Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan.
Department of Radiology, Kochi Health Sciences Center, 2125-1 Ike, Kochi, Japan.
Jpn J Radiol. 2024 Sep;42(9):1038-1046. doi: 10.1007/s11604-024-01589-1. Epub 2024 May 15.
To evaluate retrospectively the influence of percutaneous cryoablation for small renal tumors on total and affected kidney function and risk factors associated with worsening function of the affected kidney.
Between April 2016 and March 2022, 27 patients who underwent cryoablation for small renal tumors at our institution participated in this study, which investigated time-dependent changes in postoperative renal function. We evaluated estimated glomerular filtration rates (eGFRs) and split renal function revealed by scintigraphy using 99 m technetium-mercaptoacetyltriglycine (99mTc-MAG3) before cryoablation and at 1 week, 1 month, and 6 months after cryoablation. Numerous variables were analyzed to assess risk factors for worsening renal function.
Baseline eGFR (mean ± standard deviation) was 56.5 ± 23.7 mL/min/1.73 m (mean ± SD; range, 20.5-112.5). Mean eGFRs at 1 week, 1 month, and 6 months after cryoablation were 57.4 ± 24.5 (19.1-114.9), 57.1 ± 25.1 (21.5-114.9), and 53.8 ± 23.9 mL/min/1.73 m (20.0-107.5), respectively. Changes were statistically insignificant (p = 1.0000, = 0.6749, and = 0.0761, respectively). Regarding split renal function, mean baseline contribution of the affected kidney determined by 99mTc-MAG3 was 49.7% ± 6.0% (38.8-63.3%); these rates at 1 week, 1 month, and 6 months after cryoablation were 43.7% ± 8.8 (29.1-70.6%), 46.2% ± 7.7% (32.6-70.3%), and 46.0% ± 8.5% (32.5-67.6%), respectively. Differences from baseline were significant for all periods (p < 0001, < 0001, = 0.0001, respectively). Serum C reactive protein and lactate dehydrogenase at 1 day following cryoablation, tumor's nearness to the collecting system or sinus, and volume of ablated normal renal parenchyma were significantly correlated with decreased contributions of the affected kidney by > 10% after cryoablation.
Unlike total renal function, affected kidney function could worsen after cryoablation.
回顾性评估经皮冷冻消融治疗小肾肿瘤对总肾功能和患肾功能的影响，以及与患肾功能恶化相关的危险因素。
2016 年 4 月至 2022 年 3 月期间，本机构 27 例接受冷冻消融治疗小肾肿瘤的患者参与了本研究，该研究调查了术后肾功能的时间依赖性变化。我们在冷冻消融前和冷冻消融后 1 周、1 个月和 6 个月时，使用 99m 锝-巯基乙酰三甘氨酸（99mTc-MAG3）评估了估算肾小球滤过率（eGFR）和闪烁扫描显示的分肾功能。分析了许多变量，以评估肾功能恶化的危险因素。
基线时 eGFR（均数±标准差）为 56.5±23.7mL/min/1.73 m（均数±标准差；范围，20.5-112.5）。冷冻消融后 1 周、1 个月和 6 个月时的平均 eGFR 分别为 57.4±24.5（19.1-114.9）、57.1±25.1（21.5-114.9）和 53.8±23.9mL/min/1.73 m（20.0-107.5）。变化无统计学意义（p=1.0000，=0.6749，=0.0761）。关于分肾功能，99mTc-MAG3 测定的冷冻消融前患肾的平均基础贡献为 49.7%±6.0%（38.8-63.3%）；冷冻消融后 1 周、1 个月和 6 个月时的这些比率分别为 43.7%±8.8（29.1-70.6%）、46.2%±7.7%（32.6-70.3%）和 46.0%±8.5%（32.5-67.6%）。与基线相比，所有时期的差异均有统计学意义（p<0.0001，<0.0001，=0.0001）。冷冻消融后 1 天的血清 C 反应蛋白和乳酸脱氢酶、肿瘤与收集系统或窦腔的接近程度以及消融的正常肾实质体积与冷冻消融后患肾功能下降>10%显著相关。
与总肾功能不同，患肾功能在冷冻消融后可能会恶化。
