聚焦超声手术钳对肝脏损伤模式的初步研究

Preliminary study of the destructive characteristics of the liver induce by focused ultrasound surgical clamp

目的:观察聚焦超声手术钳(Focused ultrasound surgical clamp,FUSC)对离体肝脏的损伤模式。方法:FUSC由固定钳状手柄上,中轴线重合,能产生2束方向相对应的聚焦超声波的2个超声换能器构成。在超声频率为1.6MHz,声强(ISPPA)12000W/cm2条件下,对厚度4～10cm离体牛肝进行双面连续扫描辐照后,记录牛肝达到贯通性凝固性坏死的辐照时间,测量离体牛肝凝固性坏死性状的形状和特征,观察组织病理学的变化。结果:FUSC对所有厚度的肝组织均能造成贯通的凝固性坏死。凝固性坏死的形状与FUSC的声场形态基本一致,长度为2.72～3.20cm,宽为1.44～1.80cm。在相同声功率下,随着牛肝厚度增加,造成靶区贯通性凝固性坏死的时间随之增加。结论:FUSC对离体牛肝进行辐照,能造成预定靶区肝组织的贯通性凝固性坏死。本实验为肝切除术提供了一种新的手术器械。

Objective：To observe the destructive characteristics of the bovine liver induced by focused ultrasound clamp technique. Methods：A focused ultrasound surgical clamp（FUSC） consisted of two transducers fixed on a forceps-like handle. The directions of focused ultrasound beams were opposite,with the same central axes. The thickness of bovine liver in vitro ranged from 4 to 10cm. Ultrasound energy was continuously delivered to ablate the liver with a frequency of 1.6MHz,and spatial peak pulse average acoustic intensity（ISPPA） of 12 000W/cm^2. The characteristics of complete coagulation necrosis and exposure time were measured after FUSC exposure,and pathological changes in treated bovine liver tissue were observed. Results：FUSC induced complete coagulation necrosis of predetermined bovine liver targets. The shape of coagulation necrosis was corresponded with focused ultrasound beam,with 2.72 - 3.20cm in length and 1.44- 1.80cm in width. However,under the same exposure energy,exposure time for complete necrosis increased,as the thickness of the liver increased. Conclusion：FUSC can induce complete coagulation necrosis of predetermined bovine liver targets. This study would provide a novel surgical instrument for hepatectomy.