腹腔镜直视下经皮射频凝固治疗猪闭合性肝外伤的可行性研究

A feasibility study of controlling hemorrhage of blunt hepatic trauma in pigs by using laproscope combined with percutaneous radiofrequency ablation

目的研究腹腔镜直视下经皮射频凝固治疗闭合性肝外伤的可行性。方法采用自制小型撞击器撞击16头猪肝区,建立闭合性肝外伤伴活动性出血模型,损伤程度为Ⅱ~Ⅳ级。将动物模型分为两组：治疗组（12头）和对照组（4头）。采用超声及腹腔镜确定损伤程度和部位,在腹腔镜直视下经皮穿刺将射频针置入治疗组肝损伤区进行凝固止血治疗。对照组不作任何治疗。病理检查验证。结果腹腔镜直视下引导穿刺治疗,8头动物模型1次性射频凝固治疗后,成功控制肝活动性出血。4头一次凝固治疗后仍有肝活动性出血,重新布针经再次射频凝固治疗后成功止血。对照组肝包膜及肝实质呈不同程度的破裂,均可见血液自破裂口持续外溢。治疗1h后,治疗组动脉收缩压平稳,对照组动脉收缩压不稳并继续缓慢下降,治疗组失血量明显少于对照组。结论腹腔镜直视下经皮射频凝固能快速、安全、有效地控制猪闭合性肝外伤的活动性出血,有望成为一种微创治疗闭合性肝外伤的新方法。

Objective To study the feasibility of laproscope combined with percutaneous radiofrequency ablation at controlling hemorrhage in blunt hepatic trauma in pigs. Methods Sixteen pigs were randomly divided to treatment group （12 cases） and control group （4 cases）. Self-made miniature impactor was used to impact these animals to make models of blunt hepatic trauma with active bleeding. Laproscope was used to guide the insertion of radiofrequency electrodes and to monitor the treatment effect. Percutaneous radiofrequency ablation was performed to stop active bleeding. The control group was not treated. The results were compared with pathologic examinations. Results In the treatment group, hemorrhage were successfully controlled after the first treatment of percutaneous radiofrequency ablation in all cases except two. Active bleeding was stopped in the left after the second radiofrequency treatment. In the control group, the liver capsules and parenchyma ruptures occurred and hemorrhage were found in every case. One hour after the treatment, the blood pressures were stable in the treatment group. The blood pressures in the control group were unstable and decreased gradually. The blood loss of the treatment group was less than that of the control group. Conclusion Laproscope combined with percutaneous radiofrequency ablation can control hemorrhage of blunt hepatic trauma in pigs rapidly, safely and efficiently, which may be a new approach to treat blunt hepatic trauma.