Orkut Sinan, De Marini Pierre, Tan Alexander Sheng Ming, Garnon Julien, Koch Guillaume, Tricard Thibault, Lang Hervé, Cazzato Roberto Luigi, Gangi Afshin
Department of Interventional Radiology, University Hospital Strasbourg, Strasbourg, France.
Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore.
Radiol Med. 2025 Apr;130(4):493-507. doi: 10.1007/s11547-025-01954-8. Epub 2025 Jan 20.
To evaluate the at-risk organs that require protection during percutaneous cryoablation (PCA) of renal tumours and the correlation with patient and target lesion characteristics, type of protective measure used and postoperative outcomes.
Single-centre retrospective review of patients with renal tumours who underwent PCA between 2008 and 2020. Final analysis included 374 tumours. Patient, tumour, and procedure technical details were extracted and analysed. At-risk organs were classified according to tumour location relative to kidney side, pyelic axis, and polar lines.
There were 171 (46.0%) tumours in the left kidney, and 194 (52.0%) in the right. Cryoprotection was required for 272 (272/374; 73.0%) tumours, with hydrodissection (216/374; 58.0%) being the most common technique. Protective measures were used for 82 (82/93; 88.0%) tumours in under/normal-weight patients and 143 (143/196; 73.0%) in overweight/obese ones (P = 0.004). In the left kidney, colon was the most common at-risk organ (63/171; 37.0%), followed by spleen (21/171; 12.3%), small bowel (21/171; 12.3%), ureter (19/171; 11.1%), abdominal wall (15/171; 8.8%), psoas muscle (10/171; 5.8%), and pancreas (9/171; 5.3%). In the right kidney, common at-risk organs were the colon (67/194; 35.0%), liver (50/194; 25.7%), ureter (15/194; 15.5%), diaphragm (16/194; 8.2%), abdominal wall (14/194; 7.2%), and duodenum (12/194; 6.1%). No cryoinjuries to at-risk organs occurred.
Hydrodissection is the most common cryoprotective measure used for renal tumour PCA. Under/normal-weight patients are more likely to require cryoprotection. The colon is the most common adjacent at-risk organ requiring protection for both right- and left-sided tumours.
评估肾肿瘤经皮冷冻消融术（PCA）期间需要保护的高危器官，以及与患者和靶病变特征、所采用的保护措施类型和术后结果的相关性。
对2008年至2020年间接受PCA的肾肿瘤患者进行单中心回顾性研究。最终分析纳入374个肿瘤。提取并分析患者、肿瘤及手术技术细节。根据肿瘤相对于肾侧、肾盂轴和极线的位置对高危器官进行分类。
左肾有171个（46.0%）肿瘤，右肾有194个（52.0%）。272个（272/374；73.0%）肿瘤需要冷冻保护，其中水分离法（216/374；58.0%）是最常用的技术。体重不足/正常体重患者中有82个（82/93；88.0%）肿瘤采用了保护措施，超重/肥胖患者中有143个（143/196；73.0%）肿瘤采用了保护措施（P = 0.004）。在左肾，结肠是最常见的高危器官（63/171；37.0%），其次是脾脏（21/171；12.3%）、小肠（21/171；12.3%）、输尿管（19/171；11.1%）、腹壁（15/171；8.8%）、腰大肌（10/171；5.8%）和胰腺（9/171；5.3%）。在右肾，常见的高危器官是结肠（67/194；35.0%）、肝脏（50/194；25.7%）、输尿管（15/194；15.5%）、膈肌（16/194；8.2%）、腹壁（14/194；7.2%）和十二指肠（12/194；6.1%）。未发生对高危器官的冷冻损伤。
水分离法是肾肿瘤PCA最常用的冷冻保护措施。体重不足/正常体重患者更有可能需要冷冻保护。结肠是双侧肿瘤最常见的需要保护的邻近高危器官。
