摘要目的 初步探讨冷循环射频消融联合肿瘤剜除术治疗窄基、外向型生长的巨大肾错构瘤的临床疗效.方法 回顾性分析南京大学医学院附属鼓楼医院泌尿外科2011年7月至2014年10月收治的接受冷循环射频消融联合肾肿瘤剜术的15例巨大、窄基底型肾错构瘤患者资料,男性6例,女性9例,年龄35 ～71岁,中位年龄49岁.肿瘤位于左肾6例、右肾8例,孤立肾1例.所有诊断均经超声或CT检查结果证实.肿瘤最大径8.5～12.7 cm,平均9.7 cm.所有肿瘤均呈窄基、外向型生长,无集合系统侵犯.15例患者术前平均血红蛋白为(127 ±19)g/L、平均血清肌酐为(89±53) μmol/L、患肾平均肾小球滤过率(GFR)为(32±12)ml·min-1·1.73 m-2.结果 15例患者手术均获得成功,平均手术时间(115±31) min,平均出血量(72±21)ml,术后平均住院时间(7±2)d.术中及术后均未输血,术后3d复查血红蛋白为(129±18) g/L,血清肌酐为(92±41) μmol/L,患肾GFR为(30±15)ml·min-·1.73 m-2,与术前相比差异均无统计学意义(P值均＞0.05).术后病理检查结果证实为肾错构瘤.平均随访19.5个月,术后1、3、6个月复查CT及GFR,均显示无局部复发或肾功能受损.结论 冷循环射频消融联合肿瘤剜除可安全有效地治疗窄基、外向型生长的巨大肾错构瘤,短期随访结果显示治疗效果基本达到预期目标.

abstractsObjective To initially explore the clinical effect of cool-tip radiofrequency ablation combined with enucleation for the giant hamartoma of kidney with narrow base and export-oriented way of growth.Methods The clinical date of 15 patients including 6 male and 9 female with special hamartoma of kidney underwent cool-tip radiofrequency ablation assisted enucleation from July 2011 to October 2014 were reviewed.The median age was 49 years (ranging from 35 to 71 years).There were 6 cases with left renal tumor,8 cases with right renal tumor and 1 case with solitary kidney tumor.All patients were confirmed by B ultrasound or CT scan, the mean diameter of hamartoma of kidney was 9.7 cm (8.5-12.7)cm, all tumors were located distant from the collecting system and presents with a special way of growth.The preoperative hemoglobin was (129 ± 18)g/L,SCr was (92 ±41) μmol/L, glomerular filtration rate (GFR) was (32 ± 12) ml · min-1 · 1.73 m-2.Results Cool-tip radiofrequency ablation assisted enucleation was technically successful in all patients.The mean operative duration was (115 ± 31)minutes, and the average intraoperative bleeding was (72 ± 21)ml with no blooding transfusion.The postoperative hospital stay was(7 ± 2)days, and the postoperative hemoglobin was (129 ± 18) g/L, SCr (92 ± 41) μmol/L, GFR (30 ± 15) ml · min-1 1.73 m-2.No statistic change of hemoglobin and SCr or glomerular filtration rate after operations(all P ＞ 0.05).Postoperative pathology showed that all cases were hamartoma of kidney.During a mean follow-up period of 19.5 months, none of them had local tumor recurrence or chronic renal insufficiency.Conclusions Cool-tip radiofrequency ablation assisted enucleation is both safe and effective in the treatment of huge hamartoma of kidney with a narrow base and export-oriented way of growth.The short-term follow-up shows a satisfactory therapeutic effect.