冷凍消融在腎臟血管平滑肌脂肪瘤之治療效果

江品葭¹、江博暉²、陳彥達¹、鄭元佐¹、蔡佳宏¹、

康智雄¹、王弘仁¹、陳建旭¹*

高雄長庚紀念醫院泌尿科¹、忠孝泌尿專科醫院²

Cryoablation for Renal Angiomyolipoma: Analysis of Efficacy and Complication

Ping-Chia Chiang¹, Po-Hui Chiang², Yen-Ta Chen¹, Yuan-Tso Cheng¹, Chia-Hung Tsai¹, Chih-Hsiung Kang¹, Hung-Jen Wang¹, Chien-Hsu Chen^1*

1. Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
2. Jhong Siao Urological Hospital, Kaohsiung, Taiwan

Purpose: Cryoablation therapy is a safe and feasible management for small renal masses. However, only a few reports have focused on renal angiomyolipoma (AML). We investigated the efficacy and complications of cryoablation therapy in the treatment of renal AMLs.

Materials and Methods: We retrospectively reviewed all the patients with pathologically confirmed renal AMLs treated with cryoablation between July 2008 and December 2021. Subgroup analyses were performed to evaluate the treatment outcomes of different operation methods (percutaneous echo-guided and laparoscopic approach) and histologic variant.

Results: In total, there were 26 patients (27 procedures) with renal AMLs treated with cryoablation therapy between July 2008 and December 2021. The mean tumor diameter is 4.0 cm (range, 1.5-15.4 cm). Thirteen (48.1%) patients have tumor size more than 4 cm. With regard to tumor complexity, the median PADUA score was 9, and 88.8 % of the tumors were PADUA score ≥ 8. After cryoablation, 40.7% of tumors reached complete remission and 70.3% of tumors were presented with a size reduction over 30%. 54.5% of patients undergoing percutaneous echo-guided cryoablation were under local anesthesia. The percutaneous echo-guided group had significantly shorter operation time than the laparoscopic approach (LCA) group (median 118 min vs 195 min, p = 0.002). The LCA group and the epithelioid AML group had significantly higher tumor size reduction after cryoablation. Only one patient (3.7%) encountered Clavien–Dindo Grade 3 complication.

Conclusion: This study confirmed the safety and efficacy of cryoablation for renal AMLs, even in high-complexity tumors. The tumor size reduction was in favor of LCA; however, percutaneous echo-guided cryoablation could be considered for selective patients who were not suitable for general anesthesia.