微创治疗小肾肿瘤的方法：TC 引导下的老年患者肾冷冻消融术。

Mini invasive approaches in the treatment of small renal masses: TC-guided renal cryoablation in elderly.

机构信息

University of Foggia, Department of Urology and Organ transplantation, Foggia.

University of Foggia, Department of Radiology, Foggia.

出版信息

Arch Ital Urol Androl. 2020 Dec 17;92(4). doi: 10.4081/aiua.2020.4.309.

DOI:10.4081/aiua.2020.4.309

PMID:33348952

Abstract

BACKGROUND

Today, the goal of surgery is to achieve oncological efficacy with the lowest complication rate. Computed Tomography (CT)-guided cryoablation is proposed as a safe and effective technique. We report, our series of small renal masses treated with cryoablation in elderly (> 70 years).

METHODS

From May 2014 to April 2019, 32 patients with median (IQR) age of 75.5 years (range 71-80) with small renal masses (< T1a) diagnosis, clinical anesthesia contraindications to nephron-sparing surgery or patient's will previous informed consent have been selected at our Urology Department. All patients underwent CT-guided cryoablation, preceded by needle biopsy. The cryoablation consisted in a procedure with an argon/helium gas-based system under local anesthesia. The follow-up included CT abdomen at 3, 6 and 12 months. The definition of incomplete treatment was the persistence of the lesion contrast enhancement (CE) at the end of the scan; the definition of relapse was the appearance of the CE to the 6-month control CT.

RESULTS

The median follow-up was 30 months (IQR 1-59). The median size of the tumor was 3.85 cm (IQR 1.6-4.5). All patients underwent lesion biopsy resulting in diagnosis of Renal Cell Carcinoma (RCC) in 29 patients (90.7%) and oncocytoma in 3 patients (9.3%). A median of 2 cryoprobes (IQR 1- 3) was used and 2/3 cycles of freeze-thaw of the duration of 10 minutes or 5 minutes were performed. Complications were: 3 asymptomatic transitional perirenal effusion, 2 lumbar pain well-controlled by analgesic drug. Hospital stay was 2 days (range 1-3). No case showed incomplete treatment and local relapse or metastates at the CT abdomen-pelvis with contrast medium at 12 months.

CONCLUSIONS

This study shows the efficacy and safety of percutaneous cryoablation of small renal masses in elderly population. The procedure is easy to perform, with low complication rates and well tolerated by the elderly patients.

摘要

背景

如今，外科手术的目标是在尽可能降低并发症发生率的情况下实现肿瘤治疗效果。计算机断层扫描（CT）引导下的冷冻消融被认为是一种安全有效的技术。我们报告了一组在老年（>70 岁）患者中采用冷冻消融治疗小肾肿瘤的系列病例。

方法

自 2014 年 5 月至 2019 年 4 月，我院泌尿外科选择了 32 名患有小肾肿瘤（<T1a）的患者，这些患者的年龄中位数（IQR）为 75.5 岁（范围为 71-80 岁），存在临床麻醉禁忌证或不适合行保留肾单位手术，或者患者本人事先知情同意。所有患者均在 CT 引导下行冷冻消融术，术前先行穿刺活检。冷冻消融术采用氩气/氦气为制冷剂的系统，在局部麻醉下进行。术后随访包括术后 3、6、12 个月行腹部 CT。不完全治疗的定义为扫描结束时病变仍存在强化（CE）；复发的定义为在 6 个月的 CT 随访时出现 CE。

结果

中位随访时间为 30 个月（IQR 1-59）。肿瘤的中位大小为 3.85cm（IQR 1.6-4.5）。所有患者均行病灶活检，29 例（90.7%）患者诊断为肾细胞癌（RCC），3 例（9.3%）患者诊断为嗜酸细胞瘤。使用了中位数为 2 个（IQR 1-3）冷冻探针，进行了中位数 2 个（IQR 1-3）冻融循环，每次持续 10 分钟或 5 分钟。并发症包括：3 例无症状的肾周过渡性积液，2 例腰痛经止痛药物治疗后得到控制。住院时间为 2 天（范围 1-3 天）。在 12 个月的 CT 腹部-骨盆造影中，无不完全治疗、局部复发或转移的病例。