Breda Alberto, Lam John S, Riggs Stephen, Leppert John T, Gui Dorina, Said Jonathan W, Schulam Peter G, Belldegrun Arie S
Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California 90095, USA.
J Urol. 2008 Jan;179(1):333-7. doi: 10.1016/j.juro.2007.08.089. Epub 2007 Nov 19.
The treatment of small renal tumors continues to evolve in parallel with advances in ablative technology. We compared the lesion geometry of 3, 17 gauge cryoneedles to determine the most effective distance and configuration of the cryoneedles in an in vivo porcine kidney model.
Argon gas based renal cryoablation was performed in 6 pigs using a laparoscopically assisted percutaneous approach. Cryoablation using a single cryoneedle and a template of 3 cryoneedles with various ice ball shapes, including elliptical, bulb-shaped and standard 17 gauge cryoneedles (Galil Medical, Plymouth Meadow, Pennsylvania) was performed in 3 pigs. Three additional pigs underwent renal cryoablation using elliptical cryoneedles in 3 triangular template configurations with the cryoneedles spaced 1, 1.5 and 2 cm apart, respectively. The animals were sacrificed a minimum of 2 weeks following treatment.
Elliptical cryoneedles achieved the largest area of necrosis when used in single and template configurations. When used in a template configuration of 3 needles 1, 1.5 and 2 cm apart from each other the calculated volume of necrosis was 4.3 x 4.5 x 2.5, 4.9 x 4.1 x 2.5 and 4.0 x 4.5 x 2.5 cm, respectively.
Using a single 17 gauge cryoneedle is inadequate for treating most small renal tumors. Cryoneedles with an elliptical ice ball are most effective for achieving consistent and reliable tissue destruction. The 1.5 cm template configuration generated the largest area of necrosis. Our data suggest that with the current technology renal cryoablation should be limited to lesions not greater than 4 cm.
随着消融技术的进步，小肾肿瘤的治疗也在不断发展。我们比较了3根17号冷冻针的病灶几何形状，以确定在体内猪肾模型中冷冻针的最有效距离和配置。
对6头猪采用腹腔镜辅助经皮方法进行基于氩气的肾冷冻消融。3头猪使用单根冷冻针和3根冷冻针模板进行冷冻消融，冰球形状各异，包括椭圆形、球形和标准17号冷冻针（加利尔医疗公司，宾夕法尼亚州普利茅斯草地）。另外3头猪采用椭圆形冷冻针，分别以3种三角形模板配置进行肾冷冻消融，冷冻针间距分别为1、1.5和2厘米。治疗后至少2周处死动物。
椭圆形冷冻针在单独使用和模板配置中均能实现最大坏死面积。当以3根针间距分别为1、1.5和2厘米的模板配置使用时，计算出的坏死体积分别为4.3×4.5×2.5、4.9×4.1×2.5和4.0×4.5×2.5立方厘米。
使用单根17号冷冻针不足以治疗大多数小肾肿瘤。具有椭圆形冰球的冷冻针对于实现一致且可靠的组织破坏最为有效。1.5厘米的模板配置产生的坏死面积最大。我们的数据表明，就目前的技术而言，肾冷冻消融应限于不大于4厘米的病灶。
