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目的:探讨射频消融对人离体肾癌消融坏死范围、形态及周围组织的影响,为临床应用提供理论依据。方法:12例行后腹腔镜下肾根治切除术的肾癌患者(肿瘤最大径≤3.2cm)的肾脏,根据消融的组织及时间设置为四组:5min正常肾组(A组,12例次)、5min肾癌组(B组,6例次)、12min正常肾组(C组,12例次)及12 min肾癌组(D组,6例次)。标本送入病理科后,给予不同时间射频消融,肉眼下观察射频消融时的状态、正常肾组织和肿瘤组织消融坏死范围及集合系统完整性。随后制作病理切片,观察消融组织的病理改变。结果:1射频消融时的组织外表面温度升高,组织皱缩、内陷,并有热气泡顺针道溢出;2正常肾组织射频消融灶的形态为围绕射频针的椭球形,长轴平行射频针,小于3.2cm肾肿瘤组织消融灶形态为肿瘤原始形状,包膜形成肿瘤和正常肾组织的明显分界;3与C组相比,A组射频消融直径显著减小(P<0.01),B组的消融范围不一致,小于2cm的肿瘤消融直径为肿瘤最大径,大于2cm的肿瘤消融直径为2cm,D组消融直径为肿瘤最大径;4集合系统损伤2例,见于针尖靠近集合系统小于5mm的肾脏。结论:5min射频消融对于小于3.2cm的肿瘤不能保证彻底消融,而12 min射频消融能够完全有效的达到杀灭肿瘤的目的;包膜完整时,形成“高压锅”效应,小于3.2cm的肿瘤可以任何角度进针;包膜不完整时,手术时尽可能保证射频针与肿瘤的长轴吻合,如为肾脏腹侧、中心部位的肿瘤,腹腔镜辅助射频消融可能更合适;当肿瘤靠近集合系统时,尤其压迫肾盂或肾盏的肿瘤,集合系统可能会受到损伤,可行集合系统冷水灌注保护;消融组织表面温度升高,对于肿瘤毗邻肠道、脾脏等器官时,腹腔镜手术辅助可能更加安全。
Objective: To investigate the influence of radiofrequency ablation on the range, shape and surrounding tissue of human renal cell carcinoma in ablation and necrosis, and to provide a theoretical basis for clinical application. Methods: Twelve patients with renal cell carcinoma (maximum tumor diameter ≤3.2cm) undergoing laparoscopic radical nephrectomy were divided into four groups according to the tissue and time of ablation: group A (n = 12) ), 5min renal cell carcinoma (B group, 6 cases), 12min normal renal group (C group, 12 cases) and 12min renal cell carcinoma group (D group, 6 cases). After the specimens were sent to the department of pathology, radiofrequency ablation was given at different times, the status of radiofrequency ablation was observed with the naked eye, the range of ablation and necrosis of normal kidney tissues and tumor tissues, and the integrity of the collection system. Pathological sections were made later to observe the pathological changes of ablated tissue. Results: 1 The temperature of the external surface of the tissue during radiofrequency ablation increased, the tissue was shrunken, retracted, and there was a hot air bubble along the needle path. 2 The morphology of RFA in normal renal tissue was ellipsoidal around the RF needle with its long axis parallel Radiofrequency needle, the tumor size of less than 3.2cm in renal tumor tissue was the demarcation between the original shape of tumor, tumor of tumor formation and normal renal tissue.3 Compared with group C, the diameter of radiofrequency ablation in group A was significantly reduced (P <0.01) The ablation range of Group B was inconsistent. The diameter of tumor ablation less than 2 cm was the largest diameter of tumor, the diameter of ablation of tumor larger than 2 cm was 2 cm and the diameter of ablation of Group D was the maximum diameter of tumor. Kidney. Conclusions: Radiofrequency ablation for 5 min can not guarantee complete ablation for tumors less than 3.2 cm, and 12 min radiofrequency ablation can completely and effectively achieve the goal of killing tumors. When the capsule is intact, tumors with a “pressure cooker” effect less than 3.2 cm Can be into the needle at any angle; incomplete capsule, the operation as far as possible to ensure that the radio frequency needle and the long axis of the tumor anastomosis, such as the kidney ventral, central tumor, laparoscopic-assisted radiofrequency ablation may be more appropriate; when the tumor is close to the collection System, especially oppression of renal pelvis or calyx tumor, the collection system may be damaged, feasible collection system cold water perfusion protection; surface ablation temperature increases, the tumor adjacent to the intestine, spleen and other organs, laparoscopic surgery may be more auxiliary Safety.