摘要
背景与目的:肿瘤在累及肝门区域时,外科切除的难度大,肿瘤易复发。射频消融作为一种成熟的方法在累及肝门区肿瘤治疗中是否具有更大优势,是临床关注的问题。本实验观察单极射频消融时间与消融范围的相关性;对第一和第二肝门区组织消融处理,了解消融对血管及胆管系统的影响及其病理改变。方法:选用健康家猪6只,体重(47.0±2.5)kg/只。常规麻醉,开腹,在每一肝脏实质内共确定3个位点进行射频消融,射频消融基础功率设定为60W,时间分别为3min、5min、10min。对第二肝门的部位和第一肝门的位置分别进行5min和10min射频消融处理,然后关闭腹部伤口,继续饲养7～10天,将猪放血处死,完整取出肝脏。结果:大体标本上不同时间产生的结果为组织消融范围不同,均呈椭圆型。3min、5min、10min消融时间产生坏死区长径分别为(2.7±0.2)cm、(4.6±1.1)cm、(5.8±0.7)cm;在大体标本上第一和第二肝门区消融坏死范围宽径分别为(3.2±1.1)cm、(3.3±0.4)cm,第一肝门区和第二肝门区血管壁、胆管系统未见有明确破坏,病理结果显示血管壁和胆管壁有炎症细胞浸润。第二肝门区消融,病理结果显示:5只邻近血管壁的消融区域完全坏死,1只显示在邻近血管壁正常肝组织中合并有大片状坏死。第一肝门区消融结果,病理分析消融中心部位肝组织完全坏死,4只邻近血管壁的消融区域完全坏死,2只显示在邻近血管壁正常肝组织中合并有大片状坏死。结论:射频消融时间影响消融组织的坏死范围。消融对门静脉、肝动脉、肝门区胆管系统影响较少,在肝门区组织中实行消融是安全的。
BACKGROUND ＆ OBJECTIVE： When tumor invaded the hepatic portal, the difficulty of surgical resection is increased and the probability of hepatic tumor relapse is increased. Whether the perfused needle radiofrequency ablation （RFA）, as a mature technique, has more advantages in the treatment of tumors involving the portal region is a hot topic in clinic. This study was to investigate the correlation of ablation time to tumor necrosis area, and observe the pathologic changes of the vessel and bile duct after application of perfused needle RFA in the first and second portal region parenchyma in swine. METHODS, Six healthy swine weighted （47.0±2.5） kg were treated with RFA at 60 W in 5 areas of the liver： 3 min, 5 min, and 10 min for 3 regions in different segments, 10 min for the first portal region, and 5 min for the second portal region. The swine were killed at 7-10 days after RFA. The necrosis area was measured. The pathologic changes of the vessel and bile duct were observed. RESULTS： In the hepatic parenchyma, the necrotic areas were oval, the length diameters of necrotic areas were （2.7±0.2）, （4.6±1.1）, and （5.8 ±0.7） cm respectively when ablated for 3, 5, and 10 min. In the first and second hepatic portal regions, the width diameters of necrotic areas were （3.2±1.1） cm and （3.3± 0.4） cm; no obvious damage was observed in the vessel and bile duct, but chronic inflammation was observed in the wall. In the second hepatic portal region, hepatic tissue close to the vessel wall showed complete necrosis in 5 swine and partial necrosis in 1 swine after ablation; in the first hepatic portal region, hepatic tissue close to the vessel wall showed complete necrosis in 4 swine and partial necrosis in 2 swine after ablation. CONCLUSIONS： The necrotic area in ablated tissue is enlarged along with the duration of RFA. Ablation has little impact on the vessel and bile duct grossly and microscopically, therefore, it is safe for the hepatic portal area.
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2007年第11期1194-1198,共5页
Chinese Journal of Cancer
基金
广东省自然科学基金项目(No.06021218)~~
关键词
消融
单极射频
肝脏
猪
安全性
Radiofrequency
perfused needle
Liver
Swine
