Department of Urology, University-Hospital of Parma, Italy.
Department of Radiologic Sciences, University-Hospital of Parma, Parma, Italy.
Acta Biomed. 2022 Oct 26;93(5):e2022220. doi: 10.23750/abm.v93i5.12827.
In the last decades, the refinements in the imaging techniques led to an increased number of detected renal tumors. If radical and partial nephrectomy remain the gold standard for the treatment of renal cancer, Radio-Frequency Ablation (RFA) has emerged as a therapeutic option for renal masses. Even if this technique is minimally-invasive, it requires a proper preoperative anatomic study and in some cases RFA treatment is technically challenging. To date, there is no standardization for studying challenging cases before treatment and to plan a safe and effective procedure when intervening organs are in the trajectory of the needle. In this study we searched the literature focusing on the challenging cases and strategy applied to manage the treatment safely and effectively.
MedLine and Embase via Ovid database were searched, using the following key words: Percutaneous RFA, radiofrequency, renal ablation, kidney ablation, renal thermoablation, kidney thermoablation, hydrodissection, heat sink. The difficulties found in the literature while performing the ablation procedure were grouped and a categorization of the strategies applied to perform a safe and effective procedure was proposed, in the aim to standardize the approach for treatment of challenging cases. Literature was analyzed according with selection criteria agreed by the Authors.
The literature review showed four groups of lesions requiring an experienced approach. Group 1: Lesions close to the bowel. Group 2: Lesions close to the urinary tract. Group 3: Lesions close to intervening organs. Group 4: Lesions close to large vessels (heat-sink phenomenon).
When planning a RFA treatment, a standardized approach to challenging masses is possible. This review make the treatment of these masses more systematic and safe.
在过去的几十年中，成像技术的改进导致检测到的肾肿瘤数量增加。如果根治性和部分肾切除术仍然是治疗肾癌的金标准，那么射频消融（RFA）已成为治疗肾肿瘤的一种治疗选择。即使这种技术是微创的，它也需要进行适当的术前解剖研究，并且在某些情况下，RFA 治疗在技术上具有挑战性。迄今为止，在治疗前尚无针对挑战性病例的标准化研究方法，也无法在介入器官处于针道轨迹时规划安全有效的手术方案。在这项研究中，我们搜索了文献，重点研究了具有挑战性的病例以及用于安全有效地进行治疗的策略。
通过 Ovid 数据库在 MedLine 和 Embase 上进行搜索，使用以下关键词：经皮 RFA、射频、肾消融、肾消融、肾热消融、肾热消融、水分离、热汇。在进行消融过程中，文献中发现的困难被分组，并提出了一种分类策略，以安全有效地进行手术，旨在为治疗具有挑战性的病例制定标准方法。根据作者商定的选择标准对文献进行了分析。
文献复习显示，需要有经验的方法治疗的病变有四组。第 1 组：靠近肠道的病变。第 2 组：靠近泌尿道的病变。第 3 组：靠近介入器官的病变。第 4 组：靠近大血管（热汇现象）的病变。
在规划 RFA 治疗时，可以采用标准化方法治疗具有挑战性的肿块。本综述使这些肿块的治疗更加系统和安全。
