CAJ | 학술논문

目的探讨冷循环射频初始功率、射频时间、射频针等因素对消融效果的影响,评价超声判断消融区的价值.方法超声全程监控下对新鲜离体牛肝进行冷循环射频消融,单电极针作用下观察不同初始功率(80 W、120 W)和不同射频时间(5 min、8 min、10 min)消融灶的实时演变过程,此外进行5 min射频时间下不同初始功率(80 W、120 W)的集束针实验.实验结束后纵剖开标本,肉眼观察消融灶形态,并测量其大小,光学显微镜下观察消融灶病理学变化.结果肉眼测量消融灶显示:初始功率80 W组消融灶随时间延长而增大,但扩展速度呈减缓趋势,初始功率120 W组消融灶随时间扩大不明显;在射频时间较短的情况下初始功率120 W组消融灶大于初始功率80 W组,时间延长后两者差别缩小,射频时间达10 min后两者形成大小相似的消融灶.集束针所形成消融灶的纵横比小于单电极针,剖面更接近圆形.超声显示强回声区范围与实际消融区有一定误差,纵径多大于实际,横径受声影遮盖难以测定,在大消融灶中往往小于实际.光学显微镜下消融区细胞形态、结构无明显变化.结论不同的射频时间和初始功率对冷循环射频消融能力有一定影响,高初始功率在增加产热的同时也降低热能传导,实际应用中应综合考虑.与单电极针相比,集束针形成的消融灶更接近实体肝肿瘤形态,对2 cm左右的小肝癌疗效更可靠.超声可用于引导射频定位,但不能准确判定消融区边界.
목적 탐토랭순배사빈초시공솔、사빈시간、사빈침등인소대소융효과적영향,평개초성판단소융구적개치.방법 초성전정감공하대신선리체우간진행랭순배사빈소융,단전겁침작용하관찰불동초시공솔(80 W、120 W)화불동사빈시간(5 min、8 min、10 min)소융조적실시연변과정,차외진행5 min사빈시간하불동초시공솔(80 W、120 W)적집속침실험.실험결속후종부개표본,육안관찰소융조형태,병측량기대소,광학현미경하관찰소융조병이학변화.결과 육안측량소융조현시:초시공솔80 W조소융조수시간연장이증대,단확전속도정감완추세,초시공솔120 W조소융조수시간확대불명현;재사빈시간교단적정황하초시공솔120 W조소융조대우초시공솔80 W조,시간연장후량자차별축소,사빈시간체10 min후량자형성대소상사적소융조.집속침소형성소융조적종횡비소우단전겁침,부면경접근원형.초성현시강회성구범위여실제소융구유일정오차,종경다대우실제,횡경수성영차개난이측정,재대소융조중왕왕소우실제.광학현미경하소융구세포형태、결구무명현변화.결론 불동적사빈시간화초시공솔대랭순배사빈소융능력유일정영향,고초시공솔재증가산열적동시야강저열능전도,실제응용중응종합고필.여단전겁침상비,집속침형성적소융조경접근실체간종류형태,대2 cm좌우적소간암료효경가고.초성가용우인도사빈정위,단불능준학판정소융구변계.
Objective To investigate the effects of output power,action time and radiofrequency(RF) needle on the cool-tip radiofrequency ablation(RFA) by experimental tools and to determine the value of ultrasonography in size evaluation of RFA zone.Methods The cool-tip RFA to fresh calf liver were monitored by ultrasound.The experiments by single electrode needle were performed with different combination of output power (80 W,120 W) and time (5 min,8 min,10 min).The cluster needle was used for assessment at 5 min with different output power(80 W,120 W).After the end of trial,the longitudinal specimens were cut open.The view and size of the ablation zone were recorded with naked eyes.The pathological changes displayed by optical microscope were recorded as well.Results The measurement of ablation zone with naked eyes showed with the ablation zone expanded with time in 80 W-power cases,but the pace of expansion slowed down,but in 120 W-power cases,expansion of the ablation zone was not obvious; the ablation zone in 120 W-power was bigger than that in 80 W-power at 5 min,their difference decreased with time,and the ablation zones were similar at 10 min.The cluster needle can produce ablation zone with lesser aspect ratio than that of single electrode needle,consequently similar to circle.Ultrasonic measurement of the ablation zone had real discrepancy.Most of longitudinal diameters were greater than the real ones,while in large ablation lesions,vertical diameters were often less than the real ones.Under optical microscope,no change could be found in shape and structure of the cells in ablation zone.Conclusion The output power and performing time have impact on ablation.The high-power output increased heat production as well as reduction of heat conduction.Compared with single electrode needle,the cluster needle produced ablation zone closer to real hepatic tumor,thus has more reliable effect to small hepatocellular carcinoma with diameter around 2 cm.The ultrasond has a great significance in RFA guidance,but it could not accurately define the border of ablation zone.