Nakada S Y, Lee F T, Warner T, Chosy S G, Moon T D
Department of Surgery, University of Wisconsin Medical School, Madison 53792, USA.
Urology. 1998 May;51(5A Suppl):161-6. doi: 10.1016/s0090-4295(98)00080-6.
To verify histologically whether cryosurgery of the kidney can be accomplished reproducibly without injuring adjacent structures, using a combination of ultrasound and laparoscopic guidance.
Six kidneys from three domestic female farm pigs were utilized in the study. Under general anesthesia and after obtaining pneumoperitoneum, the lower pole of the kidney was mobilized laparoscopically and the ureter and adjacent bowel were protected with saline-soaked gauze. Two 3.8 mm-cryoprobes were placed percutaneously into the lower pole and cryoablation was carried out under laparoscopic and ultrasound guidance using a double-freeze technique (10-minute freeze and 5-minute thaw cycles to a probe temperature of -185 degrees C to -196 degrees C) in five kidneys (one control). The kidneys, adjacent ureter and bowel were harvested acutely, and macroscopic, histologic, and electron microscopic evaluation of all specimens was performed.
Macroscopically, clear margins of cryodestruction corresponded with the ultrasound images of the iceball. In all five treated kidneys, reproducible cell death corresponding to visible margins of cryodestruction were verified histologically. Cell death was further corroborated by electron microscopy. Adjacent structures (ureter and bowel) were sectioned and no significant damage was noted. Blood pressure remained constant throughout the procedure. A crack in the renal parenchyma of one kidney was noted during the thaw phase; at harvest that animal was found to have an intraperitoneal hemorrhage.
Combined laparoscopic and ultrasound-guided cryoablation of the lower pole of the kidney can be accomplished reproducibly in the porcine model without injury to adjacent structures.
通过超声和腹腔镜引导相结合的方式，从组织学角度验证肾脏冷冻手术能否在不损伤相邻结构的情况下可重复进行。
本研究使用了来自三只家养雌性农场猪的六个肾脏。在全身麻醉并建立气腹后，通过腹腔镜游离肾脏下极，并用浸有生理盐水的纱布保护输尿管和相邻肠管。将两根3.8毫米的冷冻探针经皮插入下极，在腹腔镜和超声引导下，对五个肾脏（一个作为对照）采用双冻技术（冷冻10分钟，解冻5分钟，使探针温度达到-185℃至-196℃）进行冷冻消融。术后立即切除肾脏、相邻的输尿管和肠管，对所有标本进行宏观、组织学和电子显微镜评估。
宏观上，冷冻破坏的清晰边界与冰球的超声图像相对应。在所有五个接受治疗的肾脏中，组织学证实了与可见冷冻破坏边界相对应的可重复细胞死亡。电子显微镜进一步证实了细胞死亡。对相邻结构（输尿管和肠管）进行切片，未发现明显损伤。整个手术过程中血压保持恒定。在解冻阶段发现一个肾脏的肾实质出现裂缝；在取材时发现该动物有腹腔内出血。
在猪模型中，联合腹腔镜和超声引导下对肾脏下极进行冷冻消融可重复进行，且不会损伤相邻结构。
