Young Jennifer L, Louie Michael K, Ortiz-Vanderdys Cervando G, McCormick David W, Huynh Victor B, Kaplan Adam G, Jain Nick S, Pick Donald L, Andrade Lorena A, Osann Kathryn E, Kolla Surendra B, Sountoulides Petros, Kaufmann Oskar G, McDougall Elspeth M, Clayman Ralph V
Department of Urology, University of California Irvine, Orange, California, USA.
J Endourol. 2009 Sep;23(9):1451-5. doi: 10.1089/end.2009.0396.
Pneumoperitoneum is known to decrease blood flow to the kidney during laparoscopy. We investigated if this change in blood flow would increase the size of the cryolesion.
Twelve Yorkshire swine underwent laparoscopy-guided percutaneous cryoablation of the upper and lower pole of each kidney at four randomized pneumoperitoneum pressures (10, 15, 20, and 25 mm Hg). Cryolesions were made with a 1.47-mm IceRod (Galil Medical, Plymouth Meeting, PA). Each site underwent two 10-minute freeze cycles separated by a 5-minute active thaw with pressurized helium gas. At the conclusion of each freeze cycle, the iceball volume was measured with intraoperative ultrasound. After completion of the four cryolesions, the kidneys were harvested, and the cryolesion surface area was calculated. The lesions were fixed in 10% buffered formalin and then excised with a 1-mm margin to obtain a volume measurement using fluid displacement.
Iceball volume was 3.41, 2.85, 3.44, and 2.36 cm(3) for freeze cycle 1 (p = 0.16) and 3.67, 3.34, 4.88, 3.95 cm(3) for freeze cycle 2 (p = 0.20) at 10, 15, 20, and 25 mm Hg, respectively. Cryolesion volume by fluid displacement was 4.06, 3.77, 3.97, and 3.93 cm(3) (p = 0.86) and cryolesion surface area was 4.55, 4.38, 4.39, and 4.20 cm(2) (p = 0.71) at 10, 15, 20, and 25 mm Hg, respectively.
In this study, pneumoperitoneum pressure between 10 and 25 mm Hg did not affect iceball size as measured by intraoperative ultrasound, cryolesion volume by fluid displacement, or cryolesion surface.
已知气腹会在腹腔镜检查期间减少肾脏的血流。我们研究了这种血流变化是否会增加冷冻损伤的大小。
12头约克夏猪在四个随机气腹压力（10、15、20和25mmHg）下接受了腹腔镜引导下经皮对每个肾脏的上极和下极进行冷冻消融。使用1.47毫米的IceRod（加利尔医疗公司，宾夕法尼亚州普利茅斯会议）制造冷冻损伤。每个部位进行两个10分钟的冷冻周期，中间间隔5分钟用加压氦气进行主动解冻。在每个冷冻周期结束时，用术中超声测量冰球体积。完成四个冷冻损伤后，取出肾脏，并计算冷冻损伤的表面积。将损伤固定在10%缓冲福尔马林中，然后以1毫米的边缘切除以使用液体置换获得体积测量值。
在10、15、20和25mmHg时，冷冻周期1的冰球体积分别为3.41、2.85、3.44和2.36cm³（p = 0.16），冷冻周期2的冰球体积分别为3.67、3.34、4.88、3.95cm³（p = 0.20）。在10、15、20和25mmHg时，通过液体置换测量的冷冻损伤体积分别为4.06、3.77、3.97和3.93cm³（p = 0.86），冷冻损伤表面积分别为4.55、4.38、4.39和4.20cm²（p = 0.71）。
在本研究中，10至25mmHg之间的气腹压力不影响术中超声测量的冰球大小、液体置换测量的冷冻损伤体积或冷冻损伤表面。
