CAJ | 학술논문

目的探讨肾肿瘤射频消融（ RFA）的有效性、安全性及技术参数。方法选择临床根治性肾肿瘤切除术病例30例，均为单侧单发肿瘤，按肿瘤最大直径（φmax ）及RFA前是否阻断肾动脉分组：A组φmax≤4.0 cm，10例，其中A1组5例，RFA前先阻断肾动脉，A2组5例，RFA前不阻断肾动脉；B组4.0 cm＜φmax＜6.0 cm，10例，其中B1组5例，RFA前先阻断肾动脉，B2组5例，RFA前不阻断肾动脉；C组φmax≥6.0 cm，10例，其中C1组5例，RFA前先阻断肾动脉，C2组5例，RFA前不阻断肾动脉。经开放或腹腔镜手术，先游离肾肿瘤及肾蒂血管，每组RFA前阻断或不阻断各5例，直视下对肾肿瘤进行单次RFA，消融频率均为450 kHz，再根治性切除肾肿瘤，将肿瘤进行病理切片检查，获得肾肿瘤内部及边缘消融灶的病理表现，分析病理结果与肿瘤大小、消融时间及RFA前阻断肾动脉与否之间的关系。结果所有病例均为肾细胞癌，其中透明细胞癌25例，集合管癌5例。消融参数、RFA前阻断肾动脉与否及肿瘤大小与病理结果关系如下：A组消融时间10 min，A1组消融灶直径约（5.2±0.5）cm，A2组消融灶直径约（4.5±0.6）cm（A1 vs． A2，P＝0.035）；B组消融时间12 min，B1组消融灶直径约（5.4±0.4）cm，B2组消融灶直径约（4.6±0.5）cm （B1 vs．B2，P＝0.028）；C组消融15 min，C1组消融灶直径约（5.5±0.6）cm，C2组消融灶直径约（4.8±0.8） cm（C1 vs．C2，P＝0.038）。 A、B、C组消融直径分别为（5.0±0.6）cm、（5.1±0.1）cm、（5.1±0.4）cm，组间两两比较无统计学差异（ P＞0.05）。结论在选择性病例中，肾肿瘤射频消融是安全有效的，其疗效与肿瘤的大小密切相关，对φmax≤4.0 cm的小肾癌，RFA完全可以获得超过肿瘤直径的消融直径，达到“根治”的疗效。对于φmax≥4.0 cm的大肾癌，单次RFA无法获得“根治”的疗效；在相同条件下，消融前阻断肾动脉能获得更大的消融直径；在消融10 min的情况下，再单纯延长消融时间无法获得更大的消融直径。目的探討腎腫瘤射頻消融（ RFA）的有效性、安全性及技術參數。方法選擇臨床根治性腎腫瘤切除術病例30例，均為單側單髮腫瘤，按腫瘤最大直徑（φmax ）及RFA前是否阻斷腎動脈分組：A組φmax≤4.0 cm，10例，其中A1組5例，RFA前先阻斷腎動脈，A2組5例，RFA前不阻斷腎動脈；B組4.0 cm＜φmax＜6.0 cm，10例，其中B1組5例，RFA前先阻斷腎動脈，B2組5例，RFA前不阻斷腎動脈；C組φmax≥6.0 cm，10例，其中C1組5例，RFA前先阻斷腎動脈，C2組5例，RFA前不阻斷腎動脈。經開放或腹腔鏡手術，先遊離腎腫瘤及腎蒂血管，每組RFA前阻斷或不阻斷各5例，直視下對腎腫瘤進行單次RFA，消融頻率均為450 kHz，再根治性切除腎腫瘤，將腫瘤進行病理切片檢查，穫得腎腫瘤內部及邊緣消融竈的病理錶現，分析病理結果與腫瘤大小、消融時間及RFA前阻斷腎動脈與否之間的關繫。結果所有病例均為腎細胞癌，其中透明細胞癌25例，集閤管癌5例。消融參數、RFA前阻斷腎動脈與否及腫瘤大小與病理結果關繫如下：A組消融時間10 min，A1組消融竈直徑約（5.2±0.5）cm，A2組消融竈直徑約（4.5±0.6）cm（A1 vs． A2，P＝0.035）；B組消融時間12 min，B1組消融竈直徑約（5.4±0.4）cm，B2組消融竈直徑約（4.6±0.5）cm （B1 vs．B2，P＝0.028）；C組消融15 min，C1組消融竈直徑約（5.5±0.6）cm，C2組消融竈直徑約（4.8±0.8） cm（C1 vs．C2，P＝0.038）。 A、B、C組消融直徑分彆為（5.0±0.6）cm、（5.1±0.1）cm、（5.1±0.4）cm，組間兩兩比較無統計學差異（ P＞0.05）。結論在選擇性病例中，腎腫瘤射頻消融是安全有效的，其療效與腫瘤的大小密切相關，對φmax≤4.0 cm的小腎癌，RFA完全可以穫得超過腫瘤直徑的消融直徑，達到“根治”的療效。對于φmax≥4.0 cm的大腎癌，單次RFA無法穫得“根治”的療效；在相同條件下，消融前阻斷腎動脈能穫得更大的消融直徑；在消融10 min的情況下，再單純延長消融時間無法穫得更大的消融直徑。
목적탐토신종류사빈소융（ RFA）적유효성、안전성급기술삼수。방법선택림상근치성신종류절제술병례30례，균위단측단발종류，안종류최대직경（φmax ）급RFA전시부조단신동맥분조：A조φmax≤4.0 cm，10례，기중A1조5례，RFA전선조단신동맥，A2조5례，RFA전불조단신동맥；B조4.0 cm＜φmax＜6.0 cm，10례，기중B1조5례，RFA전선조단신동맥，B2조5례，RFA전불조단신동맥；C조φmax≥6.0 cm，10례，기중C1조5례，RFA전선조단신동맥，C2조5례，RFA전불조단신동맥。경개방혹복강경수술，선유리신종류급신체혈관，매조RFA전조단혹불조단각5례，직시하대신종류진행단차RFA，소융빈솔균위450 kHz，재근치성절제신종류，장종류진행병리절편검사，획득신종류내부급변연소융조적병리표현，분석병리결과여종류대소、소융시간급RFA전조단신동맥여부지간적관계。결과소유병례균위신세포암，기중투명세포암25례，집합관암5례。소융삼수、RFA전조단신동맥여부급종류대소여병리결과관계여하：A조소융시간10 min，A1조소융조직경약（5.2±0.5）cm，A2조소융조직경약（4.5±0.6）cm（A1 vs． A2，P＝0.035）；B조소융시간12 min，B1조소융조직경약（5.4±0.4）cm，B2조소융조직경약（4.6±0.5）cm （B1 vs．B2，P＝0.028）；C조소융15 min，C1조소융조직경약（5.5±0.6）cm，C2조소융조직경약（4.8±0.8） cm（C1 vs．C2，P＝0.038）。 A、B、C조소융직경분별위（5.0±0.6）cm、（5.1±0.1）cm、（5.1±0.4）cm，조간량량비교무통계학차이（ P＞0.05）。결론재선택성병례중，신종류사빈소융시안전유효적，기료효여종류적대소밀절상관，대φmax≤4.0 cm적소신암，RFA완전가이획득초과종류직경적소융직경，체도“근치”적료효。대우φmax≥4.0 cm적대신암，단차RFA무법획득“근치”적료효；재상동조건하，소융전조단신동맥능획득경대적소융직경；재소융10 min적정황하，재단순연장소융시간무법획득경대적소융직경。
Objective To study the efficiency , safety and technical parameter of radiofrequency ablation ( RFA) for renal tumors .Methods Thirty patients who suffered single renal tumor and underwent radical tumor nephrectomy were divided to three groups according to the tumor diameter (φmax) and whether the renal artery was blocked or not before RFA:Group A (φmax≤4.0 cm),10 cases including A1 (the renal artery was blocked before RFA) 5 cases and A2 (the renal artery was not blocked before RFA ) 5 cases.Group B (4.0 cm<φmax<6.0 cm), 10 cases including B1( the renal artery was blocked before RFA ) 5 cases and B2 ( the renal artery was not blocked before RFA) 5 cases.Group C (φmax≥6.0 cm),10 cases including C1 (the renal artery was blocked before RFA ) 5 cases and C2 ( the renal artery was not blocked before RFA ) 5 cases.Renal tumors were received single RFA ( frequency 450 kHz ) after the tumors and renal pedicle blood vessel were exposed by the open or laparoscopic surgery.And then the tumor tissue was examined by pathological histologic analysis after radical resection of these tumors .Moreover ,the relationship between pathological examination and tumor diameter ,melting time and whether the renal artery was blocked or not before RFA was analyzed .Results All 30 cases were renal cell carcinoma including 25 cases clear cell carcinoma and 5 cases collecting duct carcinoma .The melting time of Group A was 10 min and the ablation diameter of A1 was (5.2 ±0.5) cm,A2 was (4.5 ±0.6) cm (A1 vs.A2,P=0.035).And the melting time of Group B was 12 min and the ablation diameter of B1 was (5.4 ±0.4) cm,B2 was (4.6 ±0.5) cm (B1 vs. B2,P=0.028).Furthermore,the melting time of Group C was 15 min and the ablation diameter of C1 was (5.5 ± 0.6) cm,C2 was (4.8 ±0.8) cm (C1 vs.C2,P=0.038).There was no significant difference among the average ablation diameter of Group A,B,C which was (5.0 ±0.6) cm,(5.1 ±0.1) cm,and (5.1 ±0.4) cm separately (P>0.05 ) .Conclusions The RFA was safe and effective for the selective renal carcinoma patients and the effect was related to the tumor diameter .RFA could achieve sufficient ablation diameter which was larger than the tumor diameter in the small renal carcinoma (φmax≤4.0 cm) and get the cure effects .However ,single RFA couldn′t cure the large renal carcinoma (φmax≥4.0 cm) .Larger ablation diameter would be obtained when the renal artery was blocked prior to RFA .But no more ablation diameter could be generated by simple extension of ablation time when already melted 10 min.