Hong B A, Du X, Ji Y P, Zhao Q, Wang S, Liu J, Cao Y D, Yang X, Du P, Yang Y, Zhang N
Department of Urology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing 100142,China.
Zhonghua Yi Xue Za Zhi. 2021 Dec 14;101(46):3794-3798. doi: 10.3760/cma.j.cn112137-20210707-01524.
To explore the safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy in the treatment of renal tumors. The 65 patients with renal tumors undergoing laparoscopic microwave ablation combined with partial nephrectomy from November 2017 to May 2021 were retrospectively analyzed. There were 46 males and 19 females. The average age was (56.6±14.1) years. The mean body mass index was (25.7±3.3) kg/m. The tumors located in the left kidney in 30 cases and the right kidney in 35 cases. The ECOG score was 0 in 59 patients and 1 in 6 patients. The mean maximum diameter of the tumors was (2.3±1.0) cm(1.0-5.0 cm). According to R.E.N.A.L. scoring, 41 cases were of low difficulty (4-6 points), 23 cases of medium difficulty (7-9 points) and 1 case of high difficulty (10-12 points). The renal tumors were ablated by laparoscopic microwave ablation, then followed by partial nephrectomy. Postoperative complications were observed and the prognosis was assessed by CT or MRI. The mean duration of operation was (76.6±19.4) min (40-120 min). The median intraoperative blood loss was 20 ml(5-50 ml). The median duration of postoperative hospitalization was 4 d(3-6 d). Complications of Clavien grade Ⅰ were found in 11 patients (fever, nausea and vomiting, lumbar pain), and no complications were grade Ⅱ or above. Postoperative pathology showed that no positive margin was found, and 46 cases of clear cell renal cell carcinoma (AJCC stage: T stage 42 cases, T stage 4 cases; WHO/ISUP classification: 21 cases of grade 1, 23 cases of grade 2, 2 cases of grade 3); 2 cases of type 1 papillary renal cell carcinoma (stage T, grade 1); 1 case of type 2 papillary renal cell carcinoma (T stage, grade 2); 2 cases of renal chromophobe carcinoma (all stage T); 1 case of low-grade malignant potential multilocular cystic renal tumor; 2 cases of adenocarcinoma (combined with the postoperative history of rectal cancer, metastasis was considered); 6 cases of renal angiomyolipoma; 2 cases of eosinophiloma; 1 case of papillary adenoma; 1 case of benign renal cyst and 1 case of renal hemangioma with calcification. The median follow-up was 24 months (1-42 months). Sixty-three patients survived and two died (one due to heart disease and one due to metastatic colorectal cancer). According to postoperative imaging, there were no signs of tumor recurrence or metastasis in other cases. Blood tests were performed regularly, and no significant abnormalities occurred. The safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy for the treatment of renal tumor is satisfactory, such as less intraoperative bleeding, fewer complications, less effect on renal function and postoperative pathology, providing a potential option for renal tumor treatment.
探讨腹腔镜微波消融联合部分肾切除术治疗肾肿瘤的安全性和有效性。回顾性分析2017年11月至2021年5月期间65例行腹腔镜微波消融联合部分肾切除术的肾肿瘤患者。其中男性46例，女性19例。平均年龄为(56.6±14.1)岁。平均体重指数为(25.7±3.3)kg/m²。肿瘤位于左肾30例，右肾35例。59例患者的东部肿瘤协作组(ECOG)评分为0，6例为1。肿瘤平均最大直径为(2.3±1.0)cm(1.0 - 5.0 cm)。根据R.E.N.A.L.评分，低难度(4 - 6分)41例，中等难度(7 - 9分)23例，高难度(10 - 12分)1例。先行腹腔镜微波消融肾肿瘤，然后行部分肾切除术。观察术后并发症，并通过CT或MRI评估预后。平均手术时间为(76.6±19.4)分钟(40 - 120分钟)。术中中位失血量为20 ml(5 - 50 ml)。术后中位住院时间为4天(3 - 6天)。11例患者出现ClavienⅠ级并发症(发热、恶心呕吐、腰痛)，无Ⅱ级及以上并发症。术后病理显示切缘均为阴性，透明细胞肾细胞癌46例(AJCC分期：T1期42例，T2期4例；WHO/ISUP分级：1级21例，2级23例，3级2例)；1型乳头状肾细胞癌2例(T1期，1级)；2型乳头状肾细胞癌1例(T2期，2级)；肾嫌色细胞癌2例(均为T1期)；低度恶性潜能多房囊性肾肿瘤1例；腺癌2例(结合直肠癌术后病史，考虑有转移)；肾血管平滑肌脂肪瘤6例；嗜酸性细胞瘤2例；乳头状腺瘤1例；良性肾囊肿1例；钙化性肾血管瘤1例。中位随访时间为24个月(1 - 42个月)。63例患者存活，2例死亡(1例死于心脏病，1例死于转移性结直肠癌)。根据术后影像学检查，其他病例均无肿瘤复发或转移迹象。定期进行血液检查，未出现明显异常。腹腔镜微波消融联合部分肾切除术治疗肾肿瘤的安全性和有效性令人满意，如术中出血少、并发症少、对肾功能和术后病理影响小，为肾肿瘤治疗提供了一种潜在选择。
