CAJ | 학술논문

目的：研究冷冻胆囊侧肝脏的安全性与有效性。方法对靠近胆囊0.5 cm处3只实验兔的肝脏进行氩氦刀消融，观察7d后肝脏消融区与胆囊的形态及病理学改变，以及血清转氨酶在冷冻后各时段的变化。结果消融7 d后肝脏脏面形成黄色类圆形坏死灶，平均直径为（2.25±0.35）cm。消融区与腹壁（2/3）、膈肌（1/3）、肠系膜（1/3）、胃壁（1/3）和结肠（1/3）发生粘连。1/3实验兔出现胆囊穿孔。光镜下可见广泛肝组织坏死。肝组织结构不完整，肝小叶轮廓隐约可见，肝索和肝板崩解断裂呈空网状，肝窦局部充血、局部有大量退变炎性细胞浸润和少量崩解红细胞，核溶解。1/3实验兔胆囊壁全层坏死，肌层崩解，黏膜消失，坏死区内可见大量均一红染物质。血清谷草转氨酶（AST）及谷丙转氨酶（ALT）水平均在术后显著升高，其中AST呈一过性升高，在术后第7d恢复至正常水平。结论冷冻可有效消融肝脏组织，且可能引起胆囊穿孔。
목적：연구냉동담낭측간장적안전성여유효성。방법대고근담낭0.5 cm처3지실험토적간장진행아양도소융，관찰7d후간장소융구여담낭적형태급병이학개변，이급혈청전안매재냉동후각시단적변화。결과소융7 d후간장장면형성황색류원형배사조，평균직경위（2.25±0.35）cm。소융구여복벽（2/3）、격기（1/3）、장계막（1/3）、위벽（1/3）화결장（1/3）발생점련。1/3실험토출현담낭천공。광경하가견엄범간조직배사。간조직결구불완정，간소협륜곽은약가견，간색화간판붕해단렬정공망상，간두국부충혈、국부유대량퇴변염성세포침윤화소량붕해홍세포，핵용해。1/3실험토담낭벽전층배사，기층붕해，점막소실，배사구내가견대량균일홍염물질。혈청곡초전안매（AST）급곡병전안매（ALT）수평균재술후현저승고，기중AST정일과성승고，재술후제7d회복지정상수평。결론냉동가유효소융간장조직，차가능인기담낭천공。
Objective To investigate the safety and efficiency of freezing ablation on rabbit liver 0.5 cm close to the gallbladder. Methods The probes were placed in liver tissue 0.5 cm close to the gallbladder in 3 New Zealand White Rabbits and ablations were performed with cryoablation procedures. Pathological changes of liver ablation zones and gallbladders were observing for 7 days. Results Ablations were successfully carried out in 3 rabbit for freezing ablation. The animals were sacrificed and liver and gall bladder were resected 7 days later. A circular shaped yellow necrosis zone were observed and the necrosis zone diameters was (2.25 ± 0.35) cm. Different degrees of adhesions were observed between the liver and adjacent organs such as abdominal wall, diaphragm, mesentery, stomach wall and colon. Gall bladder leakage could be found in one third of rabbits. Liver tissue structure was incomplete, lobular contour became faintly visible, fracture and collapse of liver and liver plate mesh were seen, hepatic sinus local hyperemia and a large number of degenerative inflammatory cell infiltration and small amounts of breakdown of red blood cells were also observed. At the same time, full-thickness gallbladder wall necrosis (1/3), muscular collapse and mucosal disappearance, and a large number of uniform red dye material in necrotic area were found. The expression level of ALT and AST was obviously increased after cryoablation. AST was gradually decreased and reached normal level on the 7th day. Conclusions Cryoablation is an efficiency ablation technique for liver cancer therapy, but it may induce the gallbladder leakage which must be avoided.