射频消融联合无水乙醇注射治疗肝癌协同效果的实验研究

The experimental study of synergistic effect of radiofrequency ablation combined with percutaneous ethanol injection

目的研究不同方式的射频消融（RFA）与无水乙醇（PEI）联合应用对正常兔肝脏的消融效果。方法采用24只活体新西兰大白兔正常肝脏进行研究。分为4组，每组6只。A组为RFA后PEI组：1cm单极射频针射频3min＋局部注射PEI1．5ml；B组为PEI后RFA组：局部注射PEI1.5ml＋局部1cm单极射频针射频3min；C组为RFA组：局部1cm单极射频针射频3min；D组为PEI组：局部注射PEI1．5ml。观察各组RFA术中的电阻、电流及单位消融体积能耗，行肝脏增强CT扫描分析各组消融灶大小、形态、体积、类圆率的情况。结果B组消融长径和短径[分别为（24．1±4．4）mm和（21．4±4．O）mm]显著大于c组[分别为（12．4±1．6）mm和（11．1±1．4）mm]、D组[分别为（7．7±2．3）mm和（5．1±1．5）mini（P〈0．01）。在高径和消融体积上，B组[分别为（20．3±4．9）mm。和（5879±2607）mm。]显著大于A组[分别为（14．8±2．7）mm。和（3130±1250）mm2]、c组[分别为（10．7±1．6）mm。和（767±173）mm。]、D组[分别为（6．7±1．0）mm。和（146±83）mm。]（P〈0．01）。B组产生的消融灶类圆率最高，两两比较各组类圆率差异无统计学意义（P〉o．05）。B组RFA术中电阻显著高于A组及C组（P〈0．05），B组RFA术中电流显著低于A组及C组（P〈0．05）。单位消融体积能耗A组、B组显著低于C组（P〈0．01）。结论PEI后RFA组产生的消融体积明显大于RFA后PEI组、RFA组、PEI组；PEI后RFA组单位消融体积能耗最低；PEI后RFA组产生的消融灶类圆率最高。

Objective To evaluate the validity of percutaneous radiofrequency ablation（RFA） combined with percutaneous ethanol injection（PEI） with different style in rabbit liver in vivo. Methods Twenty-four New Zealand white rabbits were included in this study and divided into four groups. Group A：RFA before PEI（n 6）, RFA （1 cm mono-electrode, maintain 3 minutes RFA） before PEI 1.5 ml Group B： PEI before RFA （n=6）, PEI 1.5 ml before RFA （1 em mono-electrode, maintain 3 minutes RFA） Group C： RFA （1 cm mono-electrode, maintain 3 minutes RFA） only （n= 6） Group D.. PEI （1.5 ml） only（n=6）. To analyze the resistance, current and energy requirement per unit of each group including RFA. To observe the size, shape, isoperimetric ratio and volume of coagu- lated necrosis of each group by enhanced CT. Results The longest diameter and the shortest diameter of group Bl-respeetirely, （24.1±4.4） mm and （21.4±4.0） mm2 were significantly larger than group C respectirely, （12.4±1.6） mm and （11.1±1.4） mini and group Drespectirely, （7.7±2.3） mm and （5.1±1.5） mm] （P〈0.01）. The height diameter and volume of coagulated necrosis of group B Erespectirely, （20.3±4.9） mm3 and （5879 4-2607） mm3] were significantly larger than the other 3 groups [（14.8±2.7） mm3 and （3130±1250） mma, （10.7±1.6） mm3 and （767±173） mm3, （6.7±1.0） mm3 and （146±83） mm3] in A, C, and a group （P〈0.01）. Isoperimetric ratios of abla- tion zone in group B was the most highest. There were no statistically significant between each group （P〉0.05）. The resistance of group B were significantly larger than group A and group C （P〈0.01）.The current of group B were significantly lower than group A and group C （P〈0.05）. The energy re- quirement per unit of group A and group B were significantly lower than group C （P〈0.01）. Conclusion The volume of coagulated necrosis of group PEI-RFA was significantly larger than the other 3 groups. The energy requirement per unit of group PEI RFA were the lowest in each group. The isoperimetric ratio of group PEI-RFA was the most highest.