METHODS: Over a 15-year period, 81 percutaneous cryoablations were performed in solitary functioning kidneys. After exclusion of patients with baseline end-stage renal disease (ESRD) and insufficient follow-up, analysis was performed on 65 procedures in 52 patients (40 men; mean age, 63.5 years). The postcryoablation renal function was based on the lowest serum creatinine within 6 months after procedure. Renal function change was defined as percentage glomerular filtration rate (GFR) change. Volumetric analysis was performed on the target lesion, renal parenchyma, and ablation zone.
RESULTS: The median tumor diameter was 2.0 cm (range, 0.8-4.7 cm). The median baseline GFR decreased from 56.4 mL/min/1.73 m2 (range, 17.5-89.7 mL/min/1.73 m2) to 46.9 mL/min/1.73 m2 (range, 16.5-89.7 mL/min/1.73 m2) at median of 95 days (P < .001), equating to a -7.9% median renal function change (range, -45.0% to +30.7%). All patients had Stage 2 or worse chronic kidney disease, and baseline function did not correlate with renal function change. The median volume of ablated parenchyma was 19.7 mL (range, 2.4-87.3 mL), equating to 8.1% (range, 0.7%-37.2%) of total parenchyma. The volume of parenchymal volume ablated correlated significantly with renal function loss, whereas age, hypertension, and diabetes mellitus did not. No patient developed ESRD within 1 year after cryoablation.
CONCLUSIONS: Cryoablation in solitary functioning kidneys resulted in a modest reduction in renal function, even in patients with chronic kidney disease and ablations up to 20% of renal parenchymal volume.
方法:在15年的时间里,在孤立的功能肾脏中进行了81次经皮冷冻消融。在排除基线终末期肾病(ESRD)且随访不足的患者后,对52例患者的65例手术进行了分析(40例男性,平均年龄63.5岁)。冷冻消融后的肾功能基于术后6个月内的最低血清肌酐。肾功能变化定义为肾小球滤过率(GFR)变化百分比。对目标病变进行体积分析,肾实质,和消融区。
结果:肿瘤直径中位数为2.0cm(范围为0.8-4.7cm)。基线GFR中位数从56.4毫升/分钟/1.73平方米(范围17.5-89.7)下降到46.9(范围16.5-89.7)在中位数95天(p<0.001),相当于-7.9%的中位肾功能变化(范围-45.0至30.7)。所有患者均患有2期或更严重的慢性肾脏疾病,基线功能与肾功能变化无关。消融薄壁组织的体积中位数为19.7mL(范围2.4-87.3mL),相当于总薄壁组织的8.1%(范围0.7-37.2%)。实质体积消融与肾功能丧失显著相关,而年龄,高血压,糖尿病没有。冷冻消融术后1年内无患者发生ESRD。
结论:孤立功能肾脏的冷冻消融术导致肾功能适度降低,即使在患有慢性肾脏疾病和消融的患者中,肾实质体积也高达20%。