Criocirurgia
Efeitos e complicações pós-tratamento
DOI:
https://doi.org/10.35172/rvz.2017.v24.336Palavras-chave:
crioterapia, crioablação, congelamento, canino, felinoResumo
A criocirurgia, muitas vezes referida como crioterapia ou crioablação, é uma técnica cirúrgica
que emprega substâncias em temperaturas criogênicas para destruir tecidos ou células
indesejáveis, principalmente neoplásicas. A morte celular ocorre devido aos efeitos do
congelamento e descongelamento, a curto e longo prazo. Em todos os métodos de tratamento
cirúrgico a complicação é inerente ao procedimento e a criocirurgia não é exceção. O presente
trabalho tem como objetivo apresentar as reações e complicações pós-tratamento decorrentes
da aplicação da criocirurgia como tratamento curativo, adjuvante ou paliativo em cães e gatos.
Muitas mudanças ocorrem no tecido tratado criocirurgicamente, que levam à destruição da
lesão cutânea, e a resposta tecidual varia de acordo com a intensidade e profundidade da
injúria criogênica. Alguns sinais, que podem ser interpretados como “efeitos colaterais” da
criocirurgia, são esperados e considerados normais porque representam a progressão do
processo fisiológico do congelamento do tecido. Alguns efeitos imediatos observados são:
dor, hemorragia, insuflação pelo gás e edema; efeitos a curto prazo: formação de bolhas,
infecção, granuloma piogênico, e reações sistêmicas, como febre; efeitos a longo prazo:
hiperplasia pseudoepiteliomatosa, hiperpigmentação, leucodermia, danos a nervos, alteração
nos pelos, estenose de orifícios naturais devido a retração cicatricial e necrose cutânea. Os
efeitos pós-tratamento dependerão da técnica de congelamento utilizada no local, da afecção
presente, do tamanho da lesão a ser tratada e da resposta individual do paciente. Apesar da
ocorrência de complicações e efeitos colaterais, a criocirurgia deve ser empregada, quando
indicada, pois os benefícios ultrapassam, quando executada corretamente, os da técnica
cirúrgica convencional.
Referências
1. Graham GF, Barham KL. Cryosurgery. Curr Probl Dermatol. 2003;15:223-50.
2. Chua KJ, Chou SK, Ho JC. An analytical study on the thermal effects of cryosurgery on
selective cell destruction. J Biomech. 2007;40:100-16.
3. Dawber RPR. Cryosurgery: complications and contraindications. Clin Dermatol.
1990;8:108-14.
4. Dewar L. Collected papers of Sir James Dewar. Cambridge: Cambridge University Press;
1927.
5. Bojrab MJ. Veterinary cryosurgery: an overview. Norden News. 1978;53:16-20.
6. Ameerally PJ, Colverg GB. Cutaneous cryotherapy in maxillofacial surgery. J Oral
Maxillofac Surg. 2007;65:1785-92.
7. Burke WA, Baden TJ, Wheeler CE, Bowdre JH. Survival of herpes simplex virus during
cryosurgery with liquid nitrogen. J Dermatol Surg Oncol. 1986;12:1033-5.
8. Jones SK, Darville JM. Transmission of virus by cryotherapy and multi-use caustic
pencils: a problem for dermatologists? Br J Dermatol. 1989;12:481-6.
9. Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37:171-
86.
10. Le Pivert P. Predictability of cryonecrosis by tissue impedancemetry. Low Temp Med.
1977;4:129-38.
11. Breitbart EW, Dachow-Siwiec E. Scientific basis. Clin Dermatol. 1990;8:5.
12. Torre D. Understanding the relationship between lateral spread of freeze and depth of
freeze. J Dermatol Surg Oncol. 1979;5:51.
13. McCarty TM, Kuhn JA. Cryotherapy for liver tumors. Oncology. 1998;12:7
14. Mazur P. Freezing of living cells: mechanisms and implications. Am J Physiol.
1984;247:125-42.
15. Reed KL, Brown TD, Conzemius MG. Focal cryogen insults for inducing segmental
ostenonecrosis: computational and experimental assessments of thermal fields. J
Biomech. 2003;36:1317-26.
16. Orpwood RD. Biophysical and engineering aspects of cryosurgery. Phys Med Biol.
1981;26:555-75.
17. Muldrew K, McGann LE. The osmotic rupture hypothesis of intracellular freezing injury.
Biophys J. 1994;66:532-41.
18. Rubinsky B. Cryosurgery. Annu Rev Biomed Eng. 2000;2:157-87.
19. Hoffmann NE, Bischof JC. The cryobiology of cryosurgical injury. Urology. 2002;60:40-
9.
20. Johnson JF. Immunologic aspects of cryosurgery: potential modulation of immune
recognition and effector cell maturation. In: Breitbart E, Dachow-Siwiec E. Clinics in
dermatology: advances in cryosurgery. New York: Elsevier; 1990. p.39.
21. Seim HB. Mechanisms of cold-induced cellular death. Vet Clin North Am Small Anim
Pract. 1980;10:755-62.
22. Ablin RJ. Current concepts in cryoimmunology. In: Zacarian SA. Cryosurgery for skin
cancer and cutaneous disorders. St Louis: Mosby; 1985. p.307-12.
23. Leopard PJ. Cryosurgery, and it’s application to oral surgery. Br J Oral Surg.
1975;13:128-52.
24. Lane JG. Practical cryosurgery: an introduction for small animal clinicians. J Small Anim
Pract. 1974;15:715-25.
25. Greiner TP, Liska WD, Withrow SJ. Cryosurgery. Vet Clin North Am Small Anim Pract.
1975;5:565-81.
26. Holmberg DL. Criocirurgia. In: Slatter D. Manual de cirurgia de pequenos animais. 3a
ed. São Paulo: Manolo; 2007. p.222-7.
27. Withrow SJ. Cryosurgery. In: Withrow SJ, MacEwen EG. Small animal clinical
oncology. 4th ed. St Louis: Saunders Elsevier; 2007. p.275-9.
28. Baust JG, Gage AA, Robilotto AT, Baust JM. The pathophysiology of thermoablation:
optimizing cryoablation. Curr Opin Urol. 2009;19:127-32.
29. Eurides D, Daleck CR, Silva LAF, Silva MSM. Criocirurgia. In: Daleck CR, De Nardi
AB, Rodaski S. Oncologia em cães e gatos. São Paulo: Roca; 2009. p.196-203.
30. Erinjeri J, Clark TWI. Cryoablation: mechanism of action and devices. J Vasc Interv
Radiol. 2010;21:187-91.
31. Keefe M, Dich DC. Cryotherapy of hand warts: a questionnaire survey of “consumers.”
Clin Exp Dermatol. 1990;15:260-3.
32. Poziomczyk CS, Koche B, Dornelles MA, Dornelles SIT. Avaliação da dor em
criocirurgia de ceratosesactinicas. An Bras Dermatol. 2011;86:645-50.
33. Graham GF. Cryosurgery for benign, premalignant and malignant lesions. In: Wheeland
RG. Cutaneous surgery. Philadelphia: Sanders; 1994. p.835.
34. Castro JLC, Silveira AMM, Castro VSP, Santalucia S, Ferreira AA, Huppes RR, et al.
Criocirurgia: revisão de literatura. Medvep Dermat. 2013;3:11-25.
35. Elton RF. Complications of cutaneous cryosurgery. J Am Acad Dermatol. 1983;8:513.
36. Lund T, Onarhei H, Wiig H, Reed RK. Mechanisms behind increased dermal inhibition
pressure in active edema. Am J Physiol. 1989;256:940-8.
37. Leappe LL. Initial changes in burns: tissue changes in burned and unburned skin of
rhesus monkeys. J Trauma. 1970;10:488-92.
38. Yoshika T, Monafo WW, Ayvazian VH, Deitz F, Flynn D. Cimetidine inhibits burn
edema formation. Am J Surg. 1978;136:81-8.
39. Mulligan MS, Till GO, Smith CW, Anderson DC, Miyasaka M, Tamatani T, et al. Role
of leukocyte adhesion molecules in lung and dermal vascular injury after thermal trauma
of skin. Am J Pathol. 1994;144:1008-15.
40. Li J, Lai-Fook SJ. Effect of hyaluronidase on interstitial pressure response to edema in
air-inflated rabbit lung. Respir Physiol. 1992;89:133-46.
41. Diess DL, Collins JN, Ardell JL, Townsley MI, Taylor AE, Ferrara JJ. Modulation of
microvascular permeability by 21-aminosteroids burn injuries. J Burn Care Rehabil.
2000;21:406-13.
42. Kuflik EG, Webb W. Effects of systemic corticosteroids on post-surgical edema and
other manifestations of the inflammatory response. J Dermatol Surg Oncol. 1985;11:464.
43. Goloubeff B, Oliveira HP. Tratamento criocirúrgico de tumores e de fístulas, em cães.
Arq Bras Med Vet Zootec.1999;51:463-70.
44. Kuflik EG. Cryosurgery for cutaneous malignancy. Dermatol Surg. 1997;23:1081-7.
45. Hancox JG, Graham GF, Yosipovitch G. Hemorrhagic bullae after cryosurgery in a
patient with hemophilia A. Dermatol Surg. 2003;29:1084-6.
46. Lucas R, Larsson CE. O uso da criocirurgia na dermatologia veterinária. Clin Vet.
2007;69:74-84.
47. Castro JC, Castro VSP, Ramos SD, Huppes R, Nardi AB, Raiser AG, et al. Criocirurgia
no tratamento de carcinoma de células escamosas em cão. Rev Colombiana Cienc Anim.
2013;5:213-21.
48. Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. J Oral
Sci. 2006;48:167-75.
49. Cecchi RM, Giomi A. Pyogenic granuloma as a complication of cryosurgery for venous
lake. Br J Dermatol. 1999;140:373-4.
50. Zacarian SA. Cryogenics: the cryolesion and the pathogenesis of cryonecrosis. In:
Zacarian SA. Cryosurgery for skin cancer and cutaneous disorders. St Louis: Mosby;
2007. p.2-3.
51. Gage AA, Meenaghan MA, Natiella JR, Greene GW. Sensitivity of pigmented mucosa
and skin to freezing injury. Cryobiology. 1979;16:348-361.
52. Zhou GY, Zhang ZY, Lin GC, Gu JZ, Qiu WL. Evaluation of cryosurgery for the
management of oral malignant mucomembranous melanoma: a survey of 107 cases
reports. Shangai Kou Qiang Yi Xue. 1999;8:92-3.
53. Lubritz RR. Cryosurgical approach to benign and precancerous tumors of the skin. In:
Zacarian SA. Cryosurgery for skin cancer and cutaneous disorders. St Louis: Mosby;
1985. p.44-8.
54. Bohler-Sommeregger K, Schuller-Petrovic S, Knobler R, Neumann PR. Reactive
lentiginous hyperpigmentation after cryosurgery for lentigomaligna. J Am Acad
Dermatol. 1992;27:523-6.
55. Kluger N, Durand L, Thoumin C, Plantier F, Cotten H, Berteloot E, et al.
Pseudoepitheliomatous epidermal hyperplasia in tattoos. Am J Clin Dermatol.
2008;9:337-40.
56. Kadunc B, Palermo E, Addorf F, Metsavaht L, Rabello L, Mattos R, Martins S. Tratado
de cirurgia dermatológica, cosmiatria e laser: da Sociedade Brasileira de Dermatologia.
Rio de Janeiro: Elsevier; 2013. p.537-54.
57. Dawber RPR. Cold kills! Clin Exp Dermatol. 1988;13:137-50.
58. Nix TW. Liquid nitrogen neuropathy. Arch Dermatol. 1965;92:185.
59. Queiroz GF, Matera JM. Criocirurgia no tratamento de tumores. Rev Educ Contin
CRMV-SP. 2004;6:53-62.
60. Shepperd JP, Dawber RPR. Wound healing and scarring after cryosurgery. Cryobiology.
1984;21:157-69.
2. Chua KJ, Chou SK, Ho JC. An analytical study on the thermal effects of cryosurgery on
selective cell destruction. J Biomech. 2007;40:100-16.
3. Dawber RPR. Cryosurgery: complications and contraindications. Clin Dermatol.
1990;8:108-14.
4. Dewar L. Collected papers of Sir James Dewar. Cambridge: Cambridge University Press;
1927.
5. Bojrab MJ. Veterinary cryosurgery: an overview. Norden News. 1978;53:16-20.
6. Ameerally PJ, Colverg GB. Cutaneous cryotherapy in maxillofacial surgery. J Oral
Maxillofac Surg. 2007;65:1785-92.
7. Burke WA, Baden TJ, Wheeler CE, Bowdre JH. Survival of herpes simplex virus during
cryosurgery with liquid nitrogen. J Dermatol Surg Oncol. 1986;12:1033-5.
8. Jones SK, Darville JM. Transmission of virus by cryotherapy and multi-use caustic
pencils: a problem for dermatologists? Br J Dermatol. 1989;12:481-6.
9. Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37:171-
86.
10. Le Pivert P. Predictability of cryonecrosis by tissue impedancemetry. Low Temp Med.
1977;4:129-38.
11. Breitbart EW, Dachow-Siwiec E. Scientific basis. Clin Dermatol. 1990;8:5.
12. Torre D. Understanding the relationship between lateral spread of freeze and depth of
freeze. J Dermatol Surg Oncol. 1979;5:51.
13. McCarty TM, Kuhn JA. Cryotherapy for liver tumors. Oncology. 1998;12:7
14. Mazur P. Freezing of living cells: mechanisms and implications. Am J Physiol.
1984;247:125-42.
15. Reed KL, Brown TD, Conzemius MG. Focal cryogen insults for inducing segmental
ostenonecrosis: computational and experimental assessments of thermal fields. J
Biomech. 2003;36:1317-26.
16. Orpwood RD. Biophysical and engineering aspects of cryosurgery. Phys Med Biol.
1981;26:555-75.
17. Muldrew K, McGann LE. The osmotic rupture hypothesis of intracellular freezing injury.
Biophys J. 1994;66:532-41.
18. Rubinsky B. Cryosurgery. Annu Rev Biomed Eng. 2000;2:157-87.
19. Hoffmann NE, Bischof JC. The cryobiology of cryosurgical injury. Urology. 2002;60:40-
9.
20. Johnson JF. Immunologic aspects of cryosurgery: potential modulation of immune
recognition and effector cell maturation. In: Breitbart E, Dachow-Siwiec E. Clinics in
dermatology: advances in cryosurgery. New York: Elsevier; 1990. p.39.
21. Seim HB. Mechanisms of cold-induced cellular death. Vet Clin North Am Small Anim
Pract. 1980;10:755-62.
22. Ablin RJ. Current concepts in cryoimmunology. In: Zacarian SA. Cryosurgery for skin
cancer and cutaneous disorders. St Louis: Mosby; 1985. p.307-12.
23. Leopard PJ. Cryosurgery, and it’s application to oral surgery. Br J Oral Surg.
1975;13:128-52.
24. Lane JG. Practical cryosurgery: an introduction for small animal clinicians. J Small Anim
Pract. 1974;15:715-25.
25. Greiner TP, Liska WD, Withrow SJ. Cryosurgery. Vet Clin North Am Small Anim Pract.
1975;5:565-81.
26. Holmberg DL. Criocirurgia. In: Slatter D. Manual de cirurgia de pequenos animais. 3a
ed. São Paulo: Manolo; 2007. p.222-7.
27. Withrow SJ. Cryosurgery. In: Withrow SJ, MacEwen EG. Small animal clinical
oncology. 4th ed. St Louis: Saunders Elsevier; 2007. p.275-9.
28. Baust JG, Gage AA, Robilotto AT, Baust JM. The pathophysiology of thermoablation:
optimizing cryoablation. Curr Opin Urol. 2009;19:127-32.
29. Eurides D, Daleck CR, Silva LAF, Silva MSM. Criocirurgia. In: Daleck CR, De Nardi
AB, Rodaski S. Oncologia em cães e gatos. São Paulo: Roca; 2009. p.196-203.
30. Erinjeri J, Clark TWI. Cryoablation: mechanism of action and devices. J Vasc Interv
Radiol. 2010;21:187-91.
31. Keefe M, Dich DC. Cryotherapy of hand warts: a questionnaire survey of “consumers.”
Clin Exp Dermatol. 1990;15:260-3.
32. Poziomczyk CS, Koche B, Dornelles MA, Dornelles SIT. Avaliação da dor em
criocirurgia de ceratosesactinicas. An Bras Dermatol. 2011;86:645-50.
33. Graham GF. Cryosurgery for benign, premalignant and malignant lesions. In: Wheeland
RG. Cutaneous surgery. Philadelphia: Sanders; 1994. p.835.
34. Castro JLC, Silveira AMM, Castro VSP, Santalucia S, Ferreira AA, Huppes RR, et al.
Criocirurgia: revisão de literatura. Medvep Dermat. 2013;3:11-25.
35. Elton RF. Complications of cutaneous cryosurgery. J Am Acad Dermatol. 1983;8:513.
36. Lund T, Onarhei H, Wiig H, Reed RK. Mechanisms behind increased dermal inhibition
pressure in active edema. Am J Physiol. 1989;256:940-8.
37. Leappe LL. Initial changes in burns: tissue changes in burned and unburned skin of
rhesus monkeys. J Trauma. 1970;10:488-92.
38. Yoshika T, Monafo WW, Ayvazian VH, Deitz F, Flynn D. Cimetidine inhibits burn
edema formation. Am J Surg. 1978;136:81-8.
39. Mulligan MS, Till GO, Smith CW, Anderson DC, Miyasaka M, Tamatani T, et al. Role
of leukocyte adhesion molecules in lung and dermal vascular injury after thermal trauma
of skin. Am J Pathol. 1994;144:1008-15.
40. Li J, Lai-Fook SJ. Effect of hyaluronidase on interstitial pressure response to edema in
air-inflated rabbit lung. Respir Physiol. 1992;89:133-46.
41. Diess DL, Collins JN, Ardell JL, Townsley MI, Taylor AE, Ferrara JJ. Modulation of
microvascular permeability by 21-aminosteroids burn injuries. J Burn Care Rehabil.
2000;21:406-13.
42. Kuflik EG, Webb W. Effects of systemic corticosteroids on post-surgical edema and
other manifestations of the inflammatory response. J Dermatol Surg Oncol. 1985;11:464.
43. Goloubeff B, Oliveira HP. Tratamento criocirúrgico de tumores e de fístulas, em cães.
Arq Bras Med Vet Zootec.1999;51:463-70.
44. Kuflik EG. Cryosurgery for cutaneous malignancy. Dermatol Surg. 1997;23:1081-7.
45. Hancox JG, Graham GF, Yosipovitch G. Hemorrhagic bullae after cryosurgery in a
patient with hemophilia A. Dermatol Surg. 2003;29:1084-6.
46. Lucas R, Larsson CE. O uso da criocirurgia na dermatologia veterinária. Clin Vet.
2007;69:74-84.
47. Castro JC, Castro VSP, Ramos SD, Huppes R, Nardi AB, Raiser AG, et al. Criocirurgia
no tratamento de carcinoma de células escamosas em cão. Rev Colombiana Cienc Anim.
2013;5:213-21.
48. Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. J Oral
Sci. 2006;48:167-75.
49. Cecchi RM, Giomi A. Pyogenic granuloma as a complication of cryosurgery for venous
lake. Br J Dermatol. 1999;140:373-4.
50. Zacarian SA. Cryogenics: the cryolesion and the pathogenesis of cryonecrosis. In:
Zacarian SA. Cryosurgery for skin cancer and cutaneous disorders. St Louis: Mosby;
2007. p.2-3.
51. Gage AA, Meenaghan MA, Natiella JR, Greene GW. Sensitivity of pigmented mucosa
and skin to freezing injury. Cryobiology. 1979;16:348-361.
52. Zhou GY, Zhang ZY, Lin GC, Gu JZ, Qiu WL. Evaluation of cryosurgery for the
management of oral malignant mucomembranous melanoma: a survey of 107 cases
reports. Shangai Kou Qiang Yi Xue. 1999;8:92-3.
53. Lubritz RR. Cryosurgical approach to benign and precancerous tumors of the skin. In:
Zacarian SA. Cryosurgery for skin cancer and cutaneous disorders. St Louis: Mosby;
1985. p.44-8.
54. Bohler-Sommeregger K, Schuller-Petrovic S, Knobler R, Neumann PR. Reactive
lentiginous hyperpigmentation after cryosurgery for lentigomaligna. J Am Acad
Dermatol. 1992;27:523-6.
55. Kluger N, Durand L, Thoumin C, Plantier F, Cotten H, Berteloot E, et al.
Pseudoepitheliomatous epidermal hyperplasia in tattoos. Am J Clin Dermatol.
2008;9:337-40.
56. Kadunc B, Palermo E, Addorf F, Metsavaht L, Rabello L, Mattos R, Martins S. Tratado
de cirurgia dermatológica, cosmiatria e laser: da Sociedade Brasileira de Dermatologia.
Rio de Janeiro: Elsevier; 2013. p.537-54.
57. Dawber RPR. Cold kills! Clin Exp Dermatol. 1988;13:137-50.
58. Nix TW. Liquid nitrogen neuropathy. Arch Dermatol. 1965;92:185.
59. Queiroz GF, Matera JM. Criocirurgia no tratamento de tumores. Rev Educ Contin
CRMV-SP. 2004;6:53-62.
60. Shepperd JP, Dawber RPR. Wound healing and scarring after cryosurgery. Cryobiology.
1984;21:157-69.
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2017-03-31
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Malburg C, Gonzalez Peres Albernaz V, Costa Castro JL. Criocirurgia: Efeitos e complicações pós-tratamento. RVZ [Internet]. 31º de março de 2017 [citado 2º de novembro de 2024];24(1):35-48. Disponível em: https://rvz.emnuvens.com.br/rvz/article/view/336
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