肾细胞癌的现代治疗(7)
4、冷冻治疗
冷冻治疗是利用液氮装置使肿瘤细胞冷冻死亡而达到治疗目的。冷冻可以使细胞内和细胞外形成冰晶，导致细胞膜破裂，蛋白质、细胞器和微血管破坏。此外，细胞迅速暴露于高渗环境，加重损害。为了增强冷冻治疗的效果，通常采用两个冷冻—融化循环，并以快速冷冻和慢速解冻的方式，使冰晶充分形成。肿瘤细胞最终凝固坏死，被吸收和局部纤维化。冷冻治疗的有效温度为-40℃，由于形成的冰球内部的5～6mm才能达到-40℃，所以治疗中应使冰球外界超过肿瘤边界1cm以上，才能达到治疗效果。文献报道可以用冷冻治疗和射频消融方法处理von Hippel-Lindau综合征，避免了多处手术切口。
冷冻治疗可以伴有严重的并发症，例如，大出血、完全性小肠梗阻(小肠壁一周形成冰球)等。在腹腔镜下施行冷冻治疗更为安全，可将肾脏完全游离，以腔内B超实时监控冰球(强回声)的形成。冷冻治疗的缺点是无法获得病理结果，损伤周围器官，肾实质出血、损伤肾集合系统形成尿瘘。还应当考查是否引起肿瘤种植。
, 百拇医药
5、间质内单光子照射治疗
传统的标准放疗在肾细胞癌治疗中的应用很少，但是放射疗法在细胞水平的治疗效果是较为肯定的。放疗可引起细胞单链和双链DNA断裂，产生细胞凋亡和阻止细胞分裂。肿瘤周围组织的消弱了外照射的效果，放疗治疗边界不清楚，并且副作用大，疗效差。而间质内照射是将一个小放射探头直接插入组织内部。可以产生精确的放疗边界，有效破坏肿瘤组织。初步的实践已证实，间质内照射在RCC治疗中是有效和安全的，可以用于小肾肿瘤的治疗，治疗范围的大小取决于照射时间和剂量。
参考文献
1、马腾骧. 中华医学会第五次全国泌尿外科学术会议,海峡两岸泌尿外科第二届学术会议纪要(泌尿肿瘤)，中华泌尿外科杂志 1997；18:10.
2、马腾骧.肾细胞癌的治疗.马腾骧主编：现代泌尿外科学,天津:天津科学技术出版社,2000.
, http://www.100md.com
3、陆曙炎译:泌尿外科手术创新的改良.(德)霍恩福勒,(美)诺维克,(德)费赤那主编.上海:上海科学技术出版社,2000.
4、Belldegrum A, deKemion JB.” Renal tumor”. In Walsh PC,et al: Campbell’s Urology, 7th edition.1998 Harcourt Publishers Limited.
5. Sawai Y, et al. Ipsilateral adrenal involvement from renal cell carcinoma: retrospective study of the predictive value of computed tomography. Urology 2002; 59:28～31.
6. Quek ML, et al. Surgical approaches to venous tumor thrombus. Semin Urol Oncol 2001; 19:88～97.
, http://www.100md.com
7. Ghavamian R,et al. Open surgical partial nephrectomy. Semin Urol Oncol 2001; 19: 103～113.
8. Piper NY, et al. Is a 1-cm margin necessary during nephron-sparing surgery for renal cell carcinoma? Urology 2001; 58:849～857.
9. Sutherland SE, et al. Does the size of the surgical margin in partial nephrectomy for renal cell cancer matter? J Urol 2002; 167: 67～64.
10. Flanigan RC, et al. The role of radical nephrectomy in metastatic renal cell carcinoma. Semin Urol Oncol 2001; 19:98～102.
, 百拇医药
11. Motzer RJ, et al. Interferon-alpha as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 2002; 20: 289～296.
12. Bukowski RM. Cytokine therapy for metastatic renal cell carcinoma. Semin Urol Oncol 2001; 19:148～154.
13. Vissers JLM, et al. The renal cell carcinoma assocated antigen G250 encodes a human leukocyte antigen (HLA)-A2.1-restricted epitope recognized by cytotoxic T lymphocytes. Cancer Res 1999; 59: 5554～5559.
, http://www.100md.com
14. Latif F, et al. Identification of the von Hippel-Lindau disease tumor suppressor gene. Science 1993; 260: 1317～1320.
15. Zisman A, et al. Laparoscopic radical nephrectomy. Semin Urol Oncol 2001; 19: 114～122.
16. Mancimi GJ, et al. Haned-assisted laparoscopic radical nephrectomy: comparison with transabdominal radical nephrectomy. Am Surg 2002; 68: 151～153.
17. Portis AJ, et al. Long-term follow up after laparoscopic radical nephrectomy. J Urol 2002; 167: 1257～1262.
, 百拇医药
18. Gill IS, et al. Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol 2002; 167: 469～477.
19. Hollenbeck BK, et al. Laparoscopic partial nephrectomy. Semin Urol oncol 2001; 19: 123～132.
20. Yoshimura K, et al. Laparoscopic partial nephrectomy with a microwave tissue coagulator for small renal tumor. J Urol 2001; 165: 1893～1896.
21. Rendon RA, et al. Development of a radiofrequency based thermal therapy technique in an in vivo porcine model for the treatment of small renal masses. J Urol 2001,166: 292～298.
, 百拇医药
22. Pavlovich CP, et al. Percutaneous radic frequency ablation of small renal tumors: initial results. J Urol 2002, 167:10～15.
23. Shingleton WB, et al. Percutaneous renal cryoablation of renal tumors in patients with von Hippel-Lindau disease. J Urol 2002; 167: 1268～1270.
24. Murphy DP, et al. Energy-based renal tumor ablation: A review. Semin Urol Oncol 2001; 19: 133～140., 百拇医药(牛远杰 马腾骧)
冷冻治疗是利用液氮装置使肿瘤细胞冷冻死亡而达到治疗目的。冷冻可以使细胞内和细胞外形成冰晶，导致细胞膜破裂，蛋白质、细胞器和微血管破坏。此外，细胞迅速暴露于高渗环境，加重损害。为了增强冷冻治疗的效果，通常采用两个冷冻—融化循环，并以快速冷冻和慢速解冻的方式，使冰晶充分形成。肿瘤细胞最终凝固坏死，被吸收和局部纤维化。冷冻治疗的有效温度为-40℃，由于形成的冰球内部的5～6mm才能达到-40℃，所以治疗中应使冰球外界超过肿瘤边界1cm以上，才能达到治疗效果。文献报道可以用冷冻治疗和射频消融方法处理von Hippel-Lindau综合征，避免了多处手术切口。
冷冻治疗可以伴有严重的并发症，例如，大出血、完全性小肠梗阻(小肠壁一周形成冰球)等。在腹腔镜下施行冷冻治疗更为安全，可将肾脏完全游离，以腔内B超实时监控冰球(强回声)的形成。冷冻治疗的缺点是无法获得病理结果，损伤周围器官，肾实质出血、损伤肾集合系统形成尿瘘。还应当考查是否引起肿瘤种植。
, 百拇医药
5、间质内单光子照射治疗
传统的标准放疗在肾细胞癌治疗中的应用很少，但是放射疗法在细胞水平的治疗效果是较为肯定的。放疗可引起细胞单链和双链DNA断裂，产生细胞凋亡和阻止细胞分裂。肿瘤周围组织的消弱了外照射的效果，放疗治疗边界不清楚，并且副作用大，疗效差。而间质内照射是将一个小放射探头直接插入组织内部。可以产生精确的放疗边界，有效破坏肿瘤组织。初步的实践已证实，间质内照射在RCC治疗中是有效和安全的，可以用于小肾肿瘤的治疗，治疗范围的大小取决于照射时间和剂量。
参考文献
1、马腾骧. 中华医学会第五次全国泌尿外科学术会议,海峡两岸泌尿外科第二届学术会议纪要(泌尿肿瘤)，中华泌尿外科杂志 1997；18:10.
2、马腾骧.肾细胞癌的治疗.马腾骧主编：现代泌尿外科学,天津:天津科学技术出版社,2000.
, http://www.100md.com
3、陆曙炎译:泌尿外科手术创新的改良.(德)霍恩福勒,(美)诺维克,(德)费赤那主编.上海:上海科学技术出版社,2000.
4、Belldegrum A, deKemion JB.” Renal tumor”. In Walsh PC,et al: Campbell’s Urology, 7th edition.1998 Harcourt Publishers Limited.
5. Sawai Y, et al. Ipsilateral adrenal involvement from renal cell carcinoma: retrospective study of the predictive value of computed tomography. Urology 2002; 59:28～31.
6. Quek ML, et al. Surgical approaches to venous tumor thrombus. Semin Urol Oncol 2001; 19:88～97.
, http://www.100md.com
7. Ghavamian R,et al. Open surgical partial nephrectomy. Semin Urol Oncol 2001; 19: 103～113.
8. Piper NY, et al. Is a 1-cm margin necessary during nephron-sparing surgery for renal cell carcinoma? Urology 2001; 58:849～857.
9. Sutherland SE, et al. Does the size of the surgical margin in partial nephrectomy for renal cell cancer matter? J Urol 2002; 167: 67～64.
10. Flanigan RC, et al. The role of radical nephrectomy in metastatic renal cell carcinoma. Semin Urol Oncol 2001; 19:98～102.
, 百拇医药
11. Motzer RJ, et al. Interferon-alpha as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 2002; 20: 289～296.
12. Bukowski RM. Cytokine therapy for metastatic renal cell carcinoma. Semin Urol Oncol 2001; 19:148～154.
13. Vissers JLM, et al. The renal cell carcinoma assocated antigen G250 encodes a human leukocyte antigen (HLA)-A2.1-restricted epitope recognized by cytotoxic T lymphocytes. Cancer Res 1999; 59: 5554～5559.
, http://www.100md.com
14. Latif F, et al. Identification of the von Hippel-Lindau disease tumor suppressor gene. Science 1993; 260: 1317～1320.
15. Zisman A, et al. Laparoscopic radical nephrectomy. Semin Urol Oncol 2001; 19: 114～122.
16. Mancimi GJ, et al. Haned-assisted laparoscopic radical nephrectomy: comparison with transabdominal radical nephrectomy. Am Surg 2002; 68: 151～153.
17. Portis AJ, et al. Long-term follow up after laparoscopic radical nephrectomy. J Urol 2002; 167: 1257～1262.
, 百拇医药
18. Gill IS, et al. Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol 2002; 167: 469～477.
19. Hollenbeck BK, et al. Laparoscopic partial nephrectomy. Semin Urol oncol 2001; 19: 123～132.
20. Yoshimura K, et al. Laparoscopic partial nephrectomy with a microwave tissue coagulator for small renal tumor. J Urol 2001; 165: 1893～1896.
21. Rendon RA, et al. Development of a radiofrequency based thermal therapy technique in an in vivo porcine model for the treatment of small renal masses. J Urol 2001,166: 292～298.
, 百拇医药
22. Pavlovich CP, et al. Percutaneous radic frequency ablation of small renal tumors: initial results. J Urol 2002, 167:10～15.
23. Shingleton WB, et al. Percutaneous renal cryoablation of renal tumors in patients with von Hippel-Lindau disease. J Urol 2002; 167: 1268～1270.
24. Murphy DP, et al. Energy-based renal tumor ablation: A review. Semin Urol Oncol 2001; 19: 133～140., 百拇医药(牛远杰 马腾骧)
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