高强度聚焦超声治疗外伤性猪肝破裂出血的实验研究

Treatment of hemostasis of traumatic hepatic injuries in pigs with high intensity focused ultrasound

目的探讨高强度聚焦超声（high intensity focused ultrasound,HIFU）治疗猪肝外伤性出血的安全性、有效性、可行性及其止血机制。方法健康猪25只随机分为HIFU组（20只）和对照组（5只）。用手术刀在猪肝脏上分别制作以下三种外伤：切割伤42条,长40 mm,深10-20 mm;贯通伤18处,直径15 mm,深20 mm;撕脱伤13处,长60-100 mm,厚25 mm。HIFU组接受HIFU止血治疗,对照组不做止血处理。结果肝外伤在HIFU处理后立即停止出血,未发生再出血或死亡,而对照组动物在30-80min内因失血过多死亡;平均止血时间分别为切割伤27s,贯通伤71s,撕脱伤218s;止血后即刻治疗区平均温度82℃;除治疗后第一天血清AST有一过性升高外,肝肾功能其它各项指标均无明显变化;病理学检查发现治疗区肝细胞和肝内血管壁出现凝固性坏死,血管腔内开始有红色血栓形成,逐渐被混合血栓替代。结论肝外伤时HIFU使破裂血管和出血组织出现凝固性坏死而发挥止血作用。HIFU治疗各种肝外伤性出血是安全、有效和可行的。

Objective The purpose of this study was to investigate the safety,efficacy,and feasibility of HIFU in the treatment of the traumatic hepatic bleeding,and to explore the mechanism of HIFU hemostasis.Methods 25 healthy pigs were randomly divided into HIFU group（n=20） and control group（n=5）.Three types of injury were made on livers as follows： 42 surgical incisions with 40 mm length and 10-20 mm depth,18 perforating wounds with 15 mm diameter and 10-20 mm depth and 13 avulsed wounds with 60-100 mm length and 25 mm depth.The pigs in HIFU group received HIFU treatment for hemostasis,but the pigs in control group did not receive any intervention.Results HIFU successfully stoped the bleeding of various liver injuries.All pigs in HIFU groups survived,and no re-bleeding was detected after HIFU treatment.But,animals in control group died of blood loss 30-80 minutes after liver injuries.The mean hemostatic times for surgical incisions,penetrating wounds,and avulsed wounds were 27s,71s,and 218s,respectively.The mean temperature was 82℃ in treated tissue immediately after bleeding stop.There was no change in functions of liver and kidney but a transient elevation of serum AST was detected one day after treatment.Pathological examination revealed coagulative necrosis of hepatic tissue,including liver cells and vascular walls induced directly by HIFU.Red thrombosis was observed in vascular cavity immediately after HIFU,and was gradually replaced by mixed thrombus.Conclusion By inducing coagulative necrosis of rupture vascular vessels and bleeding tissue,HIFU can successfully stop the bleeding of various liver injuries.HIFU could be safe,effective,and feasible in the treatment of hepatic bleeding caused by abdominal trauma.