CAJ | 학술논문

目的探讨胆汁淤积型肝硬化活体、离体猪肝(实验组)与正常活体、离体猪肝(对照组)在相同的冷循环微波消融条件下消融范围的区别.方法西藏小型猪共6只,实验组4只进行胆管结扎术,对成功建立的肝硬化模型开腹行冷循环微波消融术,同时对对照组(2只)行相同条件下的微波消融,观察消融灶形态学特征,测量消融灶纵轴、横轴,计算消融灶体积,并进行统计学分析；用HE染色法对消融灶进行病理学分析.结果实验组1只猪于胆管结扎后14 d死亡,其余3只均成功建立胆汁淤积型肝硬化模型.实验组及对照组在相同条件下(功率70 W,时间5 min)行微波消融的实验结果:(1)正常猪肝活体消融范围的短轴、长轴及体积均较离体偏小[(2.04±0.05) cm、(3.14±0.11)cm和(6.8±0.5)cm3,(2.30±0.18)cm、(3.60±0.08)cm和(10.0±1.7)cm3],且消融范围长轴及体积的差异均有统计学意义(P =0.000、0.031),但消融范围短轴的差异无统计学意义(P=0.060).(2)肝硬化猪肝模型活体消融范围的短轴、长轴及体积均较离体偏小,且差异均有统计学意义[(1.90±0.10)cm、(2.95±0.12)cm和(6.0±0.8)cm3,(2.08±0.08) cm、(3.08±0.75) cm和(7.0±0.5)cm3,P =0.028、0.026、0.008].(3)正常猪肝活体与离体消融的短轴、长轴及体积均大于相同消融条件下的硬化肝脏活体与离体消融的短轴、长轴及体积,且长轴及体积的差异有统计学意义(P =0.019、0.000,P=0.024、0.036),但消融短轴在活体及离体实验中差异均无统计学意义(P=0.110、P=0.090).结论在功率70 W,消融时间 5 min条件下,胆汁淤积型肝硬化活体与离体猪肝的消融范围小于正常猪肝的消融范围,活体猪肝的消融范围小于离体猪肝的消融范围.
목적 탐토담즙어적형간경화활체、리체저간(실험조)여정상활체、리체저간(대조조)재상동적랭순배미파소융조건하소융범위적구별.방법 서장소형저공6지,실험조4지진행담관결찰술,대성공건립적간경화모형개복행랭순배미파소융술,동시대대조조(2지)행상동조건하적미파소융,관찰소융조형태학특정,측량소융조종축、횡축,계산소융조체적,병진행통계학분석；용HE염색법대소융조진행병이학분석.결과 실험조1지저우담관결찰후14 d사망,기여3지균성공건립담즙어적형간경화모형.실험조급대조조재상동조건하(공솔70 W,시간5 min)행미파소융적실험결과:(1)정상저간활체소융범위적단축、장축급체적균교리체편소[(2.04±0.05) cm、(3.14±0.11)cm화(6.8±0.5)cm3,(2.30±0.18)cm、(3.60±0.08)cm화(10.0±1.7)cm3],차소융범위장축급체적적차이균유통계학의의(P =0.000、0.031),단소융범위단축적차이무통계학의의(P=0.060).(2)간경화저간모형활체소융범위적단축、장축급체적균교리체편소,차차이균유통계학의의[(1.90±0.10)cm、(2.95±0.12)cm화(6.0±0.8)cm3,(2.08±0.08) cm、(3.08±0.75) cm화(7.0±0.5)cm3,P =0.028、0.026、0.008].(3)정상저간활체여리체소융적단축、장축급체적균대우상동소융조건하적경화간장활체여리체소융적단축、장축급체적,차 장축급체적적차이유통계학의의(P =0.019、0.000,P=0.024、0.036),단소융단축재활체급리체실험중차이균무통계학의의(P=0.110、P=0.090).결론 재공솔70 W,소융시간 5 min조건하,담즙어적형간경화활체여리체저간적소융범위소우정상저간적소융범위,활체저간적소융범위소우리체저간적소융범위.
Objective To elucidate the difference in both in vivo and ex vivo microwave ablation in a biliary cirrhotic porcine liver model using a cooled-tip antenna.Methods Two months after biliary ductal ligation,liver biopsy was performed to confirm the establishment of biliary cirrhosis in 4 Tibetan miniature pigs.Microwave ablation with cooled-tip antenna was conducted under laparotomy using 70 W for five minutes in the experimental group (4 pigs).The control group (2 pigs) also received microwave ablation using the same settings but no surgery.Both in-vivo and ex-vivo ablations were performed in the two groups.Morphological and pathological characteristics of the ablation areas were compared.Paired comparison among the groups were conducted using t-test.Results In the cirrhotic liver group,after ablation at 70 W for five minutes,the short and long axes and volume of in vivo ablation areas were ( 1.90 ± 0.10) cm,(2.95 ±0.12) cm,and (6.0 ± 0.8) cm3 compared to (2.08 ± 0.08) cm,(3.08 ± 0.75)cm,and (7.0 ±0.5 ) cm3 of ex vivo ablation.In the normal liver group the dates were ( 2.04 ± 0.05 ) cm,( 3.14 ± 0.1 1 ) cm and ( 6.8 ± 0.5 ) cm3 ; ( 2.30 ± 0.18 ) cm,( 3.60 ± 0.08 ) cm and ( 10.0 ± 1.7 ) cm3,respectively.In vivo ablation area was smaller than ex vivo ablation area in terms of short and long axes and volume (P =0.0280.026,0.008,respectively).With the same ablation settings,both in vivo and ex vivo ablation areas in normal pig liver were larger than their counterparts in cirrhotic liver in terms of the short and long axes and volume (P=0.019,P=0.000; P=0.024,P=0.036,respectively),but the differences in the short axes of in vivo and ex vivo ablation areas failed to reach significance.Conclusion Both in vivo and ex vivo ablation areas in biliary cirrhotic pig liver were smaller than their counterparts in normal pig liver suggesting that,the ablation time or power should be relatively prolonged to enlarge the ablation zone within cirrhotic liver in order to prevent incomplete ablation with viable residual tumor.