切除术均安全有效,每种方法都有其独特优势。选择最佳方法由患者和泌尿外科医生共同决定。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be3c/5588723/e3893ac93c3b/12894_2017_269_Fig1_HTML.jpg

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