Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, São Paulo, Brazil.
Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, São Paulo, Brazil.
Eur J Radiol. 2018 Mar;100:14-22. doi: 10.1016/j.ejrad.2018.01.001. Epub 2018 Jan 10.
To describe the experience of our institution in image-guided renal nodules percutaneous cryoablation, evaluating demographic and technical aspects as well as efficacy, safety and follow up.
Retrospective study approved by our institutional review board. Seventy-one renal tumors evaluated in 60 patients treated with image guided percutaneous renal cryoablation from January 2009 to December 2015. No patient was excluded from study, even those who were lost on follow up. All the procedures were guided both by ultrasound and tomography. An argon and helium based cryoablation machine was used for all treatments. Hydrodissection was performed when the bowel or ureters were within 1 cm (iodinated contrast media in dextrose solution). Complications were assessed by the terminology criteria of the National Institutes of Health (NIH). Patients were monitored and evaluated by ultrasound, tomography, MRI and/or PET-CT.
In most procedures (91.9%) only one nodule was treated. Nodules had a median size of 1.6 cm. Most nodules (61,9%) were exophytic. Hydrodissection and retrograde warm pyeloperfusion were performed in most procedures. Among all variables evaluated in univariate analysis, nearness of nodule to collecting system and anterior/posterior location were significantly associated with PRCA complications. No other factor evaluated was significantly associated with complications.
PRCA is solid alternative to traditional surgical therapies for treatment of small renal tumors in wide subset of patients. Medium term evidence shows excellent long-term oncological results, similar to nephrectomy, with minimal risk of major complications.
描述我们机构在影像引导下经皮肾结节冷冻消融治疗中的经验，评估其人口统计学和技术方面以及疗效、安全性和随访情况。
这是一项经我们机构审查委员会批准的回顾性研究。2009 年 1 月至 2015 年 12 月，对 60 例接受影像引导经皮肾冷冻消融治疗的患者的 71 个肾肿瘤进行了评估，所有患者均未被排除在研究之外，即使是在随访中丢失的患者。所有的程序都是通过超声和计算机断层扫描引导的。所有的治疗都使用了基于氩气和氦气的冷冻消融机。当肠管或输尿管在 1cm 以内时（葡聚糖溶液中的碘造影剂）进行水分离。采用美国国立卫生研究院（NIH）的术语标准评估并发症。通过超声、计算机断层扫描、MRI 和/或 PET-CT 对患者进行监测和评估。
大多数（91.9%）程序只治疗一个结节。结节的中位数大小为 1.6cm。大多数结节（61%）为外生型。大多数程序中都进行了水分离和逆行温热肾盂灌注。在单因素分析中评估的所有变量中，结节与集合系统的接近程度和前后位置与 PRCA 并发症显著相关。没有其他因素与并发症显著相关。
PRCA 是一种替代传统手术治疗的有效方法，适用于广泛的小肾癌患者。中期证据表明，PRCA 在长期肿瘤学结果方面与肾切除术相似，且并发症风险极小。
