University of California-Irvine, Orange, California, USA.
J Urol. 2010 Feb;183(2):752-8. doi: 10.1016/j.juro.2009.09.072.
Preoperative planning for renal cryotherapy is based on isotherms established in gel. We replicated gel isotherms and correlated them with ex vivo and in vivo isotherms in a porcine model.
PERC-17 CryoProbes (1.7 mm) and IceRods (1.47 mm) underwent trials in gel, ex vivo and in vivo porcine kidneys. Temperatures were recorded at 13 predetermined locations with multipoint thermal sensors.
At the cryoprobe temperatures were not significantly different along the probe in any medium for either system (p = 0.0947 to 0.9609). However, away from the probe ex vivo and in vivo trials showed warmer temperatures toward the cryoprobe tip for each system (p = 0.0003 to 0.2141). Mean +/- SE temperature 5 mm distal to the cryoprobe tip in vivo was 19.2C +/- 16.1C for CryoProbes and 27.3C +/- 11.2C for IceRods. Temperatures were consistently colder with CryoProbes than with IceRods in gel (p <0.00005), ex vivo (p <0.00005) and in vivo (p = 0.0014). At almost all sites temperatures were significantly colder in gel and in ex vivo kidney than in in vivo kidney for CryoProbes (p = 0.0107 and 0.0008, respectively) and for IceRods (each p <0.00005).
Gel and ex vivo isotherms do not predict the in vivo pattern of freezing. Thus, they should not be used for preoperative planning. The cryoprobe should be passed 5 mm beyond the tumor border to achieve suitably cold temperatures. Multipoint thermal sensor probes are recommended to record actual temperature during renal cryotherapy.
肾冷冻治疗的术前规划基于凝胶中建立的等温线。我们复制了凝胶等温线，并在猪模型中对其与离体和体内等温线进行了相关性分析。
PERC-17 冷冻探针（1.7 毫米）和 IceRods（1.47 毫米）在凝胶、离体和活体猪肾脏中进行了试验。在 13 个预定位置使用多点热敏传感器记录温度。
在任何介质中，对于两种系统，冷冻探针的温度在探针的任何位置都没有显著差异（p = 0.0947 至 0.9609）。然而，在远离探针的离体和体内试验中，对于每个系统，都显示出远离探针尖端的温度更高（p = 0.0003 至 0.2141）。活体中距离冷冻探针尖端 5 毫米处的平均温度± SE 为 CryoProbes 为 19.2°C ± 16.1°C，IceRods 为 27.3°C ± 11.2°C。在凝胶（p <0.00005）、离体（p <0.00005）和活体（p = 0.0014）中，CryoProbes 的温度始终比 IceRods 更低。在凝胶和离体肾脏中，CryoProbes 的几乎所有部位的温度都显著低于活体肾脏（p = 0.0107 和 0.0008），IceRods 也如此（p <0.00005）。
凝胶和离体等温线不能预测冷冻的体内模式。因此，它们不应用于术前规划。应将冷冻探针穿过肿瘤边界 5 毫米以达到合适的低温。建议使用多点热敏传感器探针记录肾冷冻治疗期间的实际温度。
