介入放射学杂志
介入放射學雜誌
개입방사학잡지
JOURNAL OF INTERVENTIONAL RADIOLOGY
2014年
4期
320-324
,共5页
梁冰%牛立志%曾健滢%周亮%周序珑%方刚%姚飞%邓春娟%汪媛%张波%李书英%邓春梅%杨惠霏%李家亮%刘建国%徐克成
樑冰%牛立誌%曾健瀅%週亮%週序瓏%方剛%姚飛%鄧春娟%汪媛%張波%李書英%鄧春梅%楊惠霏%李傢亮%劉建國%徐剋成
량빙%우립지%증건형%주량%주서롱%방강%요비%산춘연%왕원%장파%리서영%산춘매%양혜비%리가량%류건국%서극성
肝脏%不可逆电穿孔消融%胆囊%兔
肝髒%不可逆電穿孔消融%膽囊%兔
간장%불가역전천공소융%담낭%토
liver%irreversible electroporation ablation%gallbladder%rabbit
目的：研究靠近胆囊0.5 cm处不可逆电穿孔肝脏消融的安全性和有效性。方法采用新西兰白兔3只作为实验动物，在靠近胆囊0.5 cm处肝脏进行不可逆电穿孔消融，并于7 d后观察消融区域的肝脏病理反应和胆囊损伤情况。结果3只动物均成功完成消融。消融7d后，肝脏面原消融区平均直径3.00 cm黄色坏死灶，肝膈面形成1个平均直径1.67 cm类圆形黄色坏死灶。2只实验兔消融部位和腹壁、1只肝叶和膈肌发生小片段浅度粘连。2只肠系膜则与胆囊消融灶区发生严重粘连。光镜下可见肝大片坏死且消失，仅有部分凝固性坏死肝组织残留，外围有少量斑点状钙化，炎性肉芽组织和小胆管显著增生。肝门静脉血管平滑肌损伤不明显，肌层小范围纤维素样变性、胆囊黏膜上皮大部分坏死，胆囊外结缔组织水肿、胆总管部分黏膜上皮坏死，部分上皮仍存在，肌层完好。结论消融部位肝脏组织完全坏死，消融灶和周围组织分界明显，胆囊出现损伤，但无胆囊漏发生。因此，对于靠近胆囊的肝脏肿瘤而言，不可逆电穿孔可能是一种相对安全有效的选择。
目的：研究靠近膽囊0.5 cm處不可逆電穿孔肝髒消融的安全性和有效性。方法採用新西蘭白兔3隻作為實驗動物，在靠近膽囊0.5 cm處肝髒進行不可逆電穿孔消融，併于7 d後觀察消融區域的肝髒病理反應和膽囊損傷情況。結果3隻動物均成功完成消融。消融7d後，肝髒麵原消融區平均直徑3.00 cm黃色壞死竈，肝膈麵形成1箇平均直徑1.67 cm類圓形黃色壞死竈。2隻實驗兔消融部位和腹壁、1隻肝葉和膈肌髮生小片段淺度粘連。2隻腸繫膜則與膽囊消融竈區髮生嚴重粘連。光鏡下可見肝大片壞死且消失，僅有部分凝固性壞死肝組織殘留，外圍有少量斑點狀鈣化，炎性肉芽組織和小膽管顯著增生。肝門靜脈血管平滑肌損傷不明顯，肌層小範圍纖維素樣變性、膽囊黏膜上皮大部分壞死，膽囊外結締組織水腫、膽總管部分黏膜上皮壞死，部分上皮仍存在，肌層完好。結論消融部位肝髒組織完全壞死，消融竈和週圍組織分界明顯，膽囊齣現損傷，但無膽囊漏髮生。因此，對于靠近膽囊的肝髒腫瘤而言，不可逆電穿孔可能是一種相對安全有效的選擇。
목적：연구고근담낭0.5 cm처불가역전천공간장소융적안전성화유효성。방법채용신서란백토3지작위실험동물，재고근담낭0.5 cm처간장진행불가역전천공소융，병우7 d후관찰소융구역적간장병리반응화담낭손상정황。결과3지동물균성공완성소융。소융7d후，간장면원소융구평균직경3.00 cm황색배사조，간격면형성1개평균직경1.67 cm류원형황색배사조。2지실험토소융부위화복벽、1지간협화격기발생소편단천도점련。2지장계막칙여담낭소융조구발생엄중점련。광경하가견간대편배사차소실，부유부분응고성배사간조직잔류，외위유소량반점상개화，염성육아조직화소담관현저증생。간문정맥혈관평활기손상불명현，기층소범위섬유소양변성、담낭점막상피대부분배사，담낭외결체조직수종、담총관부분점막상피배사，부분상피잉존재，기층완호。결론소융부위간장조직완전배사，소융조화주위조직분계명현，담낭출현손상，단무담낭루발생。인차，대우고근담낭적간장종류이언，불가역전천공가능시일충상대안전유효적선택。
Objective To investigate the safety and efficacy of irreversible electroporation (IRE) ablation of hepatic region close (0.5 cm) to the gallbladder. Methods Three New Zealand white rabbits were used for this study. The IRE probes, which were placed in the hepatic tissue, were 0.5 cm apart from the gallbladder, and IRE ablation was performed. Seven days after the treatment the pathological changes of the hepatic ablated zones and gallbladders were examined. Results Successful IRE ablation was accomplished in all 3 rabbits. Seven days after the treatment the experimental rabbits were sacrificed, and their livers and gallbladders were collected and sent for pathological examination. Macroscopically, the hepatic surface of the ablated area showed a yellow necrotic lesion, which was (3.00 ± 0.50) cm in size. At the diaphragmatic surface of the liver a round yellow lesion was seen with a size about (1.67 ± 1.15) cm. Slight superficial adhesion could be seen at the ablated areas and abdominal wall (n=2), hepatic lobe (n=1) and diaphragm (n=1). Serious adhesion of mesentery with the ablated gallbladder was seen in two rabbits. Microscopically, massive necrosis or disappearance of the hepatic tissue together with a little residual hepatic coagulation necrosis and speckled calcifications at the peripheral region could be detected. Inflammatory granulation and prominent proliferation of the tiny biliary ducts were also observed. The damage of the vascular smooth muscle in the portal vein was not obvious. Small area of fibrinoid degeneration was seen in the muscular layer. Mucosal epithelial necrosis of the gallbladder and connective tissue edema outside the gallbladder could also be observed. Conclusion Complete necrosis of the hepatic tissue at the ablated area can be achieved by IRE ablation. The ablated zone has a clear demarcation with the surrounding tissue. No gallbladder leakage occurs although the gallbladder is damaged. Therefore, for the hepatic tumors, which are located close to the gallbladder, irreversible electroporation ablation may be regarded as a relatively safe and effective treatment.(J Intervent Radiol, 2014, 23:320-324).
