Seifert J K, Morris D L
Department of Surgery, University of New South Wales, The St. George Hospital, Kogarah, Sydney, New South Wales 2217, Australia.
World J Surg. 1999 Feb;23(2):109-13; discussion 113-4. doi: 10.1007/pl00013173.
Cryotherapy is used as a treatment for nonresectable liver tumors and adenocarcinoma of the prostate. Morbidity and mortality following cryotherapy are generally considered to be infrequent, but a syndrome of multiorgan failure, severe coagulopathy, and disseminated intravascular coagulation following hepatic cryotherapy has been described and referred to as the cryoshock phenomenon. In this study we aimed to assess and describe the incidence and clinical features of the cryoshock phenomenon following cryosurgery from the surveyed experience of a large number of clinical centers and to relate the data to the overall mortality and morbidity of this treatment. A questionnaire was sent to all cryotherapy users (n = 299) of whom we were aware. We requested information on the number of patients treated, the occurrence, and the clinical features of cryoshock and mortality and morbidity following cryotherapy of the prostate or liver. Altogether 134 completed questionnaires were returned (44.8%). Seventy-two centers had experience with hepatic cryotherapy and 62 with prostate cryotherapy. Following hepatic cryotherapy, the phenomenon of cryoshock was observed in 21 of 2173 patients (1%) and was responsible for 6 of 33 perioperative deaths (18.2%). Cryoshock was rare following prostate cryotherapy (2 of 5432 patients, 0.04%) and did not contribute to the overall mortality of 0.06%. Hepatic and prostate cryotherapy are safe. Cryoshock is rare after prostate cryotherapy but occurs in 1% of patients following hepatic cryotherapy. Cryoshock is associated with a high risk of death, being responsible for 18.2% of deaths in this survey. Research regarding the mechanism and possible avoidance of cryoshock is required.
冷冻疗法被用作不可切除性肝肿瘤和前列腺腺癌的一种治疗方法。一般认为冷冻疗法后的发病率和死亡率并不常见，但已经描述了肝冷冻疗法后出现的多器官功能衰竭、严重凝血障碍和弥散性血管内凝血综合征，并将其称为冷冻休克现象。在本研究中，我们旨在根据大量临床中心的调查经验评估和描述冷冻手术后冷冻休克现象的发生率及临床特征，并将这些数据与该治疗方法的总体死亡率和发病率相关联。我们向所有已知的冷冻疗法使用者（n = 299）发送了一份调查问卷。我们要求提供有关治疗患者数量、冷冻休克的发生情况、临床特征以及前列腺或肝脏冷冻疗法后的死亡率和发病率的信息。总共收到了134份完整的调查问卷（44.8%）。72个中心有肝冷冻疗法经验，62个中心有前列腺冷冻疗法经验。肝冷冻疗法后，在2173例患者中有21例（1%）观察到冷冻休克现象，其导致了33例围手术期死亡中的6例（18.2%）。前列腺冷冻疗法后冷冻休克很少见（在5432例患者中有2例，0.04%），且未导致总体死亡率0.06%的增加。肝脏和前列腺冷冻疗法是安全的。前列腺冷冻疗法后冷冻休克很少见，但肝冷冻疗法后1%的患者会出现。冷冻休克与高死亡风险相关，在本次调查中导致了18.2%的死亡。需要对冷冻休克的机制及可能的预防方法进行研究。
