Hruby Gregory, Edelstein Andrew, Karpf Jason, Durak Evren, Phillips Courtney, Lehman Daniel, Landman Jaime
Columbia University, New York, NY 10032, USA.
BJU Int. 2008 Sep;102(6):723-6. doi: 10.1111/j.1464-410X.2008.07735.x. Epub 2008 May 15.
To assess the risk factors for haemorrhage and renal fracture associated with renal cryoablation.
In a porcine model, 120 cryoablations were administered in 26 pigs, with five groups of 24 ice-balls each; in groups 1 and 2 asynchronous cryoprobe activation was evaluated for the 1.47- and 3.4-mm cryoprobes (IceRods, Galil Medical, Plymouth Meeting, PA, USA), respectively; in group 3, three-3.4 mm cryoprobes were used to examine synchronous probe activation; in group 4 the 1.47-mm cryoprobe was used to examine single-probe activation with premature cryoprobe extraction; and in group 5 we used a new 'guillotine' technique for upper-pole renal cryoablation. Ice-ball fractures and haemorrhage were characterized by the location, length and depth of each fracture, was well as the degree of bleeding.
In all, 26 domestic pigs successfully had renal cryoablation procedures. In group 1 and 4 there were no episodes of renal fracture; in group 2 renal fracture occurred in 10 (42%) trials. Group 3 had 22 (92%) renal fractures during the freeze/thaw cycle. Group 5 had 13 (54%) renal fractures during the freeze/thaw cycle, and there was an additional ice-ball fracture during probe removal once in 24 times.
Renal fracture is most common with the application of larger 3.4-mm cryoprobes in the synchronous and asynchronous setting. Under standard application, smaller (1.47-mm) cryoprobes result in little renal fracture or bleeding. The use of the guillotine technique is associated with a greater risk of renal fracture.
评估与肾冷冻消融相关的出血和肾破裂的危险因素。
在猪模型中，对26头猪进行了120次冷冻消融，每组24个冰球，共5组；第1组和第2组分别对1.47毫米和3.4毫米冷冻探针（美国宾夕法尼亚州普利茅斯会议市加利尔医疗公司的IceRods）的异步冷冻探针激活情况进行评估；第3组使用3个3.4毫米冷冻探针检查同步探针激活情况；第4组使用1.47毫米冷冻探针检查提前拔出冷冻探针时的单探针激活情况；第5组使用一种新的“断头台”技术进行肾上极冷冻消融。通过每条破裂的位置、长度和深度以及出血程度来描述冰球破裂和出血情况。
总共26头家猪成功接受了肾冷冻消融手术。第1组和第4组未发生肾破裂；第2组在10次（42%）试验中发生了肾破裂。第3组在冻融循环期间有22次（92%）肾破裂。第5组在冻融循环期间有13次（54%）肾破裂，并且在24次中有1次在拔出探针时出现了额外的冰球破裂。
在同步和异步设置下，使用较大的3.4毫米冷冻探针时肾破裂最为常见。在标准应用中，较小（1.47毫米）的冷冻探针导致的肾破裂或出血较少。使用断头台技术会增加肾破裂的风险。
