Bagia J S, Perera D S, Morris D L
Department of Surgery, University of New South Wales, St. George Hospital, Kogarah, Sydney, Australia.
Cryobiology. 1998 Jun;36(4):263-7. doi: 10.1006/cryo.1998.2085.
Cryoshock is a syndrome of coagulopathy, renal, and pulmonary injury following cryotherapy, and its etiology is unknown. The aim of this study was to assess the impact of hepatic cryotherapy on renal function, and whether this effect is related to volume of cryotherapy, and to identify any predictors of renal impairment in patients who undergo cryotherapy. A retrospective analysis of all patients with primary or secondary hepatic malignancy treated with cryotherapy from April 1990 to October 1996 was conducted. Ten of 204 patients with renal impairment (elevation in creatinine of greater than 0.02 mmol/L for more than 2 days postprocedure) were identified. One patient has postoperative pancreatitis with late renal impairment (20 days) and was excluded. The severity of renal impairment was usually modest (mean rise in creatinine of 0.31 mmol/L; SD, 0.19). Two patients required temporary hemodialysis. Only one patient, who had significant cardiac disease, had associated pulmonary injury and shock. Demographic data in both groups were comparable, except for a trend toward more noncolorectal cancer patients in the renal impairment group (4/9 vs 33/194). Patients in the renal impairment group had a greater number of lesions than those of the nonrenal impairment group (3.4 vs 2.1, p < 0.01), as well as larger lesion diameter (2.9 vs 1.9, p < 0.01), increased freezing time (74.7 vs 44.3, p < 0.01), and a higher aspartate transaminase (AST) (2254 vs 1157, p < 0.01). This study suggests that renal impairment is more likely to be seen in patients undergoing more extensive cryotherapy. The number and diameter of lesions together with AST data link renal injury with magnitude of liver injury--all renal impairment patients had an AST > 1000, compared with only 28% of patients who did not.
冷冻休克是冷冻治疗后出现的一种包括凝血病、肾损伤和肺损伤的综合征，其病因尚不清楚。本研究的目的是评估肝脏冷冻治疗对肾功能的影响，以及这种影响是否与冷冻治疗的范围有关，并确定接受冷冻治疗患者肾功能损害的任何预测因素。对1990年4月至1996年10月接受冷冻治疗的所有原发性或继发性肝脏恶性肿瘤患者进行了回顾性分析。在204例患者中，有10例出现肾功能损害（术后肌酐升高超过0.02 mmol/L持续2天以上）。1例患者术后发生胰腺炎并出现晚期肾功能损害（20天），被排除在外。肾功能损害的严重程度通常较轻（肌酐平均升高0.31 mmol/L；标准差，0.19）。2例患者需要临时血液透析。只有1例患有严重心脏病的患者伴有肺损伤和休克。两组的人口统计学数据具有可比性，但肾功能损害组中非结直肠癌患者的比例有增加趋势（4/9比33/194）。肾功能损害组的患者病变数量多于无肾功能损害组（3.4比2.1，p<0.01），病变直径也更大（2.9比1.9，p<0.01），冷冻时间更长（74.7比44.3，p<0.01），天冬氨酸转氨酶（AST）更高（2254比1157，p<0.01）。本研究表明，接受更广泛冷冻治疗的患者更有可能出现肾功能损害。病变的数量和直径以及AST数据将肾损伤与肝损伤程度联系起来——所有肾功能损害患者的AST>1000，而未出现肾功能损害的患者中只有28%如此。
