CAJ | 학술논문

目的评估于犬肝内大胆管旁进行射频消融(radiofrequency ablation,RFA)治疗的安全性,为临床预防RFA造成胆管损伤提供实验依据.方法健康成年杂种犬40只,随机分为4组,每组10只,雌雄不限.RFA射频针统一张开直径为(20.0±0.3)mm.RFA治疗时,能量由小到大序贯使用.开始能量为5W,以后每1 min升高5W.于距肝内大胆管不同距离(1.0～2.9 mm、3.0～4.9 mm、5.0～7.9 mm、8.0～10.0 mm)肝组织行RFA,观察治疗后不良反应、并发症、胆红素变化及胆管的病理学改变.结果距肝内大胆管1.0～2.9 mm肝组织行RFA,术后一般情况差,胆红素升高明显,大部分发生严重并发症,胆管病理见明显坏死；距离3.0～4.9 mm行RFA,术后一般情况差,胆红素升高,可发生严重并发症,胆管病理可见坏死和空泡样变性；5.0～10.0 mm时,术后一般情况好,胆红素轻微升高,未见严重并发症发生,大部分胆管病理改变仅为上皮细胞空泡样变性或正常.结论于肝内大胆管旁进行RFA时,射频针尖距离肝内大胆管≥5 mm时有较好的安全性.
목적 평고우견간내대담관방진행사빈소융(radiofrequency ablation,RFA)치료적안전성,위림상예방RFA조성담관손상제공실험의거.방법 건강성년잡충견40지,수궤분위4조,매조10지,자웅불한.RFA사빈침통일장개직경위(20.0±0.3)mm.RFA치료시,능량유소도대서관사용.개시능량위5W,이후매1 min승고5W.우거간내대담관불동거리(1.0～2.9 mm、3.0～4.9 mm、5.0～7.9 mm、8.0～10.0 mm)간조직행RFA,관찰치료후불량반응、병발증、담홍소변화급담관적병이학개변.결과 거간내대담관1.0～2.9 mm간조직행RFA,술후일반정황차,담홍소승고명현,대부분발생엄중병발증,담관병리견명현배사；거리3.0～4.9 mm행RFA,술후일반정황차,담홍소승고,가발생엄중병발증,담관병리가견배사화공포양변성；5.0～10.0 mm시,술후일반정황호,담홍소경미승고,미견엄중병발증발생,대부분담관병리개변부위상피세포공포양변성혹정상.결론 우간내대담관방진행RFA시,사빈침첨거리간내대담관≥5 mm시유교호적안전성.
Objective This study was conducted to assess the safety of radiofrequency ablation (RFA)in treating dog hepatic tissue near major intrahepatic bile ducts in order to provide data for rational use in clinical practice.Methods RFA was conducted on 40 dogs that were divided randomly into four groups.The RFA needles had a diameter of (20.0±0.3)mm,and the RFA power started at 5 W and increased 5 W each minute.The RFA treated hepatic tissues were various distances to intrahepatic bile ducts(1.0-2.9 mm,3.0-4.9 mm,5.0-7.9 mm,8.0 10.0 mm).After RFA,the complications,reactions,presence of bilirubin in blood,and pathological changes of the bile ducts were observed.Results When RFA treated hepatic tissue was 1.0 to 2.9 mm from major intrahepatic bile ducts,the general postoperative state of the dog was worse,the bilirubin had increased,there were serious complications,and the associated intrahepatic ducts had complete necrosis.When RFA treated hepatic tissue was 3.0 to 4.9 mm away from major intrahepatic bile ducts,the general postoperative state of the dog was worse,the bilirubin had increased,there were serious complications,and parts of the correlated intrahepatic bile ducts were necrotic or possessed vacuolar degeneration.When RFA treated hepatic tissue was 5.0 to 10 mm away from major intrahepatic bile ducts,the general postoperative state was good,the bilirubin had only increased slightly,there were no serious complications,and the associated bile ducts were either normal or had vacuolar changes.Conclusions Therefore,it is safe to perform RFA over 5mm in distance to the major intrahepatic bile ducts.