肝内大胆管旁射频消融治疗的安全性研究

The safety of radiofrequency ablation near major intrahepatic bile ducts

目的评估于犬肝内大胆管旁进行射频消融（radiofrequencyablation，RFA）治疗的安全性，为临床预防RFA造成胆管损伤提供实验依据。方法健康成年杂种犬40只，随机分为4组，每组10只，雌雄不限。RFA射频针统一张开直径为（20．0--4-_0．3）mm。RFA治疗时，能量由小到大序贯使用。开始能量为5W，以后每1min升高5W。于距肝内大胆管不同距离（1．0～2．9mm、3．0h4．9mm、5．O～7．9mm、8．0～10．0mm）肝组织行RFA，观察治疗后不良反应、并发症、胆红素变化及胆管的病理学改变。结果距肝内大胆管1．O～2．9mm肝组织行RFA，术后一般情况差，胆红素升高明显，大部分发生严重并发症，胆管病理见明显坏死；距离3．0～4．9mm行RFA，术后一般情况差，胆红素升高，可发生严重并发症，胆管病理可见坏死和空泡样变性；5．0～10．0mm时，术后一般情况好，胆红素轻微升高，未见严重并发症发生，大部分胆管病理改变仅为上皮细胞空泡样变性或正常。结论于肝内大胆管旁进行RFA时，射频针尖距离肝内大胆管≥5mm时有较好的安全性。

Objective This study was conducted to assess the safety of radiofrequency ablation （RFA）in treating dog hepatic tissue near major intrahepatic bile ducts in order to provide data for ra- tional use in clinical practice. Methods RFA was conducted on 40 dogs that were divided randomly into four groups. The RFA needles had a diameter of （20.0±0. 3）mm, and the RFA power started at 5 W and increased 5 W each minute. The RFA treated hepatic tissues were various distances to intra hepatic bile ducts（1.0 2.9 mm, 3.0-4.9 mm, 5.0-7.9 mm, 8.0-10.0 mm）. After RFA, the compli- cations, reactions, presence of bilirubin in blood, and pathological changes of the bile ducts were ob- served. Results When RFA treated hepatic tissue was 1.0 to 2.9 mm from major intrahepatic bile ducts, the general postoperative state of the dog was worse, the bilirubin had increased, there were serious complications, and the associated intrahepatic ducts had complete necrosis. When RFA treated hepatic tissue was 3.0 to 4.9 mm away from major intrahepatic bile ducts, the general postoperative state of the dog was worse, the bilirubin had increased, there were serious complications, and parts of the correlated intrahepatic bile ducts were necrotic or possessed vacuolar degeneration. When RFA treated hepatic tissue was 5.0 to 10 mm away from major intrahepatic bile ducts, the general postoper- ative state was good, the bilirubin had only increased slightly, there were no serious complications, and the associated bile ducts were either normal or had vacuolar changes. Conclusions Therefore, it is safe to perform RFA over 5mm in distance to the major intrahepatic bile ducts.