氩氦刀治疗实验性肝肿瘤并发出血的原因研究

Reasons of hemorrhage after argon-helium cryoablation in rabbits with experimental liver tumor

目的探讨肝癌氩氦刀冷冻治疗并发出血的原因,探索出血防治方法。方法将VX2肿瘤细胞株移植于45只大白兔肝内建立实验性肝肿瘤模型,对45只荷瘤兔的61个肿瘤进行氩氦刀治疗,观察出血的发生;术后3 d对大白兔进行320排CT增强扫描,观察治疗靶区血流灌注情况。结果(1)61个肿瘤中出血阳性判定者6个,出血发生率为9.8%。有3个肿瘤是因为冰球破裂出血,其中2个肿瘤位于同一只大白兔肝上(该2个肿瘤中的1个第2次氩氦刀时因为进针过深,导致肿瘤本身及毗邻肿瘤的冰球破裂出血),另1例是氩氦刀结束时,冰球尚未完全融化,拔刀时用力过猛导致冰球破裂出血。其余3例中,1例是在冻融过程中由于用力牵拉冰球,导致冰球与正常肝组织连接处撕裂出血;2例是在氩氦刀结束后,冰球融化,穿刺通道出血。(2)术后3 d行CT扫描发现治疗靶区小血管闭塞,大血管血流正常。结论肝癌氩氦刀作为一种微创技术,仍有出血的风险存在。出血的时间主要发生在围手术期,与不规范操作及操作过急有关,术后24 h后治疗靶区小血管闭塞,死亡风险较低。

Objective To explore the bleeding causes in argon-helium cryoablation treatment of hepatocarcinoma and the prevention and treatment method.Methods The rabbit hepatocarcinoma model was established by transplanting VX2 tumor cell line to the rabbit liver.A total of 61 tumors of 45 tumor-bearing rabbits were treated by argon-helium cryoablation.The occurrence of bleeding was observed.The 320 row CT enhanced scan was performed three days after operation to observe the blood perfusion of treatment target regions.Results Hemorrhage sign appeared in 6 out of 61 tumors,thus the incidence of hemorrhage was 9.4%.The bleeding of three tumors（two located in the same rabbit）was due to fracture of ice ball：the hemorrhage in one of two tumor in same rabbit occurred in the ice balls of tumor itself and adjacent tumor because cryoprobe was inserted deeply at the second time of argon-helium cryoablation treatment to cause bleeding;the hemorrhage in the tumor of another rabbit occurred in the end of argon-helium cryoablation treatment because of excessive force in pulling out the cryoprobe when the ice ball was not melted enough.In the remaining three tumors,bleeding of one tumor was laceration bleeding in joining position of ice ball and normal liver tissues because of excessive force in stretching the ice ball during process of freeze-thaw;the bleeding of other 2 tumors occurred in puncturing passage because of ice ball thawing after the end of argon-helium cryoablation treatment.The CT scanning three days after operation demonstrated that the small vessels in target region of treatment were occluded,but the blood flow of large vessels was normal.Conclusions As a minimally invasive technique for the treatment of hepatocarcinoma,argon-helium cryoablation still exists bleeding risk.The hemorrhage occurs mainly in the perioperative period,and it is related to irregular and reckless operation.Twenty-four hours after the cryoablation,the death risk decreases because the small vessels of the treatment target regions are occluded.