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目的:回顾分析小肾肿瘤冷冻消融治疗的临床资料并总结经验。方法:2004年8月～2010年11月行腹腔镜下(腹腔镜组,n=7)或经皮穿刺(经皮组,n=24)冷冻消融治疗小肾肿瘤患者30例(31个肿瘤)。31个肿瘤中7个位于肾上极,12个位于肾中极,12个位于肾下极。冷冻治疗前均行肿瘤穿刺活检病理检查,术后定期随访。结果:平均手术时间腹腔镜组(142.1±32.9)min明显长于经皮组(103.8±29.9)min,差异有统计学意义(P=0.009)。中位出血量腹腔镜组为55ml明显多于经皮组的5ml,差异有统计学意义(P<0.001)。病理结果示19个(61.3%)肾细胞癌,4个(12.9%)嗜酸细胞瘤,5个(16.1%)良性肿瘤,3个(9.7%)穿刺标本中未见肿瘤组织。随访3～60(19.2±16.1)个月,术前平均血肌酐浓度141.5μmol/L与术后3个月复查浓度176.8μmol/L差异无统计学意义意义(P=0.212)。1例(3.2%)患者术后出现肉眼血尿,1例(3.2%)肾细胞癌患者术后6个月复发。结论:冷冻消融是治疗小肾肿瘤安全有效的方法,适用于高危患者。
Objective: To retrospectively analyze the clinical data of frozen-thawed small renal tumors and to summarize the experience. Methods: From August 2004 to November 2010, 30 patients (31 tumors) with small renal cell carcinoma underwent laparoscopic (laparoscopic group, n = 7) or percutaneous transcutaneous (n = 24) ). Seven of the 31 tumors were located in the upper pole of the kidney, 12 in the middle pole and 12 in the lower pole of the kidney. Cryotherapy before tumor biopsy pathological examination, regular follow-up. Results: The average operative time in laparoscopic group (142.1 ± 32.9) min was significantly longer than that in percutaneous group (103.8 ± 29.9) min, the difference was statistically significant (P = 0.009). The median amount of bleeding laparoscopic group was 55ml significantly more than the transdermal group of 5ml, the difference was statistically significant (P <0.001). Pathological findings showed 19 (61.3%) renal cell carcinomas, 4 (12.9%) oncocytomas, 5 (16.1%) benign tumors and no tumor tissue in 3 (9.7%) puncture specimens. The average preoperative serum creatinine concentration was 141.5μmol / L at 3 ~ 60 (19.2 ± 16.1) months after operation and 176.8μmol / L at 3 months postoperatively. There was no significant difference between the two groups (P = 0.212). One patient (3.2%) had gross hematuria after operation, and one patient (3.2%) had recurrence at 6 months after operation. Conclusion: Cryoablation is a safe and effective method for the treatment of small renal tumors and is suitable for high-risk patients.