Permpongkosol Sompol, Nicol Theresa L, Romero Frederico R, Rais-Bahrami Soroush, Aranyakasemsuk Niwat, Solomon Stephen B, Kavoussi Louis R
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Med Assoc Thai. 2009 Jan;92(1):22-6.
To evaluate the feasibility of percutaneous injection of saline in the renal subcapsular space to prevent bowel injury and histopathologic effects of bowel cryolesion during renal cryoablation in a porcine model.
Six pigs underwent percutaneous renal cryoablation with two freeze cycles in the lower pole of both kidneys. Six kidneys were injected with 10 ml saline into the renal subcapular space before cryoablation. The bowel was brought into contact with the edge of the ice ball with laparoscopic assistance during renal cryoablation, on the side with saline injection as well as on the control side. One of these animals was kept for survival follow-up and laparotomy for 7 days post cryoablation. The bowel cryolesion sites were observed and compared based on the presence or absence of renal subcapsular saline injection.
The mean diameter of acute bowel injury with and without saline renal subcapsular injection was 7.25 +/- 1.26 and 14.5 +/- 0.58 mm, respectively. The influence of injecting a saline buffer was a significant decrease in the bowel cryolesion compared to controls (p = 0.0003). In addition, a pig kept for follow-up confirmed no bowel perforation after 7 days at a site that was cryolesioned on the side with renal subcapsular saline injection, but sustained bowel perforation in another segment lesioned by contact with a kidney without a saline injection. Gross and microscopic pathological examination was consistent with these interpretations.
Preliminary results in a porcine model show that percutaneous renal subcapsular saline injection is a feasible and promising technique for preventing bowel complications of percutaneous image-guided renal cryoablation.
评估在猪模型中经皮向肾被膜下间隙注射生理盐水以预防肾冷冻消融术中肠损伤及肠冷冻损伤的组织病理学效应的可行性。
六只猪双侧肾下极接受两次冷冻循环的经皮肾冷冻消融术。六只肾在冷冻消融术前向肾被膜下间隙注射10毫升生理盐水。在肾冷冻消融术中，在腹腔镜辅助下使肠与冰球边缘接触，包括在注射生理盐水侧以及对照侧。其中一只动物在冷冻消融术后存活随访7天并进行剖腹手术。根据有无肾被膜下注射生理盐水观察并比较肠冷冻损伤部位。
有和无肾被膜下注射生理盐水时急性肠损伤的平均直径分别为7.25±1.26毫米和14.5±0.58毫米。与对照组相比，注射生理盐水缓冲液的影响是肠冷冻损伤显著减少（p = 0.0003）。此外，一只接受随访的猪在肾被膜下注射生理盐水侧冷冻损伤部位7天后未出现肠穿孔，但在另一侧因接触未注射生理盐水的肾脏而损伤的节段出现了肠穿孔。大体和显微镜病理检查与这些结果相符。
猪模型的初步结果表明，经皮肾被膜下注射生理盐水是预防经皮影像引导下肾冷冻消融术肠并发症的一种可行且有前景的技术。
