Khaws lub raum muaj nuj nqi: Kev sib piv ntawm Radiofrequency Ablation thiab Laparoscopic Partial Nephrectomy Treatment
Mar 22, 2022
Hu rau: Audrey Hu Whatsapp / hp: 0086 13880143964 Email:audrey.hu@wecistanche.com
Vanessa Acosta Ruiz, Sarah Ba˚telsson & et al.
Abstract
Keeb kwm:Radiofrequency ablation(RFA) thiablaparoscopic ib nrab nephrectomy(LPN) yog siv los kho lub raum me me (SRM;<4 cm),="" although="" there="" are="" conflicting="" results="" in="" the="" changes="" in="" creatinine="" and="" estimated="" glomerular="" filtration="" rate="" (egfr)="" after="" treatment.="" on="" contrast-enhanced="" computed="" tomography(ce-ct)images,="" the="" quantity="" and="" quality="" of="" renal="" function="" can="" be="" evaluated="" by="" calculating="" the="" split="" renal="" function="">
Lub Hom Phiaj: Sib piv rau lub raum ua haujlwm tom qab RFA (Radiofrequency ablation) los yog LPN(laparoscopic ib nrab nephrectomy) Kev kho mob ntawm SRMs los ntawm kev ntsuam xyuas ntawm SRF hauv lub raum cuam tshuam.
Cov Khoom Siv thiab Cov Txheej Txheem: Tib Tla lub raum qog ua tiav nrog RFA(Radiofrequency ablation)(n{0}}) los yog LPN(laparoscopic ib nrab nephrectomy)(n=3I) tau rov qab los piv. SRF tau suav nrog kev kho mob ua ntej CE-CT cov duab thiab thawj qhov kev kuaj mob tom qab ua tiav kev kho mob. Serum creatinine thiab eGFR qhov tseem ceeb tau sau ib txhij. Txhawm rau sib piv cov txiaj ntsig ntawm lub raum ua haujlwm, Cov Tub Kawm Ntawv t-test thiab cov qauv sib txawv ntawm cov kab sib txawv (hloov rau RFA(Radiofrequency ablation)/LPN(laparoscopic ib nrab nephrectomy)Kev kho mob, kev kho mob ua ntej SRF / eGFR, BMI, hnub nyoog, qog cov yam ntxwv, thiab Charlson Comorbidity Index) tau siv.
Cov txiaj ntsig: SRF raug txo qis hauv ob pawg, txawm hais tias qhov txo qis ntau dua hauv LPN(laparoscopic ib nrab nephrectomy)pab pawg (LPN-5.7 feem pua ) dua li hauv RFA(Radiofrequency ablation)pab pawg (RFA-3.5 feem pua ;P=0.013). Tom qab kev tshuaj ntsuam xyuas, LPN(laparoscopic ib nrab nephrectomy)pab pawg tseem muaj qhov txo qis SRF ntau dua (qhov sib txawv 3.2 feem pua ,95 feem pua kev ntseeg siab lub sijhawm I.3-I.5; P=0.00I). Tsis muaj qhov sib txawv ntawm pawg hauv kev hloov pauv ntawm creatinine / e GFR tom qab kho.
Xaus: Ob leeg RFA(Radiofrequency ablation)thiab LPN(laparoscopic ib nrab nephrectomy)yog nephron-sparing thaum kho SRMs. Txawm li cas los xij, hauv cov koob no, kev txo qis ntawm SRF hauv lub raum cuam tshuam me me tom qab RFA(Radiofrequency ablation), muaj txiaj ntsig zoo khaws cia ntawm lub raum ua haujlwm ntau dua li LPN(laparoscopic ib nrab nephrectomy).
Cov teebmeem ntawm cistanche: kho cov kab mob raum
Taw qhia
Cov tswv yim tswj hwm rau thaj chaw T1 lub raum loj suav nrog ib feem ntawm nephrectomy (PN), thermal ablation (TA), thiab kev soj ntsuam nquag (1). Raws li cov txiaj ntsig muaj sia nyob thoob plaws cov tswv yim kho mob yog qhov zoo, kev khaws cia ntawm lub raum ua haujlwm tseem ceeb heev (1,2). Cov kev tshawb fawb yav dhau los qhia txog qhov tsis sib haum xeeb ntawm lub raum ua haujlwm, ntsuas los ntawm cov ntshav creatinine lossis glomerular filtration rate (GFR), tom qab PN thiab TA(3-6). Hauv kev tshuaj ntsuam meta-tshaj (7), qhov kev hloov pauv zoo sib xws hauv GFR, qhov tshwm sim ntawm cov kab mob raum ntev, thiab cov nqi ntawm lub raum raug mob rau PN thiab TA tau tshaj tawm. Txawm hais tias creatinine thiab GFR tau siv los ntsuas lub raum ua haujlwm rau lub hom phiaj kho mob niaj hnub, lawv tsis cuam tshuam li cas lub raum kho tau teb rau kev kho mob qog noj ntshav. Thaum tshem tawm lub raum me me (SRM; Tsawg dua lossis sib npaug li 4cm), lub hom phiaj yog khaws cia nephron loj (thiab khaws GFR), uas yuav txo tau qhov kev pheej hmoo ntawm kev mob mus rau theem kawg ntawm lub raum thiab xav tau kev lim ntshav (2 ,8).
Cov ntaub ntawv hais txog seb ib qho qauv khaws cia nephron ntau dua li qhov tsis muaj. Lub raum parenchymal ntim khaws cia tau tshaj tawm tias muaj txiaj ntsig zoo nrog ablation dua nrog PN (3); Txawm li cas los xij, qhov zoo ntawm nephrons nyob rau hauv lub ntim no yuav tsis tas yuav homogenous. Kev faib lub raum ua haujlwm (SRF) tuaj yeem xam los ntawm qhov sib piv-txhim kho cov duab tomography (CE-CT), tso cai rau kev soj ntsuam ntawm lub raum ua haujlwm ntawm ob lub raum (9-14). Yog li ntawd, ob qho tib si kom muaj nuj nqis (lub raum ntim) thiab qhov zoo (txhais tau tias attenuation) ntawm lub raum parenchyma raug soj ntsuam.
Lub hom phiaj ntawm txoj kev tshawb fawb tam sim no yog los sib piv lub raum kev ua haujlwm preservative zog ntawm radiofrequencyablation(RFA) thiablaparoscopic ib nrab nephrectomy(LPN) tom qab SRM kev kho mob, los ntawm kev ntsuam xyuas ntawm lub raum kev ua haujlwm (SRF) creatinine thiab eGFR qhov tseem ceeb.
Cov teebmeem ntawm cistanche: anti-o
Khoom siv thiab txoj kev nrhiav neeg mob
Uppsala lub rooj saib xyuas kev ncaj ncees hauv cheeb tsam tau pom zoo rau txoj kev tshawb fawb (Dnr 2012/518). Ob leeg RFA(Radiofrequency ablation)thiab LPN(laparoscopic ib nrab nephrectomy)tau qhia txog kev kho mob qog nqaij hlav hauv lub raum ntawm peb lub tsev kawm ntawv xyoo 2007. Lub Kaum Hli 2007 txog Lub Kaum Ob Hlis 2016,166 tus neeg mob lub raum tau kho nrog RFA(Radiofrequency ablation)(hauv 198 ntu) thiab 92 tus neeg mob kho nrog PN (hauv 94 zaug). Kev xaiv tus neeg mob rau txhua txoj kev kho mob thiab cov txiaj ntsig kev kho mob thiab cov txiaj ntsig perioperative rau thawj 97 RFA(Radiofrequency ablation)(91 tus neeg mob) thiab 57 LPN(laparoscopic ib nrab nephrectomy)(57 tus neeg mob) kev kho mob sib law liag tau piav qhia yav dhau los (15).
Tom qab tau txais kev pom zoo sau ntawv thiab hais lus, cov neeg mob tau txheeb xyuas rov qab. Cov txheej txheem suav nrog yog: RFA(Radiofrequency ablation)los yog LPN(laparoscopic ib nrab nephrectomy)Raws li cov txheej txheem tseem ceeb hauv kev kho ib leeg, Tla, cov qog nqaij hlav tsis yog lub raum uas tshwm sim los ntawm lub raum parenchyma nrog kev siv tshuaj kho mob rau cov neeg mob hnub nyoog qis dua lossis sib npaug li 75 xyoo. Kev kho mob ua ntej CE-CT cov duab hauv ib xyoos dhau los thiab tom qab kev kho mob yuav tsum tau ua. Cov duab CT yuav tsum ua kom tau raws li cov kev xav tau rau kev ua cov duab. Cov neeg mob yuav tsum muaj ob lub raum txhawm rau suav SRF. RFA(Radiofrequency ablation)yuav tsum tau ua raws li CT kev taw qhia (nrog rau Cool-tipTM RF Ablation System E Series; Medtronic, Boulder, CO, USA) thiab PN ua nrog laparoscopic mus kom ze, tsis muaj kev hloov pauv mus rau tag nrho nephrectomy. Ib qho 100 feem pua kev ua tau zoo (ieabsence ntawm cov qog seem lossis cov qog hauv zos) nyob rau lub sijhawm ua raws (nruab nrab=38 hli; ntau yam=25-99 hli) yog qhov tsim nyog. Cov qog kho los ntawm ntau txoj kev kho mob tsis suav nrog. Tom qab tsis suav cov neeg mob uas tsis ua raws li cov txheej txheem no (Table Ntxiv), 91 cov neeg mob tau suav nrog: 60 tus neeg mob kho nrog RFA(Radiofrequency ablation)(kho hauv 64 zaug) thiab 31 kho nrog LPN(laparoscopic ib nrab nephrectomy)(hauv tag nrho 31 ntu). Ntawm cov no, 58 tus neeg mob raug xa mus (RFA 34, LPN 24) rau peb lub tsev kho mob los ntawm cov tsev kho mob hauv cheeb tsam.
RFA(Radiofrequency ablation)thiab LPN(laparoscopic ib nrab nephrectomy)kev kho mob
Lub RFA(Radiofrequency ablation)thiab LPN(laparoscopic ib nrab nephrectomy)cov txheej txheem tau piav yav dhau los (15). Luv luv, CT-guided percutaneous RFA(Radiofrequency ablation)thov ib qho ablation margin Ntau dua lossis sib npaug li 5 hli; 49 tus neeg mob tau sedated thiab ll cov neeg mob tau siv tshuaj loog. RFA(Radiofrequency ablation)Cov kev kho mob tau ua los ntawm cov kws kho mob neuro-radiologists tau paub txog hauv CT-kev pabcuam (AM nrog 30 xyoo dhau los, ML nrog 20 xyoo, thiab PD nrog 10 xyoo).
LPN(laparoscopic ib nrab nephrectomy)tau ua nyob rau hauv cov tshuaj loog siv ib tug transperitoneal mus kom ze. Cov qog resection tau ua raws li cov suture ntawm lub parenchymal defect dhau ib tug bolster ntawm Surgicel Original Absorbable Hemostat (Ethicon, Neuchatel, Switzerland). Qhov tsis xws luag tau them nrog TISSEEL (Baxter Healthcare Corporation, Westlake Village, CA, USA) rau hemostasis ntxiv. Ob tus kws kho mob urologist nrog 25 thiab 15 xyoo ntawm kev paub hauv kev phais laparoscopic ua LPN(laparoscopic ib nrab nephrectomy)kev kho mob.
Kev sau cov ntaub ntawv thiab cov ntsiab lus
Cov ntaub ntawv tus neeg mob (hnub nyoog, poj niam txiv neej, lub cev qhov hnyav [BM], kho tshiab Charlson Comorbidity Index(16) tom qab tsis suav cov qog hauv lub raum los ntawm qhov ntsuas qhov ntsuas) thiab cov yam ntxwv ntawm cov qog (cov qog loj, hloov RENAL nephelometry qhab nia [m-RNS](1 ) tau sau rov qab. Creatinine qhov tseem ceeb ua ntej (nruab nrab=1 hnub ua ntej kho) thiab hauv ib xyoos tom qab ua tiav kev kho mob (nruab nrab=310 hnub rau RFA(Radiofrequency ablation)thiab 225 hnub rau LPN(laparoscopic ib nrab nephrectomy)) raug sau los ntawm lub tsev kawm ntawv lossis los ntawm cov tsev kho mob xa mus. Qhov kwv yees glomerular filtration rate (eGFR) tau suav nrog kev hloov kho Lund-Malmö formula (18).
Cov txiaj ntsig kev kho mob tau tshaj tawm raws li Lub Koom Haum ntawm Kev Tshawb Fawb Xov Xwm (19) cov lus siv. Kev kho mob raum mob tuaj yeem suav nrog ntau qhov kev kho mob. Kev kho qog ua kom tiav tau raug txhais ua<20 hu="" of="" contrast="" enhancement="" within="" the="" zone="" where="" the="" index="" tumor="" was="" situated="" (including="" the="" surgical/ablation="">
Cov teebmeem ntawm cistanche: kho cov kab mob raum
CT raws tu qauv rau kev npaj ua ntej kev kho mob thiab kev soj ntsuam tus neeg mob
Somatom Definition Flash (Siemens, Forchheim, Lub teb chaws Yelemees) tau siv rau kev kuaj CT. Lub RFA(Radiofrequency ablation)pab pawg tau soj ntsuam CE-CT ib hnub ua ntej kev kho mob (rau kev npaj kho mob) thiab suav nrog qhov tsis zoo (UE), corticomedullary theem (CMP), nephrographic theem (NP), thiab excretory theem (EP) (nrog qhov sib piv nruab nrab Iomeron 400mg I / mL iomeprol, 1 mL / kg, siab tshaj 80 mL, Bracco Imaging SpA, Milano, Ltalis). Lub LPN(laparoscopic ib nrab nephrectomy)pab pawg tau kuaj CE-CT (hauv tib theem) ua ntej kev kho mob. Kev soj ntsuam cov duab suav nrog CE-CT scans tshiab (ntawm lub tsev kawm lossis cov tsev kho mob xa mus) nyob rau tib theem ntawm peb lub hlis (RFA pab pawg nkaus xwb), rau lub hlis, 12 lub hlis, thiab tom qab ntawd txhua xyoo tom qab kev kho mob tsawg kawg yog tsib xyoos.
Cov duab tsom xam thiab cais lub raum ua haujlwm ntsuas Kev ntsuas ntawm SRF tau los ntawm CE-CT cov duab muab cov txiaj ntsig sib piv rau cov uas tau los ntawm lub raum scintigraphy (9-14). Kev suav SRF yog raws li txoj kev siv los ntawm Nilsson li al.(11) thiab Björkman li al.(9,13). Lub MultiModality workstation (Siemens, Forchheim, Lub teb chaws Yelemees) thiab qhov kev pab cuam "Volume" tau siv rau kev soj ntsuam cov duab rov qab ntawm CMP lossis NP cov duab nrog lub thickness ntawm 5 hli (9). Ntawm qhov kev kho mob ua ntej CE-CT duab, thaj tsam ntawm kev txaus siab (ROI) tau muab tso rau hauv cov ntu axial thoob plaws qhov ntev ntawm txhua lub raum. Cov kev txwv suav nrog ROI cov cuab yeej tau teeb tsa ntawm 75-250 HU kom suav nrog tsuas yog sib piv-txhim kho lub raum parenchyma. Cov qauv uas tsis ua rau cov txheej txheem pom (xws li cov hlab ntsha, cov kab ke sau, cov ureter, thiab lub raum qog) raug cais tawm ntawm ROI. Los ntawm txhua ROI, qhov ntim (cm) thiab txhais tau tias attenuation (HU) ntawm txhua lub raum tau txiav txim siab thiab sau npe (Daim duab 1).
SRF ntawm lub raum cuam tshuam tau txais los ntawm cov qauv:
Kev tshuaj xyuas tom qab SRF tau ua tiav ntawm thawj daim duab tom qab ua tiav kev kho mob, ua tib zoo tsis suav nrog cov khoom siv ua haujlwm egsurgical clips, hemostatic agents) tso tom qab LPN(laparoscopic ib nrab nephrectomy). Cov duab tsom xam thiab SRF ntsuas tau ua los ntawm ib tus neeg nyob hauv hluav taws xob (VA) thiab cov tub ntxhais kawm kho mob (SB) qhov muag tsis pom kev ntawm ib leeg. Raws li muaj kev pom zoo sib cuam tshuam hauv SRF kev ntsuas ntawm ob tus neeg soj ntsuam (intraclass correlation coefficient [ICC] nruab nrab=0.997; 95 feem pua kev ntseeg siab lub sijhawm[Cl]=0.997-0 .998), tus nqi nruab nrab ntawm ob qhov kev ntsuas ntsuas tau siv rau kev suav SRF ntxiv. Thawj qhov kawg yog qhov hloov pauv SRF hauv lub raum cuam tshuam (los ntawm kev kho ua ntej mus rau tom qab kho) hauv feem pua ntawm cov ntsiab lus. Cov ntsiab lus thib ob yog kev hloov pauv hauv creatinine thiab eGFR qhov tseem ceeb.
Fig. 1. Piv txwv ntawm SRF xam, creatinine, thiab eGFR qhov tseem ceeb ua ntej thiab tom qab kho.Cov xub daj taw qhia ntawm cov qog ua ntej kho. Cov xub xiav taw tes rau ntawm lub raum tsis zoo tom qab kho RFA. eGFR, kwv yees glomerular pom tus nqi; RFA, radiofrequency ablation; SRF, cais lub raum ua haujlwm.
Kev txheeb cais
Rau kev sib piv ntawm cov yam ntxwv ua ntej kev kho mob ntawm LPN(laparoscopic ib nrab nephrectomy)thiab RFA(Radiofrequency ablation)pab pawg, Fisher qhov kev ntsuas tseeb tau siv rau qhov sib txawv ntawm categorical thiab Student's t-test tau siv rau qhov sib txawv tsis tu ncua. Txhawm rau txheeb xyuas qhov kev ntseeg siab ntawm tus neeg sib tw rau SRF ICC, kwv yees nrog 95 feem pua CIs tau suav nrog SPSS cov ntaub ntawv teev cov pob version 23 (SPSS Inc., Chicago, IL, USA) thiab raws li qhov ntsuas qhov ntsuas (k=2 ), absolute-pom zoo, ob-txoj kev sib xyaw ua qauv qauv.
Cov teebmeem kev kho mob tau muab piv nrog Cov Tub Ntxhais Kawm T-test thiab cov qauv sib txawv ntawm cov kab sib txawv, thiab ob qho tib si crude thiab kho qhov sib txawv nrog 95 feem pua CI tau tshaj tawm. Peb tus qauv regression cais tau haum nrog qhov kev hloov pauv (tus nqi tom qab - tus nqi ua ntej) hauv SRF, eGFR, thiab creatinine raws li cov lus teb sib txawv. Kev kho mob (LPN/RFA), tus nqi ua ntej ntawm cov lus teb sib txawv, thiab confounders (kev kho ua ntej eGFR, BM, hnub nyoog, qog loj, qog ze ze [nruab nrab ntawm qhov kev sau los yog qhov ntswg] thiab Charlson Comorbidity Index) tau suav nrog hauv cov qauv raws li piav qhia variables. Confounders raug xaiv los hloov kho raws li kev paub ua ntej txog lawv cov txiaj ntsig ntawm lub raum kev ua haujlwm thiab xaiv kev kho mob. Txhua qhov kev txheeb xyuas tshwj tsis yog kev suav ntawm ICC tau ua tiav siv SAS software, version 9.4 (SAS Institute, Inc., Cary, NC, USA), tshwj tsis yog kev suav ntawm ICC. Tag nrho cov kev xeem txheeb cais tau ob-tailed nrog ib theem tseem ceeb ntawm 0.05.
Cov teebmeem ntawm cistanche: kho cov kab mob raum
Cov txiaj ntsig
Hauv RFA(Radiofrequency ablation)pab pawg, 56 tus neeg mob tau kho hauv ib zaug thiab plaub tus neeg mob xav tau ob zaug ablation kom ua tiav kev kho mob qog noj ntshav. Txhua tus neeg mob hauv LPN(laparoscopic ib nrab nephrectomy)pab pawg raug kho nyob rau hauv ib zaug. Cov neeg mob hauv RFA(Radiofrequency ablation)pab pawg neeg laus dua, tab sis tsis muaj qhov sib txawv ntawm poj niam txiv neej, txhais tau tias BMI, CCI, lossis cov yam ntxwv qog nqaij hlav ntawm ob pawg (Table 1). Tumor histopathology rau txhua pab pawg kho mob tau nthuav tawm hauv Table 1.
Tsis muaj qhov sib txawv hauv kev kho mob ua ntej SRF ntawm ob pawg (Table 2). SRF raug txo nyob rau hauv ob pawg tom qab kev kho mob (Fig.2); Txawm li cas los xij, kev txo qis ntawm SRF tau ntau dua hauv LPN(laparoscopic ib nrab nephrectomy)pab pawg (-5.7 feem pua ) dua li hauv RFA(Radiofrequency ablation)pab pawg (-3.5 feem pua : txawv=2.2 feem pua cov ntsiab lus, P=0.013; Table 2). Tom qab kev hloov kho, LPN(laparoscopic ib nrab nephrectomy)pab pawg tseem muaj qhov txo qis ntawm SRF ntau dua li RFA(Radiofrequency ablation)pab pawg (Table 2).Lwm cov lus, SRF yog 3.2 feem pua qis dua hauv LPN(laparoscopic ib nrab nephrectomy)pab pawg dua hauv RFA(Radiofrequency ablation)pab pawg (P=0.001).
Muaj ob qhov kev tawm tsam hauv LPN(laparoscopic ib nrab nephrectomy)pab pawg nrog kev txo qis hauv SRF (Fig. 2). Vim yog adhesions los ntawm kev phais yav dhau los thiab perfusion los ntawm ob peb lub polar hlab ntsha txo visibility thaum lub sij hawm resection, cov nyuaj resections coj mus rau ib tug ntau dua resection margin tshaj qhov pib xav (Fig. 3). Txawm hais tias tshem tawm ob tus neeg mob no los ntawm kev tshuaj xyuas, LPN(laparoscopic ib nrab nephrectomy)pab pawg tseem pom qhov poob SRF ntau dua li RFA(Radiofrequency ablation)pab pawg (kho qhov sib txawv =2.1 feem pua cov ntsiab lus, 95 feem pua CI=0.58-3.57, P=0.007).
Tsis muaj qhov sib txawv ntawm ob pawg hauv kev kho mob ua ntej creatinine, tab sis qis me ntsis ua ntej kho eGFR hauv RFA(Radiofrequency ablation)pawg tau pom. Lub raum ua haujlwm tau cuam tshuam tom qab kev kho mob thiab raug ntsuas raws li kev nce hauv creatinine thiab txo qis hauv eGFR (Table 2). Txawm li cas los xij, tsis muaj qhov sib txawv ntawm cov pab pawg txog kev hloov pauv ntawm cov txiaj ntsig no (Table 2).
cistanche tubulosa txiaj ntsig: txhim kho lub raum ua haujlwm
Kev sib tham
Ob leeg RFA(Radiofrequency ablation)thiab LPN(laparoscopic ib nrab nephrectomy)pom tias muaj kev khaws cia siab ntawm lub raum ua haujlwm thaum kho SRMs. Txawm li cas los xij, RFA(Radiofrequency ablation)Kev kho mob tau cuam tshuam nrog kev khaws cia zoo dua ntawm lub raum kev ua haujlwm ntawm lub raum kho, ntsuas raws li kev txo qis ntau dua hauv SRF tom qab LPN(laparoscopic ib nrab nephrectomy)(Fig. 2 thiab Table 2).
Kev khaws cia lub raum ntim yog ib qho tseem ceeb tshaj plaws ntawm lub raum kev ua haujlwm tom qab PN(5,20-22). Woldu et al. (3) qhia txog kev khaws cia ntau dua ntawm lub raum ntim thiab hloov pauv me me hauv GFR tom qab TA dua tom qab PN; Txawm li cas los xij, qhov ua tau zoo ntawm kev ua haujlwm nephrons nyob rau hauv lub raum ntim ntim yuav tsis yog homogenous. Zhu et al.(23) qhia txog qhov txo qis ntawm SRF hauv lawv ob lub raum kho nrog RFA(Radiofrequency ablation)-pab laparoscopic qog enucleation dua li LPN(laparoscopic ib nrab nephrectomy). Qhov txo qis ntawm SRF hauv ob pawg (RFA-9.4 feem pua , LPN(laparoscopic ib nrab nephrectomy)-17 feem pua )(23) ntau dua hauv qhov kev tshawb fawb no (RFA-3.5 feem pua , LPN-5.7 feem pua ) thiab tuaj yeem piav qhia ib feem los ntawm qhov sib txawv ntawm cov txheej txheem kho mob. Tsis tas li ntawd, lawv qhov kev ntsuam xyuas ntawm SRF los ntawm renogram muaj nws qhov kev txwv tsis pub muaj (9); Yog li ntawd, kev ntsuas ntawm SRF ntawm CE-CT tej zaum yuav yog ib qho kev ntsuam xyuas ntawm lub raum muaj nuj nqi (9,10).
Table 1. Cov yam ntxwv ntawm tus neeg mob thiab qog nqaij hlav raug faib raws li kev kho mob.
Ob peb lub laj thawj tuaj yeem suav rau qis SRF poob tom qab RFA(Radiofrequency ablation)tom qab LPN(laparoscopic ib nrab nephrectomy). Cov qog loj zuj zus thiab qhov nruab nrab yog txuam nrog kev poob ntawm parenchymal ntim (24); Txawm li cas los xij, peb pab pawg kho mob tsis txawv ntawm cov kev txwv no. Rhuav tshem RFA(Radiofrequency ablation)ib txwm ua nyob rau hauv cov mob uas tsis yog-ischemic; Yog li ntawd, ib ntus vascular clamping thiab nro thov rau lub raum parenchyma thaum lub sij hawm herniorrhaphy tuaj yeem ua rau lub raum hypotrophy nrog kev txo qis hauv SRF tom qab LPN.(laparoscopic ib nrab nephrectomy). Lub npoo-puab incision tshem tawm cov qog hauv LPN(laparoscopic ib nrab nephrectomy)(25) tuaj yeem ua rau poob ntau dua ntawm cov nephrons dua li tshem cov qog nrog ib qho chaw zoo li ablation tau yoog rau qog cov duab thiab qhov loj me. Qhov teeb meem ntau dua hauv LPN(laparoscopic ib nrab nephrectomy)pab pawg (raws li qhia hauv kev tshawb fawb yav dhau los (15)) tuaj yeem ntxiv rau kev ua phem rau lub raum ntxiv. Txawm li cas los xij, tseem muaj qhov txo qis dua ntawm SRF tom qab LPN(laparoscopic ib nrab nephrectomy)nyob rau hauv kev sib piv kev tsom xam thiab qhov sib txawv no tseem ceeb heev tom qab kho kev tsom xam thiab cais tawm ntawm ob LPN(laparoscopic ib nrab nephrectomy)outliers. Qee qhov kev soj ntsuam hauv RFA(Radiofrequency ablation)pab pawg muaj qhov tsawg kawg nkaus hauv SRF tom qab kev kho mob (Fig.2), uas tuaj yeem yog qhov tshwm sim ntawm kev ntsuas qhov yuam kev thiab yog li txo qis pawg SRF hloov pauv nrog RFA(Radiofrequency ablation)kev kho mob.
Table 2. Kev kho mob ua ntej, tom qab kev kho mob, thiab kev hloov hauv lub raum ua haujlwm los ntawm txoj kev kho mob.
Renal compensatory mechanisms thiab lub raum tsis zoo ib txwm tuaj yeem npog cov txheej txheem nephron-sparing muaj rau lub raum ua haujlwm (5). Txhawm rau kov yeej qhov teeb meem no, ntau qhov kev tshawb fawb tsom rau cov neeg mob uas muaj ob lub raum kho nrog PN lossis TA(4,26,27). Kev tsis sib haum xeeb ntawm cov txiaj ntsig ntawm GFR thiab creatinine qhov tseem ceeb tom qab kev kho mob thiab suav nrog cov qog nqaij hlav sib txawv, pab pawg sib txawv hauv cov yam ntxwv ua ntej, thiab TA / PNtechniques txwv lawv cov lus xaus (4,26,27).
Qhov sib txawv me me hauv kev kho ua ntej eGFR feem ntau yuav qhia txog hnub nyoog sib txawv ntawm pawg. Cov neeg mob hauv RFA(Radiofrequency ablation)pab pawg neeg laus dua (Table 1), tab sis lub hnub nyoog sib txawv tsis zoo li piav qhia cov txiaj ntsig, vim lawv tau hloov kho rau hnub nyoog hauv kev tshuaj xyuas ntau yam sib txawv. Kev kho mob ua ntej zoo ntshav creatinine thiab eGFR hauv ob pawg tuaj yeem piav qhia qee yam vim li cas cov txiaj ntsig no tsis cuam tshuam loj heev tom qab kev kho mob thiab vim li cas tsis muaj qhov sib txawv ntawm qhov kev hloov pauv ntawm cov txiaj ntsig ntawm pab pawg kho mob (5). Txawm li cas los xij, kev tshawb fawb yav dhau los tau tshaj tawm tias percutaneous ablation tsis cuam tshuam rau lub raum kev ua haujlwm, txawm tias cov neeg mob uas muaj kab mob raum ua ntej (28).
Raws li lub raum ua haujlwm poob qis dhau sijhawm, qhov kev txwv rau txoj kev tshawb fawb tam sim no yog qhov kev kho mob tom qab kev kho mob creatinine qhov tseem ceeb tau sau los ntawm lub sijhawm sib txawv rau ob pawg kho mob. Plaub tus neeg mob hauv RFA(Radiofrequency ablation)pab pawg neeg xav tau ntau qhov kev kho mob kom ua tiav kev kho mob qog noj ntshav, yog li cuam tshuam rau lub sijhawm nruab nrab ntawm lub sijhawm uas cov txiaj ntsig creatinine tau sau. Lub RFA(Radiofrequency ablation)pab pawg muaj thawj CT ua ntej me ntsis ntawm LPN(laparoscopic ib nrab nephrectomy)pab pawg, txawm tias qhov sib txawv no tsawg heev (peb lub hlis). Cov sijhawm sib txawv no hauv kev sau cov ntaub ntawv, yam tsis muaj nyob hauv kev tshawb nrhiav rov qab, tuaj yeem cuam tshuam qhov tshwm sim.
Qhov kev tshawb nrhiav ib-chaw rov qab los ntawm peb qhov kev paub thawj zaug nrog ob txoj kev kho mob muaj ntau yam kev txwv. Txawm hais tias kev hloov kho cov qog thiab cov yam ntxwv ntawm tus neeg mob tau ua tiav, cov neeg mob thiab kws phais neeg nyiam tuaj yeem piav qhia qhov kev tshawb pom. Txoj kev tshawb no tau txwv ntxiv los ntawm kev cais cov neeg mob uas tsis tuaj yeem dhau CE-CT, uas tuaj yeem npog qhov tsis ua haujlwm ntawm lub raum hauv ob pawg. Serum creatinine tsis tau ua nyob rau hauv ib lub chaw kuaj mob, uas tuaj yeem qhia qhov yuam kev rau kev sib piv ntawm creatinine thiab eGFR. Kev soj ntsuam creatinine thiab GFR raug txwv rau ib qho kev kho mob tom qab, yam tsis tau ntsuas lub raum ua haujlwm ntev. Lwm yam kab mob sib kis (xws li ntshav qab zib, ntshav siab), qhov sib txawv ntawm qhov sib txawv nruab nrab siv hauv txhua pab pawg kho mob, qhov sib txawv ntawm txoj kev siv tshuaj loog, lossis cov tshuaj uas yuav cuam tshuam rau lub raum ua haujlwm tsis raug ntsuas. Cov txiaj ntsig muaj sia nyob muaj feem cuam tshuam nrog kev hloov pauv hauv SRF tsis raug ntsuas, txawm tias qhov no tsis yog lub hom phiaj tseem ceeb. SRF tsis yog qhov ntsuas ntawm lub raum ua haujlwm; Yog li ntawd, kev txhais cov txiaj ntsig rau tus neeg mob lub raum ua haujlwm tsis tau. CE-CT-based SRF kev ntsuas yog ib txoj hauv kev zoo rau kev soj ntsuam kev ua haujlwm rau lub raum (9,12,14); Txawm li cas los xij, txoj kev no tuaj yeem xav tau kev soj ntsuam ntxiv hauv cov neeg mob kho mob raum. Txawm li cas los xij, RFA(Radiofrequency ablation)yog txuam nrog kev khaws cia ntawm lub raum ua haujlwm zoo dua li LPN(laparoscopic ib nrab nephrectomy)thaum ntsuas SRF. Raws li SRMs feem ntau pom nyob rau hauv cov neeg mob laus uas muaj kab mob raum ua ntej, kev khaws cia ntawm lub raum ua haujlwm tseem ceeb hauv pab pawg no txhawm rau txo qis kev loj hlob ntawm cov kab mob raum kawg (29).
Hauv kev xaus, ob qho tib si RFA(Radiofrequency ablation)thiab LPN(laparoscopic ib nrab nephrectomy)yog cov neeg ua haujlwm zoo ua ntej ntawm lub raum ua haujlwm thaum kho SRMs. Nyob rau hauv no series, RFA(Radiofrequency ablation)tau cuam tshuam nrog kev khaws cia ntawm lub raum ua haujlwm zoo dua li LPN(laparoscopic ib nrab nephrectomy)thaum soj ntsuam cov txiaj ntsig ntawm kev kho mob ntawm lub raum cuam tshuam SRF. Tsis muaj qhov sib txawv ntawm kev hloov pauv ntawm creatinine thiab eGFR tom qab kho, uas tuaj yeem piav qhia los ntawm lub raum cov txheej txheem them nyiaj.
Cov teebmeem ntawm cistanche: txhim kho lub raum ua haujlwm
Cov ntaub ntawv
1. Finelli A, Ismaila N, Bro B, et al. Kev Tswj Ntawm Lub Raum Me Me: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2017;35:668-680.
2. Ljungberg B, Bensalah K, Canfield S, et al.EAU cov lus qhia ntawm lub raum cell carcinoma: 2014 hloov tshiab. Euro Urol 2015; 67:913-924.
3. Woldu SL, Thoreson GR, OkhunovZ, thiab al.Kev sib piv ntawm lub raum parenchymal ntim preservation ntawm ib feem nephrectomy, cryoablation, thiab radiofrequency ablation siv 3D ntim ntsuas. J Endourol 2015; 29:948-955.
4. Raman JD, Raj GV, Lucas SM, et al. Lub raum ua haujlwm tau zoo rau cov qog nqaij hlav hauv lub raum ib leeg tswj los ntawm cov txheej txheem ablative lossis extirpative. BJU Int 2010; 105:496-500.
5. Biles MJ, DeCastro GJ, Woldu SL. Lub raum ua haujlwm raws li cov txheej txheem nephron-sparing: tsuas yog teeb meem ntawm ntim? Plaub Hlis 2016; 17:8.
6. Katsanos K, Maili L, Krokidis M, et al. Kev tshuaj xyuas thiab kev tshuaj ntsuam xyuas meta ntawm thermal ablation piv rau kev phais nephrectomy rau cov qog nqaij hlav me me. Cardiovasc Intervent Radiol 2014; 37:427-437.
7. Patel HD.Pierorazio PM, Johnson MH, thiab al. Lub raum ua haujlwm tau zoo tom qab kev phais, ablation, thiab kev saib xyuas ntawm lub raum qog hauv zos: kev tshuaj xyuas thiab kev tshuaj xyuas meta. Clin J Am Soc Nephrol 2017; 12:1057-1069.
8. Go AS, Chertow GM, Fan D, et al. Cov kab mob hauv lub raum ntev thiab kev pheej hmoo ntawm kev tuag, kab mob plawv, thiab pw hauv tsev kho mob. N Engl J Med 2004;351:1296-1305.
9. Björkman H. Alternative method for assessment of split renal function [Dissertation].Uppsala: Uppsala University, 2008.
10. Summerlin AL, Lockhart ME, Strang AM, et al. Kev txiav txim siab ntawm kev faib lub raum ua haujlwm los ntawm 3D rov tsim kho ntawm CT angiograms: kev sib piv nrog lub koob yees duab gamma renography. AJR Am J Roentgenol 2008; 191: 1552–1558.
