翻译肾肿瘤射频消融

InternationalJournalofUrology(2012)19,241–247 doi:10.1111/j.1442-2042.2011.02918.xOriginalArticle:ClinicalInvestigationRadiofrequencyablationofsynchronousbilateralrenalcellcarcinoma同步性双侧肾细胞癌的射频消融治疗ShiweiZhang,*XiaozhiZhao,*ChangweiJi,GuangxiangLiu,XiaogongLi,GutianZhang,WeidongGanandHongqianGuoUrologyDepartment,TheAffiliatedNanjingDrumTowerHospital,NanjingUniversityMedicalSchool,Nanjing,Jiangsu,ChinaAbbreviations&AcronymsC=centralCT=computedtomographyE=exophyticGFR=glomerularfiltrationrateIP=intraparenchymalLPN=laparoscopicpartialnephrectomyLRFA=laparoscopicradiofrequencyablationLRN=laparoscopicradicalnephrectomyM=mixedMDRD=ModificationofDietinRenalDiseaseNSS=nephron-sparingsurgeryOPN=openpartialnephrectomyORFA=openradiofrequencyablationPN=partialnephrectomyPRFA=percutaneousradiofrequencyablationRCC=renalcellcarcinomaRFA=radiofrequencyablationRN=radicalnephrectomyCorrespondence:HongqianGuoM.D.,UrologyDepartment,TheAffiliatedNanjingDrumTowerHospital,NanjingUniversityMedicalSchool,321ZhongshanRoad,Nanjing,Jiangsu210008,China.Email:dr.guohongqian@*Thesetwoauthorscontributedequallytothiswork.Received30July2011;accepted31October2011.Onlinepublication30November2011

Objectives:Thetreatmentofsynchronousbilateralrenalcellcarcinomaischalleng-ing.Radiofrequencyablationhasbeenincreasinglyappliedinthemanagementofrenaltumors.Herein,wereportourexperienceofradiofrequencyablationon12patientswithsynchronousbilateralrenalcellcarcinoma.双侧肾细胞癌的治疗具有挑战性。射频消融治疗肾肿瘤的治疗已越来越多的应用。在此，我们报告我们的经验同步性双侧肾细胞癌12例的射频消融治疗。Methods:FromMarch2006toSeptember2010,12patientswithbilateralsynchro-noussporadicrenalcellcarcinoma(29lesionsoverall)wereidentifiedfromourkidneydatabase.Themeanagewas62.3years(range35–81).Themeantumordiameterwas4.5cm(range0.9–9.0).从3月2006至九月2010，12例双侧同步散发性肾细胞癌（29个病灶整体）是我们的肾脏数据库鉴定。平均年龄为62.3岁（然通用电气35-81）。平均肿瘤直径为4.5厘米Threepatientsreceivedunilateralradiofrequencyablationandcontralateralradicalnephrectomy,whereasninepatientsreceivedbilateralradiofre-quencyablation.Theoncologicalandfunctionaloutcomeswereanalyzed.Contrast-enhancedcomputedtomographyexaminationswerecarriedoutatday7,andat3and6monthsaftertheprocedure,andevery6monthsthereafter.三例行单侧射频消融和侧根治性肾切除，而九例患者行双侧射频消融。肿瘤学和功能结果变了。对比增强计算机断层扫描在7天，并在3个月和6个月后的程序，并每6个月后。Results:Themeanfollow-upperiodwas33months(range10–64).Thelocaltumorcontrolratewas93.1%(27/29).Cancer-specificsurvivalandtheoverallsurvivalrateswere100%.Nodeathorrenalfailureaftertheprocedurewasfound.Inpatientswhounderwentbilateralradiofrequencyablation,thelatestmeanglomerularfiltrationratehadnotsignificantlydeclinedcomparedwithpreoperativelevels(93.713.0mL/min/1.73m2vs96.913.3mL/min/1.73m2,respectively;P>0.05).平均随访时间为33个月（范围10-64）。局部肿瘤控制率为93.1%（27/29）。肿瘤特异性生存率和总生存率分别为100%。没有死亡或肾衰竭后程序被发现。在接受双边射频消融术的患者中，最新的平均肾小球滤过率与术前相比无明显下降（93。713毫升/分钟/1.73平方米和96.913.3毫升/分钟/1.73平方米，分别；P0.05）。Conclusion:Radiofrequencyablationshowsencouragingoutcomesinthetreatmentofbilateralrenalcellcarcinoma.Itcanprovideadequatelocaltumorcontrolandcancer-specificsurvivalcomparedwithnephron-sparingsurgerywhilenotaffectingtherenalfunction.Keywords:glomerularfiltrationrate,laparoscopicnephrectomy,radiofrequencyablation,renalcellcarcinoma,synchronousbilateraltumor.IntroductionTheincidenceofbilateralRCChasbeenreportedtovaryfrom1.8%to11.0%.1SurgeryisthemethodofchoicefortreatingbilateralsporadicRCC,asithasacomparableprognosistothatforunilateralsporadicRCC.2However,bilateralsynchronousRCCposesasurgicalchallengeinbalancingoncologicalefficacyandpreservingrenalfunction.Bynow,thereisnostandardproceduretodealwithbilateralRCC.NSSisbecomingthepreferabletreatmenttopreserverenalfunction.双侧肾癌的发病率已从1.8%变化到11%。1手术是治疗双侧散发性肾癌的首选方法，因为它的单向，类似的预后Al散发性肾癌。2然而，双侧肾细胞癌是一个外科手术的挑战平衡肿瘤的疗效和保护肾功能。现在，没有标准的程序来处理票据横向碾压混凝土。NSS成为较好的治疗保护肾功能。RFAisaminimallyinvasiveprocedureusedinthetreatmentofrenaltumorsthathasbeenofferedasanalternativetoopenorLPNinpatientswithsmallrenaltumors.3CumulatingdatahaveshownthatRFAispromisingtreatmentforrenaltumorswithashortlearningcurveandrelativelylowincidenceofmajorcomplications.InitialresultsfromtheUrologyDepartmentofNanjingDrumTowerHospitalinNanjing,China,suggestedthatthelaparo-scopicRFAonsmallrenalmasswassafe,withoutcomesofpatientscomparablewiththosebypartialnephrectomy.4射频消融是一种微创手术用于肾肿瘤已提供作为替代品来打开或小肾肿瘤患者肾治疗。3累积的数据表明，RFA是一个学习曲线短的肾肿瘤治疗和并发症发生率相对较低。从南京市鼓楼医院泌尿科的初步结果在南京，中国，建议腹腔镜下RFA治疗肾脏小肿瘤是安全的，与患者的肾部分切除术效果的比较。©2011TheJapaneseUrologicalAssociation 241SZHANGETAL.Sofar,therearenopublisheddatafocusedonbilateralRCCtreatedbyRFA.ThepurposeofthepresentstudywastoretrospectivelyassesstheeffectivenessandsafetyofRFAinbilateralRCCinashortperiodoffollowup.到目前为止，有没有公布的数据集中在双侧肾癌的射频消融治疗。本研究的目的是回顾性评估的有效性和安全在双侧肾癌RFASHORT随访。MethodsPatientsFromMarch2006toSeptember2010,12patientswithbilateralsynchronoussporadicRCCwereidentifiedfromourkidneydatabase.Patientswithknownhereditarysyn-dromesorunilateralRCCandbenignneoplasmonthecon-tralateralkidneywereexcludedfromthepresentanalysis.从2010至九月2006，12例双侧同步散发肾细胞癌被确定从我们的肾脏数据库。与已知的遗传性综合征或单侧肾癌和良性肿瘤患者在与健侧肾肿瘤被排除的现状分析。Allpatientswereofferedconventionalnephron-sparingsurgeryandRFAthroughinformedconsent.Themean(range)ageofthepatientsatpresentationwas62.3years(35–81)andnine(75%)weremale.Themean(range)tumordiameterwas4.5cm(0.9–9.0).所有患者均给予常规保留肾单位手术和射频消融通过知情同意。在呈现的患者的平均（范围）的年龄为62.3岁（35-81）和九（75%）为男性。T他的意思是（范围）肿瘤直径为4.5厘米Tumorswerestagedaccord-ingtotheInternationalUnionAgainstCancerTNMClassi-fication(2006).肿瘤分期根据对肿瘤TNM分类国际联盟Thepathologicalstagingandgradingweregenerallycarriedoutonthekidneywiththemostextensivecancer.对肾脏的病理分期和分级，一般都进行了最广泛的癌症。Oneofthepatientsshowedmultifocallesions,withfourontheleftsideandthreeontherightside.RFAorlaparoscopicradicalnephrectomywerecarriedoutonthesepatientsdependingonthetumorsizeandlocation.其中一例表现为多发性病变，左侧四例，右侧三例。RFA或腹腔镜根治性肾切除术治疗取决于肿瘤的患者进行尺寸和位置。Threepatients(25%)receivedunilateralRFAandcontralateralradicalnephrectomy(RN),andninepatients(75%)receivedbilateralRFA.Patientswereevaluatedbycontrast-enhancedCTexamination7daysaftertreatmentandwithsubsequentCTassessmentat3months,6months,andevery6monthsthereafter.三例患者（25%）接受单侧RFA和侧根治性肾切除术（RN），九例（75%）行双侧RFA。通过对比增强扫描7天对患者进行评价该后处理和随后的CT评估在3个月、6个月，以后每6个月。Allpatientsunderwentatleast10monthsofradiographicfollowup.Themean(range)radiographicfollow-updurationwas33months(10–64).所有患者均接受至少10个月的影像学随访。平均（范围）影像学随访时间为33个月LaparoscopicRFAPatientsreceivedgeneralanesthesia.Usingaretroperitonealapproach,thefatoverlyingthetumorwasdissectedandthetumorwaslocalizedusingdirectvisionorlaparoscopicultrasonography.患者全身麻醉。采用腹膜后入路，将脂肪覆于肿瘤上，并用直接视觉或腹腔镜超声检查定位肿瘤。Allpatientsunderwentatumorbiopsy(TruCore,22G;MedicalDeviceTechnologies,Gainesville,FL,USA)beforeRFA.Thecool-tipsystem(Radionics,Bur-lington,MA,USA)wasusedforlaparoscopicRFAandwascontrolledbyafeedbackalgorithm.所有患者均行肿瘤活检（trucore，22G；医疗设备技术，盖恩斯维尔，佛罗里达州，美国）RFA治疗前。冷端系统（09036115，但lington，MA，USA）是用于腹腔镜射频消融并被一个反馈算法控制。Theradiofrequencygenerator(Radionics)monitoredtissueimpendenceandautomaticallyadjustedtheoutputofmaximumenergydeliv-ery.射频发生器（电子学）监测组织的阻抗和自动调节输出能量最大的分娩。Theelectrodewaskeptat15–20°Cbymeansofinternalcoolingwithchilledwaterdeliveredfromaperistalticpumpwhilethesurroundingtumorwasheatedtoalethaltempera-ture(>60°C)duringtheprocedure.Singleelectrodes(17G)withamaximalablationdiameterof1cm,2cmand3cmwereusedaccordingtolesionsizes.电极是由冷却水由蠕动泵而周围的肿瘤被加热到致命的温度保持在15–内部冷却装置20°C（60°C）在P程序。单电极（17g）与最大切削直径1厘米，2厘米和3厘米，根据病变大小。TheRFAprobewasintroducedthroughtheabdominalwallorthroughthelap-aroscopictrocar.Intraoperativeultrasonography(BK,Herlev,Denmark)wasusedtoguidetheinitialinsertionoftheRFAprobetothedeepestmarginoftreatment.射频消融探头经腹壁或经腹腔镜套管介绍。术中超声（BK，莱乌，丹麦）是用来指导RFA前初始插入是在最深的边缘。RFAwascarriedoutforacycleof12minperlesionaccordingtothemanufacturer’srecommendations.Extracycleswereappliedatthesurgeon’sdiscretionifablationwasconsid-eredincompleteonvisual.RFA进行周期为12分钟每病变根据制造商的建议。额外的周期被施加在外科医生的决定是否考虑不完全消融在VISual。Theelectrodetrackwasablatedbeforeitwaswithdrawn.电极轨迹后才撤回。Ultrasound-guidedpercutaneousRFAPatientsreceivedgeneralanesthesiaandwereplacedinproneorlateraldecubitouspositiondependingonthesiteofthelesion.患者接受全身麻醉，俯卧或侧decubitous位置根据病变部位。AnultrasonographydevicewasusedtodefinetheexactskinlocationfortheinsertionandguidetheinitialinsertionoftheRFAprobetothedeepestmarginoftreat-ment.Afterbiopsy,thesamesystemwasappliedforpercu-taneousRFA.超声诊断设备是用来定义精确的皮肤位置插入引导RFA探头的初始插入治疗深缘。活检后，相同的系统EM应用于经皮RFA。Singleelectrodes(17G)withamaximalablationdiameterof1cm,2cmand3cmwereusedaccord-ingtolesionsizes.TheprocedureofRFAwassimilartolaparoscopicRFA.单电极（17g）与最大切削直径1厘米，2厘米和3厘米，分别根据病灶大小。射频消融的过程类似于腹腔镜下射频消融。OpenRFAGenerallyspeaking,openRFAisrarelyusedonpatients.OnlyoneofthesepatientsunderwentopenRFA.一般来说，开放RFA是很少使用的患者。只有其中一个病人行开腹RFA。Thepatientreceivedgeneralanesthesiaandwasplacedinaspineposi-tion.Inourcase,thetransperitonealapproachwasappliedwithamedianincision.病人接受麻醉和放在脊柱的位置。在我们的例子中，腹腔的方法是采用正中切口。Afterthetumorswereexposed,RFAwasappliedrightafterbiopsy.Intraoperativeultrasonogra-phywasusedtoguidetheinitialinsertionoftheRFAprobetothedeepestmarginoftreatment.TheprocedureofRFAwassimilartolaparoscopicRFA.后暴露肿瘤，射频消融治疗后活检的应用。术中超声是用来指导射频消融探头插入到初始治疗最深的边缘。亲程序类似于腹腔镜下射频消融RFA。FollowupVariousfollow-upprotocolshavebeenappliedforradiofrequency-ablatedrenaltumors.各种后续协议已应用于射频消融肾脏肿瘤。Contrast-enhancedCTcurrentlyappearstobethemosteffectivemethod.5Perm-pongkosoletal.recommendedfollowingupwithCTormagneticresonanceimagingbetween1and3monthsaftertheprocedure,6and12monthspostoperatively,andonceyearlythereafter.6增强CT目前看来是最有效的方法。5烫发pongkosol等人。建议术后至1个月后，在术后至3个月内进行磁共振成像术后6个月和12个月，一次Atourinstitution,initialcontrast-enhancedCTexaminationwascarriedout7daysaftertheprocedure,andsubsequentCTassessmentwasmadeat3months,6months,andevery6monthsthereafter.在我们的机构，最初的对比增强扫描进行了7天之后的程序，和随后的评估是在3个月，6个月，每6个月之后Suc-cessfulablationwasdefinedwhenthelesionshowedlessthan10HUofcontrastmediumenhancementonCTscan.7成功消融的定义是当病变显示小于10胡对比剂增强CT扫描Recurrencewasdefinedasanynewenhancement(>10HU)afteranon-enhancingscan.8EachpatientunderwentserumcreatininemeasurementwitheveryCTexamination,andtheGFRwascalculatedusingthemodifiedModificationofDietinRenalDiseaseequation:9复发定义为任何新的增强（10胡）在非增强扫描。8每位患者的血清肌酐测量每一个CT检查，与肾小球滤过率的计算采用肾脏病患者的饮食修正：242 ©2011TheJapaneseUrologicalAssociationRFAandsynchronousbilateralRCC(a) (b)(c) (d)Figure1BilateralRFAwasappliedona55-year-oldmalepatient(patientnumber4).Thetumorswere3.5cmand2.8cmindiameter,andwerelocatedinthedorsaloftherightkidneyandventraloftheleftkidney.(a)双边RFA应用于一个55岁的男性患者（4例）。肿瘤直径3.5厘米、2.8cm，分别位于右肾和腹侧的左孩子背内伊。Contrast-enhancedCT(arterialphase)obtainedbeforesurgeryshowsenhancementofthetumor.(b)在术前增强的肿瘤的对比度增强（动脉期）。Contrast-enhancedCT(arterialphase)obtained7daysafterablationshowsabsenceofenhancement,indicatingcompletetumornecrosis.(c)对比增强扫描（动脉期），消融后7天显示没有增强，表示完全肿瘤坏死。Contrast-enhancedCT(arterialphase)obtained6monthsafterablationshowsabsenceofenhancementandtheablatedlesionbecamesmallercomparedwiththepreviousCTscan.(d)增强CT扫描（动脉期）获得了6个月后，消融显示增强和消融没有变小，与以前相比，CT扫描Contrast-enhancedCT(arterialphase)obtained1yearafterablationshowstheabsenceofenhancementandtheablatedlesioncontinuesshrinkingcomparedwiththepreviousCTscan.增强CT扫描（动脉期）获得了1年后消融显示增强和消融的情况下继续缩小与以前相比，CT扫描。GFR=175×(serumcreatinine)11.54×(age)−0.203×(0.742iffemale)StatisticalanalysiswascarriedoutusingSPSSvol.17.0(SPSS,Chicago,IL,USA).ResultsAllpatientsunderwentsimultaneoustreatmentonbilateralkidneys.Threepatients(25%)underwentunilateralRFAandcontralateralRN.Ninepatients(75%)underwentbilateralRFAbydifferentapproaches,whichareshowninTable1.所有患者同时治疗双侧肾脏。三例（25%）行单侧RFA和侧RN。九例（75%）行双侧RFA通过不同的途径他，这在表1。Thelocaltumorcontrolratewas93.1%(27/29).Figure1showsthebilateraltumorsofpatientnumber4,whichwerecompletelyablatedandconfirmedbyenhancedCTscan.局部肿瘤控制率为93.1%（27/29）。图1显示了4号病人双侧肿瘤完全消融，均经CT增强扫描。Nopatientsdiedduringthefollow-upperiod.Boththecancer-specificsurvivalrateandtheoverallsurvivalratewere100%.Twotumors(2/29)wereshowntohaveincompleteablationduringthecontrast-enhancedCTscan7daysaftertheprocedure.CTscan7daysaftertheprocedure.随访期间无死亡病例。肿瘤特异性生存率和总生存率分别为100%。两个肿瘤（2/29）被证明在对不完全消融术后7天增强扫描。Onetumor(5.1cm)wasintheexophyticoftherightkidneyofpatientnumber6andtheothertumor(3.8cm)wasinthecenteroftherightkidneyofpatientnumber11.一个肿瘤（5.1厘米）的患者数在6右肾血管和其他肿瘤（3.8厘米）是在患者的右肾中心11号Patientnumber6underwentasecondPRFA1monthaftertheinitialRFAandthetumorwasconfirmedcompletelyablatedbycontrast-enhancedCTscan.病人数的6进行了第二次治疗1个月后首次RFA肿瘤完全消融的增强CT扫描证实。Patientnumber11wasundercloseobservationandtheresiduumwasstable.Fourminorcomplicationswereobserved.编号11是在密切观察下，渣油稳定。观察四个小并发症Threepatientsexperiencedpostsurgeryfever.Patientnumber7withacentraltumor(3.5cm)intheleftkidneyandanexophytictumor(2.8cm)intherightkidneyunderwentgrosshematuria.Grosshematuriadisappeared3dayslaterwithoutanyintervention.三例患者出现术后发热。病人7号与中央的肿瘤（3.5厘米）在左肾和外生性肿瘤（2.8厘米）在右肾行肉眼血尿。毛哼哼尔托莉雅消失了3天之后没有任何干预Nomajorcomplicationwasfoundaftersurgery.Nopatientrequireddialysis,eithertemporaryorpermanent.ForpatientswhounderwentbilateralRFA,术后无重大并发症发生。无患者需要透析，无论是暂时性或永久性。为患者行双侧RFA，pre-RFAandpost-RFAmeanGFRlevelwere96.913.3mL/min/1.73m2and93.713.0mL/min/1.73m2(P<0.05,Student’st-test),respectively.Forpatientswhoreceivedunilateralradiofrequencyablationandcontralateralradicalnephrectomy,pre-RFAandpost-RFAmeanGFRlevelwere87.45.1mL/min/1.73m2and59.59.1mL/min/1.73m2(P>0.05,Student’st-test),respectively.DiscussionWhenfacedwithapatientpresentingwithsynchronousbilateralRCC,itisnecessarytodevelopasurgicalplanaimedataccomplishingtwoimportantgoals:thecompleteresectionofalltumorsandthemaintenanceofrenalfunc-tionadequatetokeepthepatientoffhemodialysis.当面对一个与同步的双侧肾细胞癌的患者，有必要制定一个手术计划，旨在实现2个重要目标：所有肿瘤的完全切除肾功能足以使病人从血液透析©2011TheJapaneseUrologicalAssociation 243244©2011TheJapaneseUrologicalAssociationSZHANGETAL.Table1 TumorcharacteristicsandoutcomeanalysisPatientSexAgeTumorsize(location)†TreatmentPathologyComplicationFollowupIncompleteGFR_MDRDno.(years)(months)ablation(mL/min/1.73m2)*Left(cm)Right(cm)LeftRightMinor‡MajorPre-RFAPost-RFA§1Male535.4(E)2.2(E)LRFAPRFAClearcell--63-117.2112.62Male447.5(M)2.6(E)LRNPFRAClearcell+-53-85.659.73¶Female352.9(IP)2.0(C)ORFAORFAOncocytoma/chromophobe--44-98.389.54Male553.5(IP)2.8(IP)PRFALRFAClearcell--42-98.5101.45Male654.5(M)6.3(M)PRFALRNPapillary--37-83.468.56Male423.7(E)5.1(E)LRFAPRFAClearcell+-35+102.692.17Male813.5(C)2.9(E)PRFAPRFAClearcell+-31-69.171.28Male594.3(E)1.8(IP)LRFAPRFAPapillary--26-123.6114.29Female429.0(M)2.1(E)RNPRFAClearcell--23-93.250.310Male720.9(IP)2.8(E)PRFAPFRAClearcell--17-79.370.211Female533.2(E)3.8(C)PRFALRFAPapillary+-15+100.7105.212Male613.1(E)3.5(E)LRFAPRFAChromophobe--10-82.687.2*P<0.05pre-RFAversuspost-RFA(Student’st-test);P>0.05pre-RFAversuspost-RFA(forpatientswhounderwentbilateralRFA).†Tumorlocationsaredividedintofourdifferenttypes.Exophyticarethetumorsthatarisefromtherenalcortex,protrudeintotheperinephricspaceandaresurroundedbyfat.Centraltumorsarelocatedinthemedullaandprotrudeintothehilumandintraparenchymaltumorsareconfinedtothecortex,butdonotprotrudeintotheperinephricfatorhilum.Mixedarethetumorsthatinvolvebothcentralandperipheralportionsofthekidney.10‡Minorcomplicationsincludedpostsurgeryfeverinthreepatientsandgrosshematuriainonepatient.§Post-RFAGFRshowedthemostrecentvalue.¶Patientnumber3hadsevenlesions,withfourontheleftsideandthreeontherightside.Thetumorsizeshowninthetablewasthemaximumsizeamongtheselesions.RFAandsynchronousbilateralRCCPNhasbecomeanintegralpartofthesurgicalmanagementofsmall,localizedRCC.11伪随机性已成为小、局部肾癌手术治疗的一个重要组成部分Withthedevelopmentoflaparo-scopicskills,LPNisnowanestablishedalternativetreat-mentforT1atumorsinmanycenters.12随着腹腔镜技术的发展，现在是一个既定的替代治疗的使用在许多中心T1a期肿瘤治疗However,LPNisassociatedwithalonglearningcurve,increasedwarmischemiatimeandahighermorbidityratecomparedwithOPN.13然而，LPN是一个漫长的学习曲线有关，增加热缺血时间和较高的发病率与OPNThoughOPNandLPNarebecomingthe“goldstan-dard”treatmentfortheT1aexophyticrenaltumor,itisstillabigchallengetomanagecentralorintraparenchymalrenaltumorswithlongerischemiatimeandahigherincidenceofcomplications.尽管OPN和LPN成为T1a期外生性肾肿瘤的“金标准”的治疗，它仍然是管理中心或脑实质内有较长的缺血T肾肿瘤的一大挑战时间和并发症的发生率较高BilateralRCCisoftendistinguishedbymul-tifocality,whichwasnotsocommoninthepresentseries.Inarecentlyreportedautopsystudy,88%ofthemultifocaltumorsoccurredinsynchronousbilateralRCC.14双侧肾癌通常是由多tifocality区分，这在目前是不太常见的系列。在最近报道的尸检研究，多灶性肿瘤88%发生于双侧同步RAL碾压混凝土。Inaddi-tion,thereisahigherproportionofpapillaryRCCinbilat-eralthanunilateralRCC,whichisconsideredmorelikelytobemultifocalthanothersubtypes.另外，还有比单侧碾压混凝土高的乳头状癌体积艾莱依比例，这被认为是比其他类型更容易焦MultifocalitycouldimpaircompletesurgicalresectionwithPNorLPNinbilat-eralRCCmorethaninunilateralRCC,inwhichmultifocal-ityisnotascommonandmightcauseahigherincidenceofcomplications.15多灶性损害了完整的手术切除与PN或LPN体积比艾莱依RCC单侧碾压混凝土，其中多灶性是不常见的，可能会造成较高的发病率比较应用Inthepresentstudy,onlyonepatientshowedmultifocalitywiththepathology“Oncocytoma/Chromophobe”,25%patientswereindentifiedwithpapil-larycancerbyhistologyexamination,whichwasinaccordancewithotherliterature.在目前的研究中，只有一个病人表现为多灶性的“嗜酸细胞瘤/病理性”，25%例经组织学检查发现有乳头状癌，这是在交流与其他文献依据BeforeablationtherapywasappliedinRCCtreatment,therewerevariousstrategiestodealwithbilateralRCC.治疗前应用消融治疗，治疗双侧肾细胞癌有不同的策略。Mostsurgeonspreferatwo-stepapproach,suchasthatsuggestedbyPaherniketal.andFranketal.16,17大多数医生喜欢两步法，如建议的pahernik等人。和坦率等。Ingeneral,fourstrategiesareapplied,includingradicalnephrectomyfollowedbypartialnephrectomy,partialnephrectomyfol-lowedbycontralateralradicalnephrectomyandpartialnephrectomyfollowedbycontralateralpartialnephrectomyandbilateralradicalnephrectomy.总的来说，四种策略的应用，包括根治性肾切除术后肾部分切除术、肾部分切除术，其次为侧根治性肾切除术、肾部分切除术后对侧肾部分切除术和双侧肾癌根治术。Thefirstapproachhastheadvantagesofallowingthehistologicalsubtypeoftheprimarytumortobedetermined,anddetectingpotentiallyadverseprognosticsigns,suchasregionallymphnodeinvolvementorvascularinvasion.第一种方法是使原发肿瘤的组织学亚型被确定的优势，和检测潜在的不良预后的标志，如区域淋巴结参与运动或血管浸润。Thesecondapproachhastheadvantageofusingthecontralateralkidneytoassistthepatientthroughapotentialperiodoftemporaryunilateralrenalinsufficiencythatcanoccurafteracomplicatedpartialnephrectomy.二种方法的优点是使用对侧肾脏，以协助病人通过一个潜在的临时性单侧肾功能不全，可以发生在一个复杂的时间段肾部分切除术Thethirdapproachisthemostlikelytopre-servethefunctionofthenormalkidney.第三种方法是最有可能预先服务的正常肾功能。Onthecontrary,Bluteetal.usedasingleprocedureinmorethan70%oftheirpatients,andshowedperi-operativecomplicationratesthatwerecomparabletothosefromsurgeryforunilateralRCC.2相反，比重计等。在70%以上的患者中使用了一个单一的程序，并显示围手术期并发症的发生率，与那些从手术的单方面肾癌Theadvantagesofsimulta-neousbilateralinterventionarereducedpsychologicalandphysiologicalstress,singleanesthesia,lessmedication,lessbloodloss,shorterhospitalstayandconvalescence,andconsiderablecostsavings.同时进行的双边干预的优点是心理和生理压力，单一的麻醉，少用药减少，出血少，住院时间短，康复，和可观的成本节约Inthepresentseries,allofthese12patientsunderwentsimultaneousintervention,withnomajorcomplicationfound.WiththeapplicationofRFA,bilateralRCCcaneasilybemanagedbyasingleprocedure.在本系列中，所有这12例患者同时进行干预，没有发现主要的并发症。随着射频消融中的应用，双侧肾癌可以很容易地通过一个单一的过程管理作为Ithasbeenmorethan10yearssincethefirstRFAwasappliedinthetreatmentofrenaltumor.Withshort-andintermediate-termdataintheliteratureshowinglowcomplicationratesandexcellentoncologicaloutcomes,18RFAisincreasinglybeingusedinyoungerpatientsandonlargermasses.19自从第一射频应用于肾肿瘤的治疗已经超过10年。具有短期和中期的数据，在文献中显示低并发症发生率和良好的生态的结果，18RFA被越来越多地应用于年轻患者或较大的群众RFAcanbeappliedbymeansofopen,laparoscopicandpercutaneousapproaches.20RFA可以通过开放的应用，腹腔镜和经皮的方法PRFAguidedbyCT,magneticresonanceimagingorultrasonicdeviceispreferredbymanyurologistsandradiologistsfortheleastinvasivenessandfastestrecovery.21CT引导下射频消融，磁共振成像或超声设备是由许多泌尿科医师和放射科医师首选最小侵袭和最快的恢复OpenRFAisseldomappliedonpatients,onlyonepatientinthepresentseriesunderwentopenRFA,becauseofamultifocaltumoronbothsides(sizefrom0.9cmto2.9cm).开放RFA应用很少的患者，在本系列中只有一个病人行开腹RFA，因为两边的多灶性肿瘤（从0.9厘米到2.9厘米大小）Therefore,wecarriedoutopenRFAbyamedianincisionguidedbyanintraoperativeultrasonicdevicetoensuretheaccuracyandsafetyoftheRFAprocedure.因此，我们进行了开放式的引导下RFA正中切口术中超声装置保证RFA术的准确性和安全性。LaparoscopicRFAcarriedoutundergeneralanesthesiaistypicallyusedforanteriorandmedialtumors,orthoseincloseproximitytotheureter,renalhilumoradjacentorgans.腹腔镜下射频消融在全麻下进行通常用于前部和内侧的肿瘤，或在邻近的输尿管、肾门或邻近器官LaparoscopicRFAwasmorefrequentlyappliedinourcenterforthefollowingreasons.First,thelaparoscopicapproachallowsaggressivemobilizationofrenaltumorsandplacementofthepr