Percutaneous Cryoablation of Masses in a Solitary Kidney
Percutaneous Cryoablation of Masses in a Solitary Kidney
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DOI：
10.2214/ajr.09.2978
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发表时间：
2010-06-01
影响因子：
5
通讯作者：
Charboneau, J. William
中科院分区：
文献类型：
--
作者：
Weisbrod, Adam J.;Atwell, Thomas D.;Charboneau, J. William
OBJECTIVE.本研究的目的是确定孤立肾肿瘤经皮冷冻消融术对肾功能、治疗相关并发症和局部肿瘤控制的影响。回顾性分析了2003年3月至2008年11月期间接受经皮肾冷冻消融术治疗的孤立肾患者病例。在消融术前、消融术后第1天、消融术后3-6个月以及我院记录的最近一次评估时，通过测量血清肌酐浓度和肾小球滤过率分析肾功能。在审查消融前和消融后图像后，列表显示肿瘤指数大小、冰球大小和局部肿瘤控制。结果。31例患者的38个肿瘤（平均最大直径，3.0 cm;范围，1.7-7.3 cm）接受了35次冷冻消融术。平均随访14个月（范围< 1-42个月）后，29例患者的肌酐浓度中位数增加0.1 mg/dL（p = 0.0089），肾小球滤过率中位数降低4.7 mL/min/1.73 m2（p = 0.0335）。25例肾功能随访3个月或更长时间的患者中有15例肾功能下降。这15例患者中有10例（67%）既往有涉及同一孤立肾的肾消融或肾部分切除术史。没有患者需要透析。35例手术后发生7例3级或以上并发症（不良事件通用术语标准）（并发症发生率20%）。中位住院时间为1天（范围：1-19天）。局部肿瘤控制率为92%。经皮冷冻消融术是治疗孤立肾患者肾肿瘤的有效方法，可使肾功能损失降至最低。既往接受过肾部分切除术或孤立肾消融术的患者可能比未接受过这些手术的患者更容易发生肾功能丧失。
OBJECTIVE. The purpose of this study was to determine the effect of percutaneous cryoablation of tumors in a solitary kidney on renal function, treatment-related complications, and local tumor control.MATERIALS AND METHODS. A retrospective review of the cases of patients with a solitary kidney treated with percutaneous renal cryoablation from March 2003 through November 2008 was performed. Renal function was analyzed with serum creatinine concentration and glomerular filtration rate measured before ablation, on the first day after ablation, 3-6 months after ablation, and at the most recent evaluation on record at our institution. Index tumor size, ice ball size, and local tumor control were tabulated after review of preablation and postablation images.RESULTS. Thirty-one patients with 38 tumors (mean maximum diameter, 3.0 cm; range, 1.7-7.3 cm) were treated with 35 cryoablation procedures. After a mean follow-up period of 14 months (range, < 1-42 months), 29 patients had a 0.1-mg/dL median increase in creatinine concentration (p = 0.0089) and 4.7-mL/min/1.73 m(2) median decrease in glomerular filtration rate (p = 0.0335) from preablation levels. Fifteen of 25 patients with 3 months or more of renal function follow-up had a decrease in renal function. Ten of these 15 patients (67%) had a history of previous renal ablation or partial nephrectomy involving the same solitary kidney. No patient needed dialysis. Seven grade 3 or greater complications (Common Terminology Criteria for Adverse Events) occurred after the 35 procedures (20% complication rate). The median hospital stay was 1 day (range, 1-19 days). The local tumor control rate was 92%.CONCLUSION. Percutaneous cryoablation is effective in the management of renal tumors in patients with a solitary kidney, causing minimal loss of renal function. Patients who have previously undergone partial nephrectomy or ablation in a solitary kidney may be more susceptible to renal function loss than patients who have not undergone these procedures.