Mayo Medical School, Rochester, MN 55905, USA.
Radiology. 2011 Jan;258(1):301-7. doi: 10.1148/radiol.10100631. Epub 2010 Oct 22.
To assess safety, technical success, complications, and hemodynamic changes associated with the adrenal cryoablation procedure.
This retrospective review was approved by the institutional review board, with waiver of informed consent, and was compliant with the Health Insurance Portability and Accountability Act. Adult patients with adrenal metastasis who were treated with adrenal cryoablation between May 2005 and October 2009 were eligible for this review. Twelve patients (undergoing 13 procedures) with single adrenal tumors were included in the analysis. For statistical analysis, hemodynamic data were averaged for the patient undergoing the procedure twice. Technical success, safety, and local control were analyzed according to standard criteria. Hemodynamic changes during the procedure were analyzed and compared with data from an unmatched cohort of patients who underwent kidney (not in the upper pole) cryoablation (Wilcoxon rank sum test). A further subanalysis of hemodynamic changes was performed on the basis of whether preprocedural α- or β-adrenergic blockade was used.
With adrenal cryoablation, local control was achieved following treatment in 11 (92%; 95% confidence interval: 65.1%, 99.6%) of 12 tumors. One patient with known adrenal insufficiency underwent conservative ablation and developed ipsilateral adrenal recurrence, which was retreated. Five patients developed hypertensive crisis during the final, active thaw phase of the cryoablation procedure, and one patient developed hypertensive crisis in the immediate postablation period. Patients undergoing adrenal cryoablation experienced a significant increase in systolic blood pressure (P = .005), pulse pressure (P = .02), and mean arterial pressure (P = .01) when compared with the cohort of kidney cryoablation patients. Adrenal cryoablation patients who were not premedicated with an α-blocker (n = 5) had a higher level of systolic blood pressure increase during the cryoablation procedure when compared with their counterparts who were premedicated (n = 7) (P = .034).
Adrenal cryoablation is technically feasible with a high rate of local control. Patients premedicated with the α-blocker phenoxybenzamine appear to have a reduced risk of hypertensive crisis.
评估肾上腺冷冻消融术相关的安全性、技术成功率、并发症和血液动力学变化。
本回顾性研究经机构审查委员会批准，豁免知情同意，并符合《健康保险携带和责任法案》。2005 年 5 月至 2009 年 10 月期间，接受肾上腺冷冻消融术治疗的肾上腺转移瘤的成年患者有资格参加此项研究。对 12 例（13 次手术）单肾上腺肿瘤患者进行了分析。为了进行统计分析，对两次接受手术的患者的血液动力学数据进行了平均处理。根据标准标准，分析了技术成功率、安全性和局部控制情况。分析了手术过程中的血液动力学变化，并将其与接受肾脏（非上极）冷冻消融术的未配对患者的数据进行了比较（Wilcoxon 秩和检验）。根据是否使用术前 α 或 β 肾上腺素能阻滞剂，对血液动力学变化进行了进一步的亚分析。
在 12 例肿瘤中，11 例（92%；95%置信区间：65.1%，99.6%）经治疗后达到局部控制。1 例已知肾上腺功能不全的患者接受了保守消融治疗，同侧肾上腺复发，随后进行了再次治疗。在冷冻消融术的最后一个主动解冻阶段，有 5 例患者发生高血压危象，1 例患者在消融后即刻发生高血压危象。与接受肾脏冷冻消融术的患者相比，接受肾上腺冷冻消融术的患者收缩压（P=0.005）、脉压（P=0.02）和平均动脉压（P=0.01）均显著升高。未接受 α 阻滞剂预处理的 5 例肾上腺冷冻消融患者在冷冻消融过程中收缩压升高幅度高于接受 α 阻滞剂预处理的 7 例患者（P=0.034）。
肾上腺冷冻消融术技术上可行，局部控制率高。接受 α 阻滞剂酚芐明预处理的患者发生高血压危象的风险似乎较低。
