Hruby Gregory W, Marruffo Franzo, Ortiz Jorge, Durak Evren, Edelstein Andrew, Levi Gabriel, Landman Jaime
Department of Urology, Columbia University Medical Center, New York, New York 10032, USA.
Urology. 2007 Aug;70(2):391-5. doi: 10.1016/j.urology.2007.03.028.
To examine the feasibility of transurethral, focal, full-thickness bladder wall cryoablation in the porcine model using a novel 38-cm cryoablation probe.
A total of 18 pigs were divided into three groups. Groups 1 (n = 6) and 2 (n = 6) underwent transurethral bladder wall cryoablation in a saline environment with two freeze-thaw cycles. The pigs in groups 1 and 2 were killed after 1 and 3 weeks, respectively. The pigs in group 3 (n = 6) underwent transurethral cryoablation after the bladder had been insufflated with carbon dioxide gas. The pigs in group 3 were killed after 1 week. In all groups, laparoscopic access was obtained to protect the abdominal contents from the transmural cryoablation process. Bladder integrity was evaluated with cystography and laparoscopic visualization, and each cryolesion was excised en bloc for extensive histopathologic evaluation.
All 18 pigs successfully underwent bladder wall cryoablation. For all groups, the preoperative, postoperative, and sacrifice cystograms were without evidence of extravasation. No urinomas, hematomas, or adhesions were present in groups 1 and 2. Minimal adhesions were identified in 3 (50%) of 6 pigs in group 3. For groups 1, and 2, the mean length and width of the area of complete necrosis on histopathologic evaluation was 6.5 and 3.0 mm and 2.3 and 1.3 mm, respectively. For group 3, the mean diameter of the cryolesion was 8.2 mm. Full-thickness necrosis was confirmed in all groups.
The results of our study have shown that, in this model, complete full-thickness transurethral bladder wall cryoablation, with maintenance of bladder wall integrity, is feasible.
使用新型38厘米冷冻消融探头，在猪模型中研究经尿道局灶性膀胱壁全层冷冻消融的可行性。
总共18头猪被分为三组。第1组（n = 6）和第2组（n = 6）在盐水环境中进行经尿道膀胱壁冷冻消融，有两个冻融周期。第1组和第2组的猪分别在1周和3周后处死。第3组（n = 6）的猪在膀胱充入二氧化碳气体后进行经尿道冷冻消融。第3组的猪在1周后处死。在所有组中，通过腹腔镜进入以保护腹腔内容物免受透壁冷冻消融过程的影响。通过膀胱造影和腹腔镜观察评估膀胱完整性，并且将每个冷冻损伤整块切除以进行广泛的组织病理学评估。
所有18头猪均成功进行了膀胱壁冷冻消融。对于所有组，术前、术后和处死时的膀胱造影均无外渗迹象。第1组和第2组中没有出现尿囊肿、血肿或粘连。第3组6头猪中有3头（50%）发现有轻微粘连。对于第1组和第2组，组织病理学评估中完全坏死区域的平均长度和宽度分别为6.5毫米和3.0毫米以及2.3毫米和1.3毫米。对于第3组，冷冻损伤的平均直径为8.2毫米。所有组均证实有全层坏死。
我们的研究结果表明，在该模型中，维持膀胱壁完整性的经尿道膀胱壁全层冷冻消融是可行的。
