胆囊旁及近结肠肝脏组织射频消融.docVIP

胆囊旁及近结肠肝脏组织射频消融 　 作者：赵明， 吴沛宏，谢强， 李旺， 张海波 【摘要】 【目的】 在活体上观察多极射频消融电极展开不同直径、消融时间与组织坏死的关系，并评价消融区域组织坏死程度，分别了解在近胆囊和结肠肝曲部位肝脏消融对胆囊和结肠的影响。【方法】 家猪6只，体质量（47 ± 2.5）kg。静脉麻醉，每肝内分为5个位点进行射频消融。其中2组将消融电极展开到3 cm，每组5个点分别行5 min和10 min消融，包括距离胆囊床（5 ± 1）mm，行10 min射频消融；距离结肠肝曲（5 ± 1）mm处，行10 min射频消融，并观察消融结果。另3组电极展开到5 cm，每组5个点分别行5 min、10 min和15 min组织间消融。【结果】 消融电极展开到3 cm行5 min治疗组，5个点局部消融区域组织达到完全坏死；10 min×5 min消融治疗坏死范围相似。大体病理上消融相邻区域胆囊，结肠未见有坏死，镜下病理显示胆囊壁、结肠周围有慢性炎症并有纤维增生表现。消融电极展开到5 cm，5 min消融组织间有活性成分，15 min，10 min均可保证消融区域完全坏死。【结论】 可根据需要调整多极消融电极展开大小，在肝内接近胆囊区域、结肠肝曲部位消融安全，可发挥较好的作用。 【关键词】 消融； 多极射频； 肝脏； 猪 Abstract:【Objective】The study was performed to evaluate the necrosis after hepatic multi-electrode radiofrequency ablation (RFA), also to assess the feasibility and safety of RFA of hepatic tissue adjacent to the gallbladder wall and to the colon wall in a porcine model. 【Methods】 Six normal swine (mean weight 47 kg × 2.5 kg) in vein anesthesia were treated with RFA in the liver with 5 min,10 min, under 3 cm opening in one cycle, and with 5 min, 10 min, and 15 min RFA under 5 cm opening in one cycle. Those include RFA area adjacent to gallbladder and to colon wall about 5 mm × 1 mm. 【Result】 The area was completely necrotic with 5 min, 10 min with 3 cm opening in one cycle. The necrosis area was not completely necrotic with 5 min, but it showed completely necrosis with 10 min, 15 min under 5 cm opening in one cycle. In pathology, the adjacent gallbladder wall and colon wall were not found any necrosis and chronic inflammation cells were found in ablation area and in the wall of gallbladder and colon. 【Conclusion】 The multi-electrode can be changed its opening diameter and provide a relative suitable ablation shape. It was safety to the adjacent gallbladder and colon wall about 5 mm × 1 mm distance in radiofrequency ablation. Key words: radiofrequency; pig; liver; multi-electrode 射频消融用于实体肿瘤的治疗在临床上已广泛开展［1］，对于特殊部位的病变，如位于肝脏左叶、靠近膈顶、胆囊、结肠肝曲部位的肿瘤，通过改变消融电极的直径（如减小消融针展开面积，多点叠加）等来消融范围，减少并发症的发生，这方面临床上已见有报道[2,3]