高强度聚焦超声联合碘油栓塞损伤肝脏的病理转归及肝、肾功能的变化

Pathological regression of the liver and functional changes of the liver/kidney following combined transcatheter arterial embolization with HIFU ablation

目的探讨肝脏局部碘油栓塞联合高强度聚焦超声(HIFU)热切除术后,坏死组织的病理转归及肝、肾功能的变化,阐明联合治疗的安全性。方法10只山羊,肝左叶动脉碘油栓塞和局部HIFU热切除后,分为A、B二组,各5只。A组动物定期观察坏死组织的动态病理变化,而B组则动态观察术后的肝、肾功能变化。结果肝脏碘油栓塞和HIFU治疗后可形成明显的凝固性坏死灶并引起肝、肾功能的明显变化。但随着时间延长,坏死灶逐渐溶解吸收、纤维化,肝肾功能也逐渐恢复正常。结论局部肝脏碘油栓塞联合高强度聚焦超声热切除术是安全的。

Objective To explore the histopathological regression of necrotic tissue in the liver and functional changes of liver/kidney following combined hepatic artery embolized by lipiodol with localized ablation by high intensity focused ultrasound （HIFU）, and the security of combination therapy. Methods Ten goats were divided into two groups of A and B with 5 in each group. The morphologic changes of livers for group A were examined at the 1st, 3rd, 7th, 14th, 21st day after combined lipiodol embolization and localized ablation by HIFU. The liver and renal function tests were examined according similar to group A. Results Tissue structure of the liver was ruptured immediately after HIFU treatment. Clear demarcations separating coagulative necrosis from the nonradiative tissues were seen on the third day. Fibroplastic proliferation was observed at 14th day and later. The destructive tissue could be replaced by scarring tissue. There were obvious changes in liver functional tests after lipiodol embolization or after combined lipiodol embolization and HIFU ablation, but recovered gradually. No evident changes were found in renal function tests. Conclusion Combination therapy of transcatheter arterial embolization with high intensity focused ultrasound was a safe method in the ablation of liver.