Radio frequency ablation of small renal tumors: Intermediate results
Radio frequency ablation of small renal tumors: Intermediate results
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DOI：
10.1097/01.ju.0000119905.72574.de
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发表时间：
2004-05-01
影响因子：
6.6
通讯作者：
Wood, BJ
中科院分区：
文献类型：
--
作者：
Hwang, JJ;Walther, MM;Wood, BJ
目的：随着射频技术的不断发展，射频消融（RFA）在小肾肿瘤治疗中的临床应用得到了积极的研究。我们介绍 RFA 后患者的中期结果。材料和方法：自 2001 年 1 月以来，17 名患者（总共 24 个遗传性肾肿瘤，范围从 1.2 到 2.85 cm）在腹腔镜 (9) 或经皮 (8) 引导下使用 200 W Cool-tip RF 系统（Radionics，伯灵顿，马萨诸塞州）进行 RFA 治疗，并进行了至少 1 年的随访。如果肾肿瘤邻近肠、输尿管或大血管，经皮入路被认为是不合适的。治疗资格标准包括平均肿瘤直径小于 3.0 cm、肿瘤在 1 年内生长以及计算机断层扫描 (CT) 上对比增强（HU 变化大于 20）的实体外观。术后随访包括使用或不使用静脉造影剂的 CT 检查以及定期肾功能评估。结果：患者中位年龄为 38 岁（范围 20 至 51 岁）。中位随访时间为 385 天（范围 342 至 691），肿瘤或热病灶中位直径从 2.26 厘米减小至 1.62 厘米（p = 0.0013），并且只有 1 个位于肺门附近中心的病灶 (4%) 在 12 个月时的 CT 上表现出对比增强（HU 变化大于 10）。在通过腹腔镜消融的 15 个肾肿瘤中，13 个与肠道直接接触，2 个毗邻输尿管，需要在 RFA 前动员。在这些病例中，腹腔镜超声用于指导射频电极放置并监测消融过程。手术时间和术中失血量（平均标准误差平均值）分别为 243±29 分钟和 67 +/- 9 cc。 1 名输尿管与肿瘤粘连的患者在腹腔镜 RFA 后出现肾盂输尿管连接部梗阻，需要开腹修复。结论：在至少 1 年的随访中，24 个消融肿瘤中有 23 个在 CT 上缺乏造影剂摄取，符合我们成功 RFA 治疗的放射学标准。与使用较低射频功率发生器的早期系列相比，使用 Radionics 系统进行 RFA 治疗小肾肿瘤似乎能获得更好的治疗效果。由于对流热损失较少，高瓦数发生器可能会获得更一致的能量沉积，并随后导致目标组织中的细胞死亡。
Purpose: With evolving radio frequency technology, the clinical application of radio frequency ablation (RFA) has been actively investigated in the treatment for small renal tumors. We present our intermediate patient outcomes after RFA.Materials and Methods: Since January 2001, 17 patients with a total of 24 hereditary renal tumors ranging from 1.2 to 2.85 cm were treated with RFA using the 200 W Cool-tip RF System (Radionics, Burlington, Massachusetts) under laparoscopic (9) or percutaneous (8) guidance and had a minimum 1-year followup. A percutaneous approach was considered unsuitable if kidney tumors were contiguous to bowel, ureter or large vessels. Treatment eligibility criteria included an average tumor diameter of less than 3.0 cm, tumor growth during 1 year and solid appearance with contrast enhancement (HU change greater than 20) on computerized tomography (CT). Postoperative followup consisted of CT with and without intravenous contrast, and renal function assessment at regular intervals.Results: Median patient age was 38 years (range 20 to 51). At a median followup of 385 days (range 342 to 691), median tumor or thermal lesion diameter decreased from 2.26 to 1.62 cm (p = 0.0013), and only 1 lesion (4%), which was located centrally near the hilum, exhibited contrast enhancement (HU change greater than 10) on CT at 12 months. Of the 15 renal tumors ablated laparoscopically, 13 were in direct contact with the bowel and 2 were abutting the ureter, necessitating mobilization before RFA. Laparoscopic ultrasound was used to guide radio frequency electrode placement and monitor the ablation process in these cases. Operative time and intraoperative blood loss (mean standard mean of error) were 243 29 minutes and 67 +/- 9 cc, respectively. In 1 patient whose ureter was adherent to the tumor a ureteropelvic junction obstruction developed after laparoscopic RFA, requiring open repair.Conclusions: At the minimum 1-year followup 23 of 24 ablated tumors lacked contrast uptake on CT, meeting our radiographic criteria of successful RFA treatment. RFA treatment of small renal tumors using the Radionics system appears to result in superior treatment outcomes compared to those of earlier series with lower radio frequency power generators. A high wattage generator might attain more consistent energy deposition with subsequent cell death in the targeted tissue due to less convective heat loss.