肝门部血流对胆管腔内射频消融的影响

Effects of portal blood flow on intraductal radiofrequency ablation

目的观察活体时肝门部胆管腔内射频消融能否形成凝固区，探讨肝门部血流对凝固区大小的影响。方法从6头健康家猪选取14个肝门部胆管靶点，分为非肝门阻断组和肝门阻断组，每组7个胆管靶点。将单极电极针13mm裸露部分置入胆管腔内，输出功率5w，消融时间4min。病理检查胆管和邻近肝组织改变。结果两组剖面均可见半椭圆形灰白色凝固区，凝固区周围有明显的暗红色环状带。光镜下凝固区胆管黏膜层和黏膜下层变性、坏死；肝组织变性；暗红色环状带为肝组织出血。非肝门阻断组和肝门阻断组凝固区平均长轴直径分别为（13．29±1．38）mm、（13．29±1．11）mm，差异无统计学意义（t=0．000，P〉0．05）；凝固区平均短轴直径分别为（3．14±1．07）mm、（4．57±0．98）mm，差异有统计学意义（t=2．611，P〈0．05）。结论活体时肝门部胆管腔内射频消融可形成典型的射频消融区。肝门部血流影响凝固区短轴直径，不影响凝固区长轴直径。

Objective To observe whether coagulation zones can be produced by intraductal radiofrequency ablation （RFA） in vivo and investigate the effect of portal blood flow on the sizes of coagulation zones. Methods Fourteen bile duct targets in hepatic hilar from 6 swines were equally divided into non-Pringle manoeuvre group and Pringle manoeuvre group. A 13 mm segment of non-insulated mono-electrode was inserted into the bile duct, then RFA was performed under the condition of 5 W power output for 4 minutes. The pathological changes of bile duct and adjacent hepatic tissues were observed. Results Semi-oval offwhlte coagulation zones in the sections were observed in both groups, with obvious clark-red rims around them. Necrosis and denaturation of mucosal and submucosal layers of bile duct and denaturation of adjacent hepatic tissue in coagulation zones were observed under optical microscope. The clark-red rims revealed hepatic hemorrhage. The mean long axial diameter of coagulation zones in the non-Pringle manoeuvre group and Pringle manoeuvre group was （ 13.29 ± 1.38 ） mm and （ 13.29±1.11 ） mm, respectively, with no statistical difference （ t = 0. 000, P 〉 0.05 ）. The mean short axial diameter of coagulation zones in the non-Pringle manoeuvre group and Pringle manoeuvre group was （ 3.14 ± 1.07 ） mm and （4.57 ±0.98）mm, respectively, with statistical difference（ t =2.611, P 〈0.05）. Conclusions Intraductal RFA can produce a typical ablation zone. The portal blood flow affects the short axial diameter of coagulation zone but does not affect the long axial diameter.