Malcolm John B, Gold Robert, Derweesh Ithaar H
Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
J Endourol. 2007 Jul;21(7):721-5. doi: 10.1089/end.2006.0388.
Percutaneous renal cryoablation has been shown to be a feasible therapeutic option for small renal tumors. Despite advances in equipment design and imaging capabilities, tumor location can present challenges to the percutaneous approach. We present our pilot experience with transhepatic percutaneous cryoablation of right upper-pole renal tumors.
Three patients aged 75 to 87 years with American Society of Anesthesiologists scores of III or IV underwent transhepatic percutaneous cryoablation between November 2005 and February 2006. Tumor size ranged from 2 to 5 cm. Cryoprobe placement was guided by CT imaging, and two freeze-thaw cycles were used. Additionally, 60-second freeze-thaw cycles were used to assist with hemostasis in the transhepatic tract.
The procedure was completed percutaneously in all cases with the patient under conscious sedation. The procedure time ranged from 67 to 167 minutes. Postoperative pain was managed with minimal use of nonnarcotic oral medications. Although one patient developed a moderate perinephric hematoma and required a blood transfusion, no hepatic complications were manifest. Local treatment failure was evident in one patient with a 5-cm mass showing enhancement at follow-up imaging.
Transhepatic access for percutaneous cryoablation of renal tumors is feasible. Limitations include tumor size, as larger tumors may introduce prohibitive risks.
经皮肾冷冻消融已被证明是治疗小肾肿瘤的一种可行的治疗选择。尽管设备设计和成像能力有所进步，但肿瘤位置可能给经皮治疗带来挑战。我们介绍我们对右上极肾肿瘤经肝穿刺冷冻消融的初步经验。
2005年11月至2006年2月期间，3例年龄在75至87岁、美国麻醉医师协会评分为III或IV级的患者接受了经肝穿刺冷冻消融。肿瘤大小为2至5厘米。冷冻探针的放置由CT成像引导，采用两个冻融循环。此外，采用60秒的冻融循环来辅助经肝通道的止血。
所有病例均在患者清醒镇静下经皮完成手术。手术时间为67至167分钟。术后疼痛通过少量使用非麻醉性口服药物进行处理。虽然1例患者出现中度肾周血肿并需要输血，但未出现肝脏并发症。1例5厘米肿块的患者在随访成像时显示有强化，出现局部治疗失败。
经肝途径进行肾肿瘤的经皮冷冻消融是可行的。局限性包括肿瘤大小，因为较大的肿瘤可能带来过高的风险。
