摘要目的 评价腹腔镜射频消融治疗T1 aN0M0期肾癌的中期效果.方法 2006年3月至2009年3月40例肾癌患者,临床分期均为T1aN0M0,手术前经B超、CT检查诊断肾脏肿瘤.40例患者均为单侧发病,其中8例为孤立肾发病.40例患者中左侧22例,右侧18例,术前未发现远处转移.术中采用B超定位,行腹腔镜下射频消融治疗,术后采用CT进行随访并定期复查血肌酐,计算肾小球滤过率(eGFR).结果 所有患者顺利接受手术,平均手术时间(101 ±19)min,术中平均出血量(90±14)ml,术中、术后均无输血病例.复查CT提示39例患者肾癌病灶完全消融(一次消融成功率97.5％),1例功能性孤立肾患者在术后第7天行CT复查提示肿瘤残留,未予再次手术,密切随访至今病灶无明显变化；完全消融的39例患者中有1例患者在术后6个月时复查CT见原射频区域高密度影提示肿瘤复发,未进行再次治疗.本组患者3年肿瘤复发率2.5％,3年总体生存率及肿瘤相关生存率均为100％.40例患者术后3年时eGFR平均(72±9)ml/(min· 1.73 m2),较术前差异无统计学意义(P＞0.05).结论 腹腔镜射频消融治疗T1aN0M0期肾癌是安全有效的保留肾单位的术式,对肾功能无明显影响.

abstractsObjective To determine the effect of laparoscopic radiofrequency ablation of TlaN0M0 renal cell carcinoma (RCC) with regular follow-up.Methods All patients underwent surgery from March 2006 to March 2009.Eight cases were solitary kidney.Twenty-two cases of left RCC and 18 cases of right RCC were diagnozed by ultrasonography and CT scanning.All of the cases were T1aN0M0 stage.No metastasis was found by iconography test.By ultrasound positioning,laparoscopic radiofrequency were performed on the renal tumor.All patients were followed up with eGFR and enhanced-CT.Results All patients underwent laparoscopic radiofrequency ablation surgery successfully.The mean operation time was (101 ± 19) minutes and the mean blood loss was (90 ± 14) ml (no blood transfusion pre-and postoperation).During postoperative follow-up,enhanced CT revealed complete ablation in 39 cases (the success rate was 97.5％),and 1 residue tumor was confirmed by enhanced CT 7 days post operation.This patient was under close surveillance because of solitary kidney.No progression of the residue tumor was found during the follow-up.One case of recurrence was confirmed by enhanced CT in 6 month after operation.The 3-year recurrence rate was 2.5％.No further intervation was performed on this patient and no change was found in the recurrence area during the follow-up.Both 3-year total survival rate and 3-year cancer specific survival rate were 100％.The mean eGFR was (72 ± 9) ml/(min · 1.73 m2) in 3 years after surgery.There was no significant difference between pre-and post-operation (P ＞ 0.05).Conclusion Mid-term follow-up results show the effectiveness and safety of laparoscopic radiofrequency ablation in the treatment for T1aN0M0 RCC and have no negative influence on the renal function.