| BackgroundRenal tumor is the most common tumor of the genitourinary system, its incidence and mortality is at the second place after bladder tumor. As a renal tumor, the traditional standard treatment of Renal cell carcinoma was radical nephrectomy. With advances in the people’s health level and diagnostic techniques, the level of the diagnosis asymptomatic renal carcinoma especially small renal cell carcinoma with diameter less than3cm increased significantly. Studies confirm that asymptomatic small renal cell carcinoma is most early, and few distant metastasis; therefore, nephron-sparing operation gradually is the standard mode of operation, and the tumor free survival rate has no difference with traditional radical nephrectomy[1]. With the development of minimally invasive techniques and minimally invasive concept development, a variety of minimally invasive treatment methods are being applied to the treatment of renal tumors based on treatment nephron-sparing operation in recent years. Radiofrequency ablation, cryoablation, high intensity focused ultrasound are currently the main three minimally invasive treatment measures. Radiofrequency ablation techniques is widely used at present due to its of an earlier application and more mature technology[2].Be different from partial nephrectomy, radiofrequency ablation techniques has no intraoperative renal ischemia reperfusion injury due to occlusion of the renal artery. To summarize the factors effect the renal function after radiofrequency ablation has important clinical significance on the postoperative recovery of renal function.Glomerular filtration rate (GFR) refers to the renal plasma of glomerular filtration flowing at a certain period of time and is an important indicator of renal function.GFR can measure total kidney and renal function precisely and found impaired renal function. It is more accurate, sensitive, and good reproducibility than blood urea nitrogen (BUN), creatinine (SCr), so it can be used to judge the renal function changes after radiofrequency ablation. At present, we mainly use of single photon emission computed tomography (SPECT) renal dynamic imaging for the assessment of glomerular filtration rate. The glomerular filtration rate is assessed through the determination of plasma clearance after disposable intravenous injection of a radionuclide marker (99mTc-DTPA).This method is simple, reliable, noninvasive, and it can be used to observe the kidney damage.The enhanced CT is widely used in the assessment of radiofrequency ablation treatment effect and it can calculate the tumor volume and lesion volume accurately. This study analyzed these factors by using statistical methods, and the results showed that renal ablation volume play a major role on postoperative renal function. In recent years, with the rapid development of the technology of tumor ablation, RFA has been widely used in the treatment of small renal cell carcinoma, and it basically achieved minimally invasive purpose. Therefore, further study of the intraoperative renal factors have important clinical significance to maximize the retention of normal kidney tissues.ObjectivesDiscuss the influence of renal tumors with radiofrequency ablation on nephron function with the glomerular filtration rate (GFR) and enhanced CT. MethodsSelect the clinical data of34cases of RFA in our hospital from2007to2011.Process the image of CT enhancement scanning before and after operation using computer image analysis system after one month and one year on the tumor region, and calculate the preoperative tumor volume, postoperative tumor ablation volume.99mTc-DTPA renal radionuclide scanning is used for the assessment for preoperative, postoperative one month, one year postoperatively renal glomerular filtration rate(GFR). The renal glomerular filtration rate (GFR) and tumor volume changes was compared using paired t test; Linear regression and correlation analysis is used to the reduction of glomerular filtration rate and renal ablation volume. All data was dealt with SPSS17.0statistical software.Results1. The serum creatinine (Cr) levels showed no obvious changes between preoperative and postoperative (Crl compared with Cr2, t=1.810, P=0.325>0.05; Crl compared with Cr3, t=1.509, P=0.159>0.05; Cr2compared with Cr3, t=1.361, P=0.635>0.05).2. Contralateral kidney GFR after RFA had no significant difference compared with preoperative GFR (GFRla compared with GFR2a, t=1.110, P=0.275>0.05; GFR1a compared with GFR3a, t=1.149, P=0.259>0.05; GFR2a compared with GFR3a,t=0.341, P=0.735>0.05).3. GFR of ipsilateral kidney after RFA in one month was decreased compared to preoperative (t=3.422, P=0.002<0.05); GFR of ipsilateral kidney after RFA in one year was decreased compared to preoperative (t=3.658, P=0.001<0.05); GFR of ipsilateral renal in one month and one year did not change significantly (t=0.514, P=0.611>0.05).4. Ablation lesion area after one month was increased compared with the preoperative tumor volume (t=8.668, P=0.001<0.05); Ablation lesion area after one year was decreased compared with ablation lesion area after one month (t=6.219, P=0.001<0.05). 5. Renal ablation volume was as an independent variable X, and ipsilateral renal glomerular filtration rate reduction value of the dependent was variable Y. Their linear regression equation was Y=0.8052+1.0158X (t=13.371> t0.05/2(33), P<0.05); renal ablation volume and ipsilateral kidney GFR value decreased had strong positive correlation, and the correlation coefficient r=0.9276.Conclusions1.Radiofrequency ablation had no effect on total renal function.2. Radiofrequency ablation had no indirect damage on the contralateral kidney.3. Radiofrequency ablation has a certain damage to normal kidney tissue of ipsilateral kidney after radiofrequency ablation; There was no delayed damage.4. Radiofrequency ablation had a certain ablation to the surrounding normal kidney tissue; The region of ablation was stability after RFA and the ablation tissue had the trend of gradual absorption.5. Ipsilateral renal GFR decreased value with lesion volume of normal kidney had the linear regression and correlation; ablation volume was the main factor of ipsilateral renal glomerular filtration rate (GFR). |
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