Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
AJR Am J Roentgenol. 2010 Jun;194(6):1620-5. doi: 10.2214/AJR.09.2978.
The purpose of this study was to determine the effect of percutaneous cryoablation of tumors in a solitary kidney on renal function, treatment-related complications, and local tumor control.
A retrospective review of the cases of patients with a solitary kidney treated with percutaneous renal cryoablation from March 2003 through November 2008 was performed. Renal function was analyzed with serum creatinine concentration and glomerular filtration rate measured before ablation, on the first day after ablation, 3-6 months after ablation, and at the most recent evaluation on record at our institution. Index tumor size, ice ball size, and local tumor control were tabulated after review of preablation and postablation images.
Thirty-one patients with 38 tumors (mean maximum diameter, 3.0 cm; range, 1.7-7.3 cm) were treated with 35 cryoablation procedures. After a mean follow-up period of 14 months (range, < 1-42 months), 29 patients had a 0.1-mg/dL median increase in creatinine concentration (p = 0.0089) and 4.7-mL/min/1.73 m(2) median decrease in glomerular filtration rate (p = 0.0335) from preablation levels. Fifteen of 25 patients with 3 months or more of renal function follow-up had a decrease in renal function. Ten of these 15 patients (67%) had a history of previous renal ablation or partial nephrectomy involving the same solitary kidney. No patient needed dialysis. Seven grade 3 or greater complications (Common Terminology Criteria for Adverse Events) occurred after the 35 procedures (20% complication rate). The median hospital stay was 1 day (range, 1-19 days). The local tumor control rate was 92%.
Percutaneous cryoablation is effective in the management of renal tumors in patients with a solitary kidney, causing minimal loss of renal function. Patients who have previously undergone partial nephrectomy or ablation in a solitary kidney may be more susceptible to renal function loss than patients who have not undergone these procedures.
本研究旨在确定经皮冷冻消融孤立肾上肿瘤对肾功能、治疗相关并发症和局部肿瘤控制的影响。
对 2003 年 3 月至 2008 年 11 月接受经皮肾冷冻消融治疗的孤立肾患者的病例进行回顾性分析。在消融前、消融后第 1 天、3-6 个月和最近在我们机构的记录评估时，分析血清肌酐浓度和肾小球滤过率。在回顾消融前和消融后的图像后，列出了肿瘤指数大小、冰球大小和局部肿瘤控制情况。
31 例患者 38 个肿瘤（平均最大直径 3.0cm；范围 1.7-7.3cm）接受了 35 次冷冻消融治疗。在平均 14 个月（范围 1-42 个月）的随访后，29 例患者的肌酐浓度中位数增加了 0.1mg/dL（p=0.0089），肾小球滤过率中位数下降了 4.7mL/min/1.73m(2)（p=0.0335）。25 例有 3 个月或更长时间肾功能随访的患者中，有 15 例患者肾功能下降。这 15 例患者中有 10 例（67%）既往有同一孤立肾的肾部分切除术或消融术史。没有患者需要透析。35 次手术后发生 7 例（20%）严重 3 级或更高级别的并发症（不良事件常用术语标准）。中位住院时间为 1 天（范围 1-19 天）。局部肿瘤控制率为 92%。
经皮冷冻消融治疗孤立肾上肿瘤有效，对肾功能的影响最小。与未接受这些手术的患者相比，既往接受过肾部分切除术或消融术的孤立肾患者可能更容易出现肾功能丧失。
