超声造影结合腹腔镜经皮射频凝固治疗闭合性肝外伤的实验研究

Therapy in Hemorrhage of Blunt Hepatic Trauma Using Percutaneous Radiofrequency Ablation Combined with CEUS and Laproscope in Pigs

目的研究超声造影结合腹腔镜直视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实验猪肝区,建立闭合性活动性出血的肝外伤模型,损伤程度为II～IV级。将肝外伤模型分成治疗组(12只)和对照组(4只)。采用超声造影及腹腔镜直视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。结果超声造影准确判断肝脏损伤范围,腹腔镜引导穿刺治疗成功,12只模型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伴血液自破裂口持续外溢。1h后,治疗组动脉收缩压平稳,对照组动脉收缩压继续缓慢下降,治疗组失血量明显少于对照组(P<0.05)。结论超声造影结合腹腔镜经皮射频凝固能准确、快速、安全、有效地控制猪闭合性肝外伤的活动性出血。

Objective To study the feasibility of percutaneous radiofrequency ablation combined with contrast-enhanced ultrasonography （CELTS） and laproscope to heal hemorrhage of blunt hepatic trauma in pigs. Methods Sixteen pigs were randomly divided into treatment group （12 cases） and control group （4 cases）. Self-made miniature impactor was used to make models of blunt hepatic trauma with active bleeding. Location and degree of injury were confirmed by CELTS and laproscope. Laproscope was also used to guide the insertion of radiofrequency electrodes and monitor the treatment effect. Percutaneous radiofrequency ablation was performed to heal the active bleeding. The control group was not treated. The pathologic examinations were performed. Results In the treatment group, hemorrhage were successfully controlled after the first treatment of percutaneous radiofrequency ablation in 12 cases. Active bleeding was also stopped in another two cases after the second radiofrequency treatment. In the control group, the liver capsules and parenchyma ruptures and hemorrhage occurred in all cases. One hour after the treatment, the blood pressures were stable in treatment group, but unstable and decreased gradually in control group. The amount of blood loss of treatment group was less than that of the control group. Conclusion Percutaneous radiofrequency ablation combined with CEUS and laproscope can rapidly, safely and efficiently control hemorrhage of blunt hepatic trauma in pigs.