CT guided the preventation and treatment of hemorrhage after renal cancer cryoablation / 中华放射学杂志

ABSTRACT

Objective To explore the methods of the hemorrhage prevention and the measures of hemostasis by CT guided after renal cancer cryoablation.Methods Retrospective analysis of 8 patients of renal cell carcinoma patienthave been done,all the patients were underwent cryoablation.The basic model included 10 min frozen,3 min thawed and 1 cycle were repeated.Before the cryoprobe puncture,a CT scan was taken to observe the blood supply of the tumor and the relationship between the border of the tumor and renal cortex,renal pelvis.Besides,the path of reducing the injury of normal renal cortex and renal pelvis was chosen,and the decreased number of probes was adopted by taking conformal cryoablation to reduce the damage to the renal capsule,in theensurance of the treatment efficacy.Intraoperative CT scan was performed discontinuously,to observe the covering status of the range of ice ball on the lesion and to monitor the perirenal bleeding.Postoperative ECG and blood pressure changes was observed 24 h after operation.Besides,CT scan or blood routine examination is necessary to monitor whether active bleeding happened.Results According enhanced CT image positioning puncture path,the path of probes were selected in the shortest path between the tumor margins and the renal cortical which avoid the renal pelvis.Probes were CT-guided conformal puncture into the lesion successfully for 8 patients,according to freezing basic mode to complete cryoablation.Timely intraoperative CT scan can clearly observe that a low-density ice ball wrapped lesion completely without involving the renal pelvis and normal tissue surrounding the kidney.There was no bleeding in the procedure of cryoablation.After the probe was pulled,CT scan showed3 of the 8 patients didn't show any sign of henorrhage,in which 1 patient had heavily bleeding,about 150 ml due to the biopsy after cryoablation.The bleeding was stopped by interventional embolization.A little hemorrhage was found in two patients,about 10 ml outside renal capsule.Medium hemorrhage took place in two patients,30 nl in one patient which underwent several cycles of thawing and 60 ml in another.The patients of mild and medium hemorrhage was treated with intravenous injection of Reptilase and strict bed rest.There was a great hemorrhage in one patient,about 200 ml.The bleeding was stopped by interventional embolization.A small and moderate bleeding,it necessary to execute intravenous infusion 2 IU reptilase and strict bed rest.There was no significant active bleeding from the CT scan after 24 h operation and no change in the blood routine examination of blood hemoglobin and red blood cell count.Conclusions Before the puncture,it is necessary to perform an enhanced CT scan to understand the position,which can determine the path of the puncture.It can reduce the damage of renal cortex,renal capsule and surrounding tissue and prevent and reduce the risk of bleeding.For larger amounts of intraoperative and postoperative bleeding subjects,the embolization should be given immediately,as for the small or moderate amount of bleeding,the conservative treatment may be given firstly.