摘要目的 初步研究氩氦刀冷冻消融治疗兔VX2肾癌的可行性、有效性与安全性.方法 2012年7月至2013年1月,将38只兔VX2肾癌模型采用随机数字表法随机分为3组:冷冻消融组(15只),根治性肾切除组(15只),肿瘤对照组(8只).冷冻消融组、根治性肾切除组分别在治疗前以及治疗后第1、7、14、21天测定SCr、BUN水平;冷冻消融组、肿瘤对照组于治疗后第21天行常规超声及超声造影观察肾肿瘤灶的大小、回声改变、血流状态;治疗后第21天处死实验兔,解剖尸体了解肿瘤转移情况并行病理染色. 结果 ①冷冻消融组治疗后第1天SCr、BUN明显升高,分别为(105.80±18.66) μmol/L、(8.52±1.04) mmol/L,与治疗前[(71.00±11.33) μmol/L、(6.69±0.78) mmol/L]比较差异有统计学意义(P＜0.05),第14天恢复至治疗前正常水平(P＞0.05);治疗后第21天,冷冻消融组SCr、BUN为(81.93±20.14) μmol/L、(7.00±0.56) mmol/L,与根治性肾切除组[(103.20± 16.16) μmol/L、(8.36±0.76) mmol/L]比较差异有统计学意义(P＜0.05).②治疗后第21天,冷冻消融组、根治性肾切除组肿瘤远处转移率分别为47％、40％,组间比较差异无统计学意义(P＞0.05);冷冻消融组肿瘤灶体积为(1.35±0.24) cm3,肿瘤对照组为(4.74± 1.69) cm3,组间比较差异有统计学意义(P＜0.05).③超声造影与组织病理学检查在冷冻消融治疗肾癌的肿瘤学疗效监测方面差异无统计学意义(P＞0.05).结论 氩氦刀冷冻消融治疗兔VX2肾癌具有良好的可行性、安全性和有效性.超声造影是肾癌冷冻消融后近期疗效评价的重要手段.

abstractsObjective To study the feasibility,effectiveness and safety of cryoablation in renal VX2 tumor.Methods Thirty-eight rabbits with renal VX2 tumor in right kidney were randomized into 3 groups:cryoablation group,nephrectomy group and tumor control group (15,15 and 8 respectively).Vein blood was taken at the same time point for to investigate SCr and BUN in cryoablation and nephrectomy groups.The tumors were also evalutated by two-dimensional ultrasonography and contrast enhanced ultrasonography for the changes of the size,shape and the echo pre-treatment and post-treatment (21st day) in cryoablation and tumor control groups.Rabbits were sacrificed on the 21st day after the treatment,and the metastasis rates were compared.Results ①Significant differences were noted in favor of pre-treatment versus post-treatment with regard to SCr (71.00± 11.33 versus 105.80± 18.66 μmol/L,P＜ 0.05),BUN (6.69±0.78 versus 8.52± 1.04 mmol/L,P＜0.05) in cryoablation group,and the 2 indexes returned to pretreatment level on the 14th day after cryoablation (P＞0.05).There were significant differences between cryoablation group and nephrectomy group on the 21 st day in levels of SCr (81.93±20.14 versus 103.20± 16.16 μmol/L,P＜0.05) and BUN (7.00±0.56 versus 8.36±0.76 mmol/L,P＜0.05).②On the post-treatment day 21,there was no significant difference in the rate of metastasis in cryoablation group and nephrectomy group (47％ versus 40％,P＞0.05).The volume of the tumor in cryoablation group was significantly smaller than that in tumor control group (1.35±0.24 versus 4.74± 1.69 cm3,P＜0.05).③There was no significant difference in monitoring oncologic efficacy between contrast enhanced ultrasonography and pathologic examination (P＞0.05).Conclusions Cryoablation is an effective,safe and feasible therapy in treatment of rabbit renal VX2 tumor.Contrast enhanced ultrasonography can be used as an effective method to evaluate the therapeutic efficiency of cryoablation in renal tumor.