Determination of the Nonlethal Margin Inside the Visible "Ice-Ball" During Percutaneous Cryoablation of Renal Tissue
Determination of the Nonlethal Margin Inside the Visible "Ice-Ball" During Percutaneous Cryoablation of Renal Tissue
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DOI：
10.1007/s00270-012-0470-5
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发表时间：
2013-06-01
影响因子：
2.9
通讯作者：
Netto, George
中科院分区：
文献类型：
--
作者：
Georgiades, Christos;Rodriguez, Ronald;Netto, George
这项研究旨在确定在冷冻消融过程中，可见的“冰球”与正常肾脏组织的致死温度等温线之间的距离。动物保护委员会批准了这项研究。使用了9头成年猪：3头用来确定最佳组织染色，6头用来检验假设。麻醉后在透视下插管左肾动脉。在MR引导下，将肾脏消融，并(在完全消融结束时)通过肾动脉导管对未冻结的肾组织(冰球周围)进行染色。肾脏被取出并送去做玻片准备和检查。从每张幻灯片上，我们测量了从染色到致命组织边界(边缘)的最大距离、最小距离和中间距离。我们检查了每张幻灯片以寻找“热泵”效应的证据。总共进行了126次边缘测量(可见的“冰球”边缘，一个欧元的“致命边缘”)。这些测量是从6只实验动物制备的29张幻灯片中获得的。平均宽度为0.75±0.44 mm，最大为1.15±0.51 mm。发现它在大血管附近增加。致死区内未发现“热泵”效应。数据仅限于正常猪肾组织。考虑到“热泵”现象对正常肾组织的影响，边缘被测量为1.15+/-A 0.51 mm。为了接近“黄金标准”(肾部分切除，类似于98%)的疗效，建议最小切缘为3 mm(3x SD)。考虑到这些假设和对肾癌的外推，据报道肾癌的抗寒能力更强，致命温度为-40摄氏度，推荐的范围是6毫米。
The study was designed to determine the distance between the visible "ice-ball" and the lethal temperature isotherm for normal renal tissue during cryoablation.The Animal Care Committee approved the study. Nine adult swine were used: three to determine the optimum tissue stain and six to test the hypotheses. They were anesthetized and the left renal artery was catheterized under fluoroscopy. Under MR guidance, the kidney was ablated and (at end of a complete ablation) the nonfrozen renal tissue (surrounding the "ice-ball") was stained via renal artery catheter. Kidneys were explanted and sent for slide preparation and examination. From each slide, we measured the maximum, minimum, and an in-between distance from the stained to the lethal tissue boundaries (margin). We examined each slide for evidence of "heat pump" effect.A total of 126 measurements of the margin (visible "ice-ball"aEuro"lethal margin) were made. These measurements were obtained from 29 slides prepared from the 6 test animals. Mean width was 0.75 +/- A 0.44 mm (maximum 1.15 +/- A 0.51 mm). It was found to increase adjacent to large blood vessels. No "heat pump" effect was noted within the lethal zone. Data are limited to normal swine renal tissue.Considering the effects of the "heat pump" phenomenon for normal renal tissue, the margin was measured to be 1.15 +/- A 0.51 mm. To approximate the efficacy of the "gold standard" (partial nephrectomy, similar to 98 %), a minimum margin of 3 mm is recommended (3 x SD). Given these assumptions and extrapolating for renal cancer, which reportedly is more cryoresistant with a lethal temperature of -40 A degrees C, the recommended margin is 6 mm.