Department of Radiology, Mayo Clinic, Mayo Foundation, 200 First St. SW, Rochester, MN 55905, USA.
AJR Am J Roentgenol. 2010 Mar;194(3):779-83. doi: 10.2214/AJR.08.1570.
The purpose of this article is to describe the technique, safety, and effectiveness of percutaneous hydrodisplacement during the course of percutaneous renal cryoablation.
We retrospectively reviewed our experience in performing percutaneous hydrodisplacement during the cryoablation of renal tumors. In this subset of patients, we addressed tumor location within the kidney, tumor position relative to critical structures, effectiveness of hydrodisplacement, and complications in performing this adjunct technique. Comparisons between the two groups were made using Wilcoxon's rank sum test or chi-square test, as appropriate.
Hydrodisplacement was attempted 52 times in 50 (24%) of 206 percutaneous renal tumor cryoablations. Tumors that were located anteriorly (p < 0.0001) or in the lower pole (p = 0.001) of the kidney were more likely to require hydrodisplacement. The colon required displacement most often (n = 41), followed by the body wall (n = 3), duodenum (n = 2), jejunum and ileum (n = 2), ureter (n = 1), and psoas muscle (n = 1). There was a single complication of hemorrhage resulting from injury to an intercostal artery branch that required termination of the procedure before fluid infusion. When fluid was infused, the critical structure was displaced in 50 (96%) of 52 attempts, displacing the critical structure from its initial location by a mean distance of 16 mm (range, 3-46 mm). Both failures occurred early in our experience with hydrodisplacement, and both required balloon displacement.
Hydrodisplacement is a safe, effective, and commonly needed technique for displacement of critical structures before percutaneous cryoablation of renal tumors, particularly for tumors located anteriorly or in the lower pole of the kidney.
本文旨在描述经皮肾冷冻消融过程中经皮水置换的技术、安全性和有效性。
我们回顾性分析了在肾肿瘤冷冻消融过程中进行经皮水置换的经验。在这组患者中，我们解决了肿瘤在肾脏中的位置、肿瘤相对于关键结构的位置、水置换的效果以及执行这种辅助技术的并发症。使用 Wilcoxon 秩和检验或卡方检验（视情况而定）比较两组间的差异。
在 206 例经皮肾肿瘤冷冻消融中，52 次尝试进行水置换，涉及 50 例（24%）患者。位于肾脏前侧（p < 0.0001）或下极（p = 0.001）的肿瘤更有可能需要水置换。最常需要置换的结构是结肠（n = 41），其次是体壁（n = 3）、十二指肠（n = 2）、空肠和回肠（n = 2）、输尿管（n = 1）和腰大肌（n = 1）。有一例并发症为肋间动脉分支损伤导致出血，需要在注入液体前终止手术。当注入液体时，在 52 次尝试中有 50 次（96%）成功将关键结构移位，将关键结构从初始位置移动的平均距离为 16 毫米（范围 3-46 毫米）。两次失败均发生在我们进行水置换的早期经验中，均需要球囊置换。
水置换是经皮肾肿瘤冷冻消融前安全、有效且通常需要的关键结构移位技术，特别是对于位于肾脏前侧或下极的肿瘤。
