不可逆电穿孔消融兔胆囊侧肝脏病理学观察

Irreversible electroporation ablation of the hepatic region close to the gallbladder: pathological observation in experimental rabbits

目的研究靠近胆囊0.5 cm处不可逆电穿孔肝脏消融的安全性和有效性。方法采用新西兰白兔3只作为实验动物,在靠近胆囊0.5 cm处肝脏进行不可逆电穿孔消融,并于7 d后观察消融区域的肝脏病理反应和胆囊损伤情况。结果 3只动物均成功完成消融。消融7 d后,肝脏面原消融区平均直径3.00 cm黄色坏死灶,肝膈面形成1个平均直径1.67 cm类圆形黄色坏死灶。2只实验兔消融部位和腹壁、1只肝叶和膈肌发生小片段浅度粘连。2只肠系膜则与胆囊消融灶区发生严重粘连。光镜下可见肝大片坏死且消失,仅有部分凝固性坏死肝组织残留,外围有少量斑点状钙化,炎性肉芽组织和小胆管显著增生。肝门静脉血管平滑肌损伤不明显,肌层小范围纤维素样变性、胆囊黏膜上皮大部分坏死,胆囊外结缔组织水肿、胆总管部分黏膜上皮坏死,部分上皮仍存在,肌层完好。结论消融部位肝脏组织完全坏死,消融灶和周围组织分界明显,胆囊出现损伤,但无胆囊漏发生。因此,对于靠近胆囊的肝脏肿瘤而言,不可逆电穿孔可能是一种相对安全有效的选择。

Objective To investigate the safety and efficacy of irreversible electroporation （IRE） ablation of hepatic region close （0.5 cm） to the gallbladder. Methods Three New Zealand white rabbits were used for this study. The IRE probes, which were placed in the hepatic tissue, were 0.5 cm apart from the gallbladder, and IRE ablation was performed. Seven days after the treatment the pathological changes of the hepatic ablated zones and gallbladders were examined. Results Successful IRE ablation was accomplished in all 3 rabbits. Seven days after the treatment the experimental rabbits were sacrificed, and their livers and gallbladders were collected and sent for pathological examination. Macroscopically, the hepatic surface of the ablated area showed a yellow necrotic lesion, which was （3.00 ＆#177; 0.50） cm in size. At the diaphragmatic surface of the liver a round yellow lesion was seen with a size about （1.67 ＆#177; 1.15） cm. Slight superficial adhesion could be seen at the ablated areas and abdominal wall （n=2）, hepatic lobe （n=1） and diaphragm （n=1）. Serious adhesion of mesentery with the ablated gallbladder was seen in two rabbits. Microscopically, massive necrosis or disappearance of the hepatic tissue together with a little residual hepatic coagulation necrosis and speckled calcifications at the peripheral region could be detected. Inflammatory granulation and prominent proliferation of the tiny biliary ducts were also observed. The damage of the vascular smooth muscle in the portal vein was not obvious. Small area of fibrinoid degeneration was seen in the muscular layer. Mucosal epithelial necrosis of the gallbladder and connective tissue edema outside the gallbladder could also be observed. Conclusion Complete necrosis of the hepatic tissue at the ablated area can be achieved by IRE ablation. The ablated zone has a clear demarcation with the surrounding tissue. No gallbladder leakage occurs although the gallbladder is damaged. Therefore, for the hepatic tumors, which are located close to the gallbladder, irreversible electroporation ablation may be regarded as a relatively safe and effective treatment.（J Intervent Radiol, 2014, 23：320-324）.