Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
Institute of Urology, Fudan University, Shanghai, People's Republic of China.
Ann Surg Oncol. 2021 Dec;28(13):9201-9208. doi: 10.1245/s10434-021-10233-5. Epub 2021 Jun 15.
To investigate the safety and efficacy of ureteroscopic cryoablation by a liquid-nitrogen system in a porcine model and for patients with upper tract urothelial carcinoma (UTUC) of a solitary kidney.
In the animal experiment, the right-sided ureter was frozen in nine pigs. Eight were randomly assigned to two different groups according to the freezing duration of 60 or 90 s. The other one was designed to receive a 10-min freeze. The treated ureters were harvested at 30 min, 2 days, 4 weeks, and 3 months after cryoablation for histological evaluation. After the animal study, we conducted a pilot clinical trial that enrolled six patients who were diagnosed with UTUC of a solitary kidney and received therapeutic management with ureteroscopic cryoablation at our center. Perioperative adverse events and oncological outcomes were evaluated.
In the porcine model, the liquid-nitrogen system was capable of forming a therapeutic ice ball which infiltrated the full-thickness ureter and induced apoptosis and necrosis from mucosa to lamina muscularis through histological examination. In the clinical trial, cryoablation was successfully performed under ureteroscopy in all the patients, without intraoperative ureteral perforation, avulsion, or active hemorrhage. No recurrence in situ was observed during a median follow-up period of 12.5 months. Hydronephrosis and ureteral stricture was observed in one patient and was managed with ureteroscopic balloon dilation.
Ureteroscopic cryoablation induced by liquid nitrogen is a promising technique for conservative management of UTUC with benefits of improving local tumor control and preservation of a solitary kidney.
研究经液体氮系统行输尿管镜下冷冻消融术治疗单纯性上尿路尿路上皮癌（UTUC）的安全性和有效性。
在动物实验中，9 头猪的右侧输尿管接受冷冻治疗。8 头猪根据冷冻时间（60 秒或 90 秒）随机分为两组，另 1 头接受 10 分钟的冷冻。在冷冻消融后 30 分钟、2 天、4 周和 3 个月，对处理后的输尿管进行组织学评估。动物研究完成后，我们开展了一项初步的临床试验，纳入了 6 名诊断为单纯性上尿路尿路上皮癌且在我院接受输尿管镜下冷冻消融治疗的患者。评估围手术期不良事件和肿瘤学结果。
在猪模型中，液氮系统能够形成一个治疗性冰球，该冰球渗透全层输尿管，并通过组织学检查诱导从黏膜到肌层的细胞凋亡和坏死。在临床试验中，所有患者均在输尿管镜下成功完成了冷冻消融术，术中未发生输尿管穿孔、撕脱或活动性出血。在中位随访 12.5 个月期间，未观察到原位复发。1 例患者出现肾积水和输尿管狭窄，经输尿管镜球囊扩张治疗。
经液体氮诱导的输尿管镜下冷冻消融术是治疗单纯性上尿路尿路上皮癌的一种有前途的保守治疗方法，具有提高局部肿瘤控制和保留孤立肾脏的优势。
