射频联合多齿针无水酒精注射的实验研究

Radiofrequency ablation combined with ethanol injection by multi-pronged injection needle in a hepatic porcine model

目的探讨单纯射频与射频联合多齿针无水酒精注射对活体猪肝脏的消融毁损情况。方法将健康家猪1 2头分为2组:A组为射频联合多齿针无水酒精注射组(RFA+EI组),B组为单纯射频消融组。分别记录每次射频消融达到最高阻抗时的时间及相应功率值,消融完成后均即刻将猪处死,取出肝脏,沿射频针道方向切开毁损灶,观察并测量其毁损范围大小,在每个毁损灶的中心、边缘及距边缘旁1 cm处取材送检,观察其病理学变化。结果病理检查显示,消融毁损灶中央组织均呈完全性坏死,边缘组织可见变性、坏死、充血、出血、血管腔堵塞及炎性细胞浸润现象,距边缘旁1 cm处少量细胞变性和大量白细胞、淋巴细胞浸润,未见有组织坏死。RFA+EI组标本中组织炭化现象普遍较RFA组轻。RFA+EI组毁损灶平均最长直径为(4.7±0.4)cm,RFA组为(4.1±0.2)cm(P<0.0 5)。RFA+EI组平均射频毁损时间为(9.8±0.9)m in,RFA组为(1 4.7±1.3)m in(P<0.0 5)。结论射频联合多齿针无水酒精注射具有协同作用,可增大肝组织消融毁损范围,缩短射频消融时间。

Objective To compare radiofrequency ablation （RFA） alone and RFA combined with ethanol injection （ EI ） by multi-pronged injection needle （ Quadra-Fuse ） in ablating the pig liver. Methods Twelve pigs were divided into two groups. Groups A underwent a combination of RFA and EI ablation of the liver, group B underwent RFA alone as control. All pigs were sacrificed immediately after treatment. Ablated area with surrounding liver parenchyma was excised for gross and histological examination. Results The longest diameter of ablation area of the liver was 4. 7 ＋0. 4cm and 4. 1±0. 2cm in group A and group B, respectively （ P 〈 0.05 ）. The durations of ablation in group A and group B were 9.8 ± 0.9 and 14.7±1.3rain, respectively （ P 〈 0.05 ）. Histological staining revealed no viable hepatocytes from the center to margins of the ablated area in two groups. There was a zone of transition surrounding the ablated necrotic area that showed hepatocytes degeneration, necrosis, hyperemia and hemorrhage, etc ; infiltration of leucocytes and lymphocytes could be seen in tissues I cm distal to the margin of necrotic area. Conclusions RFA combined with ethanol injection can induce more great necrotic area and short ablating time than that of RFA alone did in normal pig liver tissue.