Abstract：
OBJECTIVE: To determine the degree of renal function deterioration after renal cryoablation in patients with a solitary functioning kidney on the basis of ablation volume.
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.
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.
摘要：
目的：本研究的目的是根据消融体积回顾性分析孤立功能肾患者在肾冷冻消融术后肾功能恶化的程度。
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％。
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％。
