射频消融肝脏膈面致膈肌损伤的研究

Diaphragmatic injury after radiofrequency ablation for the liver ahutting the diaphragm in a rabbit model

目的观察射频消融（RFA）膈下肝脏导致膈肌损伤的病理改变及其转归。方法10只新西兰白兔的膈下肝脏行开腹RFA，制作膈肌损伤模型。RFA后1周和4周行腹部增强CT检查。第2次增强CT后处死兔，行大体标本和病理学观察。结果RFA后即刻观察，见膈肌损伤区呈暗灰色，边缘呈灰白色，与正常膈肌分界清晰；膈肌损伤区而积为（0．89±0．19）cm。；无膈肌穿孔发生。RFA后1周和4周增强CT，无胸水、腹水、膈肌穿孔等征象。RFA后4周大体标本检查，膈肌损伤区域瘢痕形成，边缘明显肥厚；损伤膈肌与肝消融灶表而紧密粘连；瘢痕区面积为（0．73±0．17）cm^2，无膈肌穿孔。病理学检查，膈肌损伤区肌纤维完全消失，纤维组织代偿性增厚；膈肌损伤区边缘肌纤维数目减少，排列紊乱；肌间隙纤维组织轻度增生，淋巴细胞浸润。结论膈下肝脏RFA可致膈肌全层损伤，但这种损伤可通过瘢痕修复，不会发生膈肌穿孔等严重并发症。

Objective To assess the pathological changes and outcome of diaphragmatic injury after radiofrequency ablation （RFA） for the liver abutting the diaphragm in order to provide a theoretical sup- port of percutanous RFA for hepatocellular carcinoma abutting the diaphragm. Methods The animal mod- els of diaphragmatic injury were made by open surgery RFA for the liver abutting the diaphragm in 10 New Zealand rabbits. Helical enhanced computed tomography （CT） was performed one week and 4 weeks after RFA. The 10 rabbits were killed immediately after the second enhanced CT, and all diaphragmatic lesions underwent gross and histologic examinations. Results Immediately after RFA, the diaphragmatic lesions were gray with an outer pale rim, and no diaphragmatic perforation occurred. The boundaries between lesions and normal area were clear. The area of diaphragmatic lesions was （0. 89 ±0. 19 ） cm^2. No major complications, such as diaphragmatic perforation, pleural effusion and ascites, were detected on the postablation CT scan （one week or 4 weeks after the procedure）. At gross inspection 4 weeks after RFA, the diaphragmatic lesions became scar-like tissue with hypertrophy of margin. Adhesion formed between the diaphragmatic lesions and the surface of hepatic RFA lesions. The area of scar was （0. 73 ±0. 17） cm^2. No diaphragmatic perforation was found. On microscopic examination 4 weeks after RFA, the muscle in diaphragmatic lesions disappeared and became fibrous. Diminution, disorder and degeneration of the muscle were found in the outer rim of diaphragmatic lesions, which were replaced by fiber and lymphocyte. Conclusion It is possible to cause full-thickness diaphragmatic injury when adjacent liver is treated with RFA, but it can be repaired by scarring and there is no diaphragmatic perforation.