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Microwave Ablation of Renal Cell Carcinoma.
Journal of Endourology ( IF 2.7 ) Pub Date : 2021-09-01 , DOI: 10.1089/end.2020.1078
Jordan R Krieger 1 , Fred T Lee 1 , Timothy McCormick 1 , Timothy J Ziemlewicz 1 , J Louis Hinshaw 1 , Shane A Wells 1 , Paul E Laeseke 1 , Lindsay Stratchko 1 , Marci Alexander 1 , Sean P Hedican 1 , Sara L Best 1 , Tudor Borza 1 , Stephen Y Nakada 1 , E Jason Abel 1
Affiliation  

Management options for small renal masses include active surveillance, partial nephrectomy, radical nephrectomy, and thermal ablation. For tumors typically ≤3 cm in size, thermal ablation is a good option for those desiring an alternative to surgery or active surveillance, especially in patients who are considered high surgical risk. We favor microwave ablation because of the more rapid heating, higher temperatures that overcome the heat sink effect of vessels, reproducible cell kill, and a highly visible ablation zone formed by water vapor that corresponds well to the zone of necrosis. For central tumors, we favor cryoablation because of the slower formation of the ablation zone and less likelihood of damage to the collecting system. With microwaves, it is important to monitor the ablation zone in real time (ultrasound is the best modality for this purpose), avoid direct punctures of the collecting system, and to place probes tangential to the collecting system to avoid burning open a persistent tract between the urothelium and extrarenal spaces or causing strictures. The surgical steps described in this video cover our use of high-frequency jet ventilation with general anesthesia to minimize organ motion, initial imaging and targeting, probe insertion, hydrodissection (a technique that enables displacement of adjacent structures), the ablation itself, and finally our dressing. Postoperative cares typically consist of observation with a same-day discharge or an overnight stay. Follow-up includes a magnetic resonance imaging abdomen with and without contrast, chest X-ray, and laboratories (basic metabolic panel, complete blood count, and C-reactive protein) 6 months postablation. Overall, percutaneous microwave ablation is an effective and safe treatment option for renal cell carcinoma in both T1a and T1b tumors in selected patients with multiple studies showing excellent oncologic outcomes when compared with partial and radical nephrectomy.

中文翻译:

肾细胞癌的微波消融。

肾脏小肿块的治疗选择包括主动监测、部分肾切除术、根治性肾切除术和热消融术。对于通常小于 3 cm 的肿瘤,热消融对于那些希望替代手术或主动监测的人来说是一个不错的选择,尤其是对于被认为具有高手术风险的患者。我们赞成微波消融,因为加热速度更快,温度更高,可以克服血管的热沉效应,可重复杀死细胞,以及由水蒸气形成的高度可见的消融区,与坏死区很好地对应。对于中央肿瘤,我们倾向于冷冻消融,因为消融区的形成较慢,对收集系统的损坏可能性较小。有了微波炉,重要的是实时监测消融区(超声波是实现此目的的最佳方式),避免直接刺穿收集系统,并在收集系统的切线处放置探头以避免灼伤尿路上皮和肾外空间或引起狭窄。本视频中描述的手术步骤涵盖了我们在全身麻醉下使用高频射流通气来最大限度地减少器官运动、初始成像和靶向、探针插入、水分离(一种能够置换相邻结构的技术)、消融本身,以及最后我们的敷料。术后护理通常包括当天出院或过夜的观察。随访包括有或没有对比的磁共振成像腹部、胸部 X 光片、和实验室(基础代谢组、全血细胞计数和 C 反应蛋白) 消融后 6 个月。总体而言,经皮微波消融是治疗选定患者的 T1a 和 T1b 肾细胞癌的有效且安全的治疗选择,多项研究显示与部分和根治性肾切除术相比具有出色的肿瘤学结果。
更新日期:2021-09-01
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