Warlick Christopher A, Lima Guilherme C, Allaf Mohamad E, Varkarakis Ioannis, Permpongkosol Sompol, Schaeffer Edward M, Kavoussi Louis R, Jarrett Thomas W, Solomon Stephen B
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Urology. 2006 May;67(5):918-22. doi: 10.1016/j.urology.2005.11.058.
Percutaneous renal tumor cryoablation is being evaluated as a treatment option for small renal tumors. However, when tumors are located centrally, involvement of the collecting system by the radiographic iceball can occur. We reviewed our series of computed tomography (CT)-guided percutaneous renal tumor cryoablation to identify those cases in which there appeared to be involvement of the collecting system by the radiographic iceball and to determine any clinical sequelae of such involvement.
Retrospective review of the medical records identified 6 patients who had undergone CT-guided percutaneous renal tumor cryoablation with evidence of collecting system involvement. Measurements of the tumor size, size of the radiographic iceball, and the size of the immediate postprocedure "cryozone" (region of apparent treatment on contrast-enhanced CT) were obtained from the preprocedure, intraprocedure, and immediate postprocedure CT scans. Follow-up imaging was obtained beginning at 3 to 6 months.
Six patients were identified who met the inclusion criteria and had at least 3 months of documented follow-up. Despite the apparent involvement of the collecting system during the cryoablation procedure, no patient developed clinical signs or symptoms or radiographic evidence of a urine leak or fistula formation. Furthermore, no evidence of ureteral narrowing or stricture formation has been found to date, with a mean follow-up of 167.7 days (range 90 to 288).
We observed no clinically appreciable urine leaks despite what appeared to be obvious involvement of the collecting system by the radiographic iceball. However, care should be exercised to avoid this insult when possible until additional research has confirmed its safety.
经皮肾肿瘤冷冻消融术正作为小肾肿瘤的一种治疗选择进行评估。然而，当肿瘤位于中央时，影像学上的冰球可能会累及集合系统。我们回顾了我们一系列计算机断层扫描（CT）引导下的经皮肾肿瘤冷冻消融术病例，以识别那些影像学上冰球似乎累及集合系统的病例，并确定这种累及的任何临床后果。
对病历进行回顾性研究，确定6例接受CT引导下经皮肾肿瘤冷冻消融术且有集合系统累及证据的患者。从术前、术中和术后即刻的CT扫描中获取肿瘤大小、影像学冰球大小以及术后即刻“冷冻区”（增强CT上明显的治疗区域）大小的测量值。从3至6个月开始进行随访成像。
确定了6例符合纳入标准且有至少3个月记录在案的随访的患者。尽管在冷冻消融过程中集合系统明显受累，但没有患者出现临床体征或症状，也没有影像学证据表明存在尿液漏出或瘘管形成。此外，迄今为止未发现输尿管狭窄或狭窄形成的证据，平均随访时间为167.7天（范围90至288天）。
尽管影像学上冰球似乎明显累及集合系统，但我们未观察到临床上明显的尿液漏出。然而，在更多研究证实其安全性之前，应尽可能小心避免这种损伤。
