氩氦刀消融兔胆囊侧肝脏病理学观察

Cryoablation of hepatic region close to the gallbladder: pathological observation in experimental rabbits

目的研究冷冻胆囊侧肝脏的安全性与有效性。方法对靠近胆囊0.5 cm处3只实验兔的肝脏进行氩氦刀消融,观察7 d后肝脏消融区与胆囊的形态及病理学改变,以及血清转氨酶在冷冻后各时段的变化。结果消融7 d后肝脏脏面形成黄色类圆形坏死灶,平均直径为(2.25±0.35)cm。消融区与腹壁(2/3)、膈肌(1/3)、肠系膜(1/3)、胃壁(1/3)和结肠(1/3)发生粘连。1/3实验兔出现胆囊穿孔。光镜下可见广泛肝组织坏死。肝组织结构不完整,肝小叶轮廓隐约可见,肝索和肝板崩解断裂呈空网状,肝窦局部充血、局部有大量退变炎性细胞浸润和少量崩解红细胞,核溶解。1/3实验兔胆囊壁全层坏死,肌层崩解,黏膜消失,坏死区内可见大量均一红染物质。血清谷草转氨酶(AST)及谷丙转氨酶(ALT)水平均在术后显著升高,其中AST呈一过性升高,在术后第7d恢复至正常水平。结论冷冻可有效消融肝脏组织,且可能引起胆囊穿孔。

Objective To investigate the safety and efficiency of freezing ablation on rabbit liver 0.5 cm close to the gallbladder. Methods The probes were placed in liver tissue 0.5 cm close to the gallbladder in 3 New Zealand White Rabbits and ablations were performed with cryoablation procedures. Pathological changes of liver ablation zones and gallbladders were observing for 7 days. Results Ablations were successfully carried out in 3 rabbit for freezing ablation. The animals were sacrificed and liver and gall bladder were resected 7 days later. A circular shaped yellow necrosis zone were observed and the necrosis zone diameters was （2.25 ± 0.35） cm. Different degrees of adhesions were observed between the liver and adjacent organs such as abdominal wall, diaphragm, mesentery, stomach wall and colon. Gall bladder leakage could be found in one third of rabbits. Liver tissue structure was incomplete, lobular contour became faintly visible, fracture and collapse of liver and liver plate mesh were seen, hepatic sinus local hyperemia and a large number of degenerative inflammatory cell infiltration and small amounts of breakdown of red blood cells were also observed. At the same time, full-thickness gallbladder wall necrosis （1/3）, muscular collapse and mucosal disappearance, and a large number of uniform red dye material in necrotic area were found. The expression level of ALT and AST was obviously increased after cryoablation. AST was gradually decreased and reached normal level on the 7th day. Conclusions Cryoablation is an efficiency ablation technique for liver cancer therapy, but it may induce the gallbladder leakage which must be avoided.