【摘要】 目的:评价冷冻消融对猪肾实质、肾脏微循环、集合系统的影响,为临床冷冻消融肾脏肿瘤的可行性及安全性提供实验理论依据。方法:五指山小型实验猪实验组6头,ipath200光学系统导引下1.47mm氩氦冷冻探针植入集合系统周围,冻融两个循环;对照组2头,仅行穿刺。术中动态监测冰球形成情况。术后1天、14天、30天分别行1.5T高场磁共振检查。结果:实验猪均穿刺并冷冻消融成功。冷冻10min,冰球最大并大部分位于靶组织内,显示为椭圆形极低信号影。术后1.5TMR显示靶区组织T1WI、T2WI均呈低信号伴周围不连续的斑片状高信号出血带。周围可见水肿信号。注入GD-DTPA后,冷冻中心无明显强化,周边见均匀强化环。结论:MR导向穿刺准确率高,未发现继发于冷冻的集合系统损伤,对于小肾癌、局限性的累及集合系统的肾肿瘤安全可行。更多还原

【Abstract】 Objective:To determine the effect of cryoablation on renal parenchyma,renal microcirculation and collecting system in the porcine kidney.This experiment showed theoretical basement for the safety and efficacy of renal tumor cryoablation.Methods:Eight wuzhishan pig inbreeding line(WZSP) were divided into two groups,the experiment group included 6 swine which were treated with cryoablation procedures under the guidance of optical tracking system(iPath 200,Philips Medical System).Cryoablation was performed using a high-pressure argon system(Cryo-Hit system) with a double freeze/thaw cycle.A 1.47 mm MR-compatible cryoprobe was advanced into the target near the collecting system;The control group two swine,only puncture.The iceball can be tracked dynamically during the procedure.Follow-up dynamic MR imagings were obtained after 1,14 and 30 days of the operation.Results:In the animal experiments,the puncture was successful in all 8 cases.10 minutes after freezing,the iceball was mostly located in the target tissue with the largest diameter,appear as oval-shaped low signal.1.5T T1WI and T2WI of the target tissue after the protocol showed low signal with discontinuous patchy high signal(ribbon bleeding area),surrounding edema signal.After the injection of GD-DTPA,homogeneous enhancement ring can be seen around the iceball without center enhancement.Conclusion:MR-guided puncture is of high accuracy.No evidence of damage to the renal collecting system secondary to freezing is found.These data have clinical relevance for treatment of a small,localized,central renal tumor in proximity to the pelvicaliceal system without damage to the collecting system.更多还原