Neel H B
Laryngoscope. 1980 Aug;90(8 Pt 2):1-48. doi: 10.1288/00005537-198008001-00001.
Cryosurgery is that branch of cryobiology and surgery which deals with the therapeutic application of cold at profoundly low temperatures (those below 0 degrees C) for the purpose of destroying tissues in selected target sites. The freezing process induces coagulation necrosis and is confined to the tissues within the region of the probe application and the ice ball. The degree and extent of tissue destruction depend largely on the size of the ice ball and the temperatures within it. Various types of equipment and probes are commercially available for cryosurgery, but it was only after the development of reliable, versatile cryosurgical systems cooled by liquid nitrogen that numerous applications for cryosurgery were proposed, including therapy for cancer. In the treatment of cancer, clinical success with cryosurgery has led to the more wide-spread application of this modality in selected patients. Cryosurgery has been used for readily accessible lesions in specific anatomic areas, most frequently the skin and oral cavity. It is an attractive alternative to extirpative surgery, particularly in the head and neck, where removal of large portions of the mandible or maxilla are often required to control cancer. Therefore, it is not surprising that many of the pioneering efforts in the treatment of cancer have been conducted by otorhinolaryngologists. The full theoretic potential of cryotherapy was somewhat slow to be realized because many early endeavors were directed toward palliation, especially of accessible tumors of the skin and oral cavity, after failure of tumor control by radiation or surgery or both. This limited application during the early period of evaluation reflected a naturally timorous course that was taken by those who introduced the new modality into clinical practice. This period paralleled the development of new apparatus, early clinical trials, and the assessment of the clinical potential of cryosurgery in patients with incurable cancer--those whose conditions were deemed hopeless. Today, cryosurgery is selectively applied for the treatment of patients with tumors involving structures such as bone, oropharyngeal mucosa, temporal bone, skin, brain, retina, prostate, uterine cervix, and tracheobronchial tree. Although general guidelines for the application of cryosurgery to cancer can be gleaned from various clinical reports, the optimal conditions of freezing have not been specially defined. Animal experiments are necessary to study the variables methodically and in detail. The temporal and physical conditions for cryogenic necrosis of cancer require delineation so that cell death can be predictably and consistently reproduced. This is the thrust of this paper.
冷冻外科是低温生物学和外科学的一个分支，它涉及在极低温度（低于0摄氏度）下将低温用于治疗目的，以破坏选定目标部位的组织。冷冻过程会引发凝固性坏死，且局限于探头应用区域和冰球内的组织。组织破坏的程度和范围很大程度上取决于冰球的大小及其内部的温度。市场上有各种类型的冷冻外科设备和探头可供使用，但直到可靠、通用的液氮冷却冷冻外科系统出现后，才提出了众多冷冻外科应用，包括癌症治疗。在癌症治疗中，冷冻外科的临床成功促使这种治疗方式在特定患者中得到更广泛应用。冷冻外科已用于特定解剖区域易于触及的病变，最常见的是皮肤和口腔。它是根治性手术的一种有吸引力的替代方法，特别是在头颈部，那里通常需要切除大部分下颌骨或上颌骨来控制癌症。因此，许多癌症治疗的开创性工作由耳鼻喉科医生进行也就不足为奇了。冷冻疗法的全部理论潜力在一定程度上实现得较为缓慢，因为许多早期努力都旨在缓解症状，尤其是对于皮肤和口腔易于触及的肿瘤，这些肿瘤在放疗或手术或两者治疗失败后出现。在评估早期这种有限的应用反映了那些将这种新治疗方式引入临床实践的人自然采取的谨慎态度。这个时期与新设备的开发、早期临床试验以及对无法治愈的癌症患者（即那些病情被认为无望的患者）冷冻外科临床潜力的评估并行。如今，冷冻外科被选择性地应用于治疗涉及骨骼、口咽黏膜、颞骨、皮肤、脑、视网膜、前列腺、子宫颈和气管支气管树等结构的肿瘤患者。尽管可以从各种临床报告中收集到冷冻外科应用于癌症的一般指南，但尚未特别定义冷冻的最佳条件。有必要通过动物实验系统地、详细地研究各种变量。癌症低温坏死的时间和物理条件需要明确，以便能够可预测且一致地再现细胞死亡。这就是本文的主旨。
