中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
15期
1178-1181
,共4页
张秀梅%汪欣%万远廉%陈国卫%李荣杰%陈敏华
張秀梅%汪訢%萬遠廉%陳國衛%李榮傑%陳敏華
장수매%왕흔%만원렴%진국위%리영걸%진민화
肝%消融技术%动物实验
肝%消融技術%動物實驗
간%소융기술%동물실험
Liver%Ablation techniques%Animal experimentation
目的 探讨肝脏分次多部位经皮及开腹射频消融策略实施的可行性及疗效.方法 活体家猪1只,先后3次(间隔5d)行超声引导下经皮及开腹肝脏射频消融,共产生6个消融灶,经皮超声、超声造影、开腹术中超声、增强CT等影像学方法观察射频消融对胆系、腹壁、肝静脉及门静脉等结构变化及射频消融疗效.结果 肝门部消融灶致邻近肝总管扩张,与之平行布针的消融灶内的肝静脉未见明显实性栓子,2个消融灶未完全相融;被膜下注水后进行射频消融仍可见邻近腹壁小范围灼伤,随时间延长,被膜下充血肝组织发生凝固坏死;术中专用射频电极针末端形成碳化颗粒,出针过程中致针道出血,使用明胶海绵止血效果佳;在能量相同条件下,阻断入肝血流后消融灶明显增大.结论 多种射频消融方式具有较好的可行性和安全性,特殊部位肿瘤消融并发症增加.
目的 探討肝髒分次多部位經皮及開腹射頻消融策略實施的可行性及療效.方法 活體傢豬1隻,先後3次(間隔5d)行超聲引導下經皮及開腹肝髒射頻消融,共產生6箇消融竈,經皮超聲、超聲造影、開腹術中超聲、增彊CT等影像學方法觀察射頻消融對膽繫、腹壁、肝靜脈及門靜脈等結構變化及射頻消融療效.結果 肝門部消融竈緻鄰近肝總管擴張,與之平行佈針的消融竈內的肝靜脈未見明顯實性栓子,2箇消融竈未完全相融;被膜下註水後進行射頻消融仍可見鄰近腹壁小範圍灼傷,隨時間延長,被膜下充血肝組織髮生凝固壞死;術中專用射頻電極針末耑形成碳化顆粒,齣針過程中緻針道齣血,使用明膠海綿止血效果佳;在能量相同條件下,阻斷入肝血流後消融竈明顯增大.結論 多種射頻消融方式具有較好的可行性和安全性,特殊部位腫瘤消融併髮癥增加.
목적 탐토간장분차다부위경피급개복사빈소융책략실시적가행성급료효.방법 활체가저1지,선후3차(간격5d)행초성인도하경피급개복간장사빈소융,공산생6개소융조,경피초성、초성조영、개복술중초성、증강CT등영상학방법관찰사빈소융대담계、복벽、간정맥급문정맥등결구변화급사빈소융료효.결과 간문부소융조치린근간총관확장,여지평행포침적소융조내적간정맥미견명현실성전자,2개소융조미완전상융;피막하주수후진행사빈소융잉가견린근복벽소범위작상,수시간연장,피막하충혈간조직발생응고배사;술중전용사빈전겁침말단형성탄화과립,출침과정중치침도출혈,사용명효해면지혈효과가;재능량상동조건하,조단입간혈류후소융조명현증대.결론 다충사빈소융방식구유교호적가행성화안전성,특수부위종류소융병발증증가.
Objective To explore the feasibility and efficacy of multiple-radiofrequency ablation (RFA) in swine liver.Methods One swine undergone percutaneous and intra-operative RFA for three times in succession (an interval of 5 days) guided by real-time ultrasound.Then 6 ablated lesions formed.The outcome of RFA and the change of tissues adjacent to ablated lesions (billiary,liver vascular and abdominal wall) were observed by trans-abdominal ultrasonography (US),contrast enhanced ultrasound (CEUS),intra-operative ultrasound (IOUS) and contrast enhanced computed tomography (CT).Results Bile duct dilatation was found beside primary porta hepatis on US,CT,IOUS after RFA.There was no thrombus in liver vein through the ablated lesion with electrodes parallel to primary porta hepatis.Two ablated lesions were incompletely fused together.Small thermal injury was observed on abdominal wall after an injection of saline into subcapsular gap.Subcapsular hepatic tissue around ablation lesion changed into coagulative necrosis from hyperemia with elapsing time.Carbonizing granule formed during RFA on the top of intro-operative radio-frequency electrode easily caused bleeding along the withdrawing passage.Gelfoam was helpful to stop bleeding during intro-operative RFA.Occluding blood flow into liver definitely enlarged ablated area with the same amount of RFA energy.Conclusion Multiple-RFA is feasible and efficacious for patients with RFA indication.But the complications of RFA increase if the ablation areas are adjacent to such organs as bile duct,stomach,intestine and diaphragm,etc.