聚焦超声手术钳联合声诺维辅助肝部分切除术的实验研究

Experimental study of using focused ultrasound surgical clamp(FUSC)combined with SonoVue for bloodless partial hepatectomy

目的:探讨聚焦超声手术钳(Focused ultrasond surgical clamp,FUSC)在肝部分切除术中应用的可行性和有效性及SonoVue对FUSC的增效作用。方法:12只健康山羊分为Ⅰ组(FUSC组,n=6)为对照组,Ⅱ组(FUSC+SonoVue组,n=6)为实验组。FUSC由固定在钳状手柄上,中轴线重合,能产生两束方向相对应的聚焦超声波的二个超声换能器构成。手术进腹暴露游离肝脏,在超声频率为1.6MHz,声功率为150W条件下,使用FUSC沿制订的预切线对肝脏进行辐照后,行肝左外叶切除术。对照组动物直接接受FUSC辐照肝脏靶区,实验组动物注射声诺维即刻接受FUSC辐照。术后局部取材进行组织病理学检查,记录肝切除术出血量、FUSC辐照时间和手术时间、肝断面面积、术后并发症和死亡率,观察动物血常规、肝功能的变化。结果:所有实验动物无死亡和并发症。Ⅰ组出血量为(16.9±4.2)ml,辐照时间为(174±9)s;Ⅱ组出血量为(16.3±3.5)ml,辐照时间为(122±9)s。Ⅰ组和Ⅱ组在单位面积断面的平均出血量上无显著性差异(P>0.05);Ⅰ组和Ⅱ组在单位面积断面的平均FUSC辐照时间上存在统计学差异(P<0.05)。组织病理学检查可见靶区肝组织凝固性坏死和小血管坏死及闭塞;两组动物手术后血清ALT、AST、TB、DB术后均有一过性的增高,术后7d恢复到术前水平。结论:聚焦超声手术钳辅助肝部分切除术是可行和有效的,具有出血少、手术时间短、操作方便等优越性,联合应用SonoVue可增强FUSC的生物学效应,提高FUSC效率,进一步缩短手术时间。

Objective： To investigate the feasibility and efficacy of focused ultrasound surgical clamp（ FUSC ）for partial hepatectomy, and find out the enhancement effect of SonoVue to FUSC. Methods： Twelve healthy goats were randomly divided into a FUSC group（n=6） in which FUSC was only used for the liver ablation,and a SonoVue ± FUSC group（n=6） in which FUSC was performed immediately after iv injection of ultrasound contrast agent SonoVue. A FUSC was comprised of two ultrasound transducers fixed on a forceps-like handle. The directions of focused ultrasound beams produced by both transducers were opposite, with the same central axes. Ultrasound energy was continuously delivered by two transducers to ablate liver tissue located between both transducers. The frequency was 1.6 MHz,and the acoustic power was 150 W. All goats in both groups underwent laparotomy, and then the liver was totally exposed for an ablative procedure. Blood loss, FUSC exposure time, operation time required for the hepatectomy and the cross-section area of the resected liver were recorded. Histological changes were observed in the removed liver, and 10ml blood samples were collected in each goat to measure blood cells and hepatic functions after surgical procedure. All goats were followed up for complications and survival. Results： After surgical procedure, all animals survived well, and no complications were observed during follow-up period. Mean blood loss and mean exposure time were（16.9±4.2）ml and（174 ± 9）s in the FUSC group,and（16.3 ± 3.5）ml and（122 ± 9） s in the SonoVue±FUSC group respectively. A statistical difference of average FUSC exposure time per unit area（P〈0.05） was significantly observed between two groups. There was no significant difference of average in both groups. Pathological necrosis of the targeted liver severely destroyed, with blood loss per unit area（P〉0.05） examination showed coagulation tissue, and small blood vessels the occlusion of the ablated vessels. There was a transient increase of serum ALT,AST,TB and DB levels postoperatively in all goats,and they reduced to a normal level 7 days after surgical procedure. Conclusion： FUSC is feasible and effective for partial hepatectomy,which has advantage of convenience,less time and blood loss. FUSC combined with microbubble contrast agent（SonoVue） can enhance the biological effects of FUSC and improve the efficiency of FUSC.