CAJ | 학술논문

目的比较不同功率氩等离子凝固术(APC)及不同作用时间冷冻消融术对犬正常气管的急性损伤深度,以探讨不同处理方式的效果和安全性.方法对8条杂种犬的气管行APC(功率分别为30和60W)和冷冻消融(时间分别为30和60s)处理,分为APC 30 W组、APC 60 W组、冷冻30 s组、冷冻60 s组及正常气管组,每组8例标本.48 h后行肉眼、组织病理和电镜观察,统计每种处理方式的损伤深度.结果冷冻30 s组和冷冻60s组损伤深度均达气道软骨浅层,冷冻30 s组可见软骨细胞变性,冷冻60 s组软骨细胞变性增多,偶见软骨细胞坏死;APC 30 W组损伤深度达气道软骨浅层并可见部分软骨细胞坏死,APC 60 W组损伤深度达气道软骨深层及外膜层,可见多数软骨细胞坏死.前3组组织损伤深度8只动物均达到了软骨浅层,仅冷冻60 s组有2只达到了软骨深层;而APC 60 W组损伤深度8只动物均达到了软骨深层,与前3组处理方式比较差异有统计学意义(P＜0.05).结论常规参数的冷冻及APC消融对正常气管的损伤深度即可达软骨浅层,并导致软骨细胞变性,而APC 60 W组损伤深度可达气道软骨深层及外膜层,并造成软骨细胞坏死、气道壁不可逆的损伤.提示在气道腔内消融治疗中接近气管壁或消融管壁型病变时,应禁用APC消融治疗,而冷冻消融治疗最好控制在30 s以内.
목적 비교불동공솔아등리자응고술(APC)급불동작용시간냉동소융술대견정상기관적급성손상심도,이탐토불동처리방식적효과화안전성.방법 대8조잡충견적기관행APC(공솔분별위30화60W)화냉동소융(시간분별위30화60s)처리,분위APC 30 W조、APC 60 W조、냉동30 s조、냉동60 s조급정상기관조,매조8례표본.48 h후행육안、조직병리화전경관찰,통계매충처리방식적손상심도.결과 냉동30 s조화냉동60s조손상심도균체기도연골천층,냉동30 s조가견연골세포변성,냉동60 s조연골세포변성증다,우견연골세포배사;APC 30 W조손상심도체기도연골천층병가견부분연골세포배사,APC 60 W조손상심도체기도연골심층급외막층,가견다수연골세포배사.전3조조직손상심도8지동물균체도료연골천층,부냉동60 s조유2지체도료연골심층;이APC 60 W조손상심도8지동물균체도료연골심층,여전3조처리방식비교차이유통계학의의(P＜0.05).결론 상규삼수적냉동급APC소융대정상기관적손상심도즉가체연골천층,병도치연골세포변성,이APC 60 W조손상심도가체기도연골심층급외막층,병조성연골세포배사、기도벽불가역적손상.제시재기도강내소융치료중접근기관벽혹소융관벽형병변시,응금용APC소융치료,이냉동소융치료최호공제재30 s이내.
Objective To observe the damage depth on normal canine trachea by using argon plasma coagulation (APC) at different power settings or cryoablation with different freezing duration,and to discuss the efficacy and safety of these different treatments.Methods APC (the power settings were 30 W and 60 W) and cryoablation (the freezing durations were 30 s and 60 s) were performed on the trachea of 8 dogs.The animals were killed 48 h after the treatment.The tracheal specimens were processed and divided into 5 groups:Cryoablation 30 s(Group A),Cryoablation 60 s (Group B),APC 30 W (Group C),APC 60 W (Group D)and the control group.Gross observation,histopathological study and electron microscopic examination were performed.Results The tracheal injury in Group A and Group B reached the shallow part of airway cartilage layer,and 2 in Group B reached the deep part of airway cartilage layer.In Group A,cartilage cell degeneration could be seen,but in Group B,cartilage cell degeneration was worse and even necrosis was found.In Group C,the damage depth also reached the shallow part of the cartilage layer and necrosis of cartilage cells could be seen.In Group D,the damage depth reached the deep part of airway cartilage layer and even outer membrane of the trachea.More necrosis of cartilage cells was found.Conclusion When using cryoablation or APC with normal parameters,the injury in normal canine trachea could reach the shallow part of cartilage layer and cartilage cell degeneration could occur.When using APC 60 W,damage depth could reach the deep part of cartilage layer and even outer membrane of the trachea,leading to cartilage cell necrosis and even irreversible damage on airways.Therefore,it is highly recommended that,when managing lesions adjacent to or in the airway wall,APC ablation should be avoided and cryoablation time should be controlled within 30 s.