内镜超声引导下微波消融猪肝脏及胰腺的实验研究

An experimental study on endoscopic ultrasound-guided microwave ablation for porcine liver and pancreas

目的通过对猪肝脏、胰腺行内镜超声引导下微波消融术后的机体生理状态及局部病理改变的观察,探讨微波消融术的可行性与安全性。方法以健康小型猪8头为实验对象。全麻后插入内镜超声,在胃内扫查定位肝脏、胰腺,经内镜超声钳道插入直径1.9mm微波消融针消融肝脏和胰腺。肝脏消融功率设置为65W,时间10min;胰腺消融功率设置为60W,时间5min。术前及术后检测肝转氨酶、血清淀粉酶生化指标,并于术后当天行腹部CT平扫观测消融范围及并发症情况。术后6h、24h各处死2头观察穿刺路径上有无重要结构损伤。其余4头饲养至术后2周,观察术后动物饮食、活动、精神状态。对解剖后肝脏、胰腺组织消融区进行病理分析,以未消融区组织做对照。结果8头小型猪均顺利接受内镜超声引导下肝脏、胰腺微波消融术,消融灶18处(肝脏10处、胰腺8处),除1例胰腺定位困难,其他手术过程顺利,术中动物生命体征平稳。术后当天CT平扫提示肝脏及胰腺出现类圆形低密度灶[肝脏消融灶最大径(2.8±0.3)cm,胰腺消融灶最大径(1.8±0.2)cm],未见腹腔游离气体及胸腹腔积液。术后6h血淀粉酶开始升高,术后12~24h出现峰值,肝酶仅轻度升高。术后继续饲养组动物出现短时间拒食及活动减少,但均于术后1~2d开始逐渐恢复正常,未见发热、呕吐等异常表现。处死组动物除1例胰腺消融时发生胃壁灼伤外,其他均无穿刺道灼伤、邻近器官损伤及出血情况。病理观察可见肝脏消融中心大片凝固性坏死及周围出血区;胰腺消融区组织可见散在灶状坏死。结论初步证实内镜超声引导下微波消融术消融猪肝脏、胰腺安全可行,未来有望用于人体肝脏、胰腺疾病的治疗。

ObjectiveTo evaluate the feasibility and safety of endoscopic ultrasound-guided microwave ablation (EUS-MWA) for porcine liver and pancreas by assessing physiological state and pathological changes. MethodsEUS-MWA was performed on liver and pancreas of 8 healthy pigs after general anesthesia. The needle size was 1.9 mm in diameter, and the power of ablation was 65 W, 10 min on liver and 60 W, 5 min on pancreas. The levels of blood amylase and hepatic transaminase were examined before and after the operation. All pigs underwent CT scan on the right postoperative day to assess the extent of ablation and complications. Two pigs were killed 6 hours after operation and 2 others were killed 24 hours after operation to assess structural damage around the puncture path. The remaining 4 pigs were raised to 2 weeks after operation to observe diet, activities and mental state. The ablated areas of liver and pancreas underwent pathological analysis after dissection, and non-ablation regions were treated as the control. ResultsAll 8 pigs underwent EUS-MWA and their vital signs were stable during the operation. Except for the difficulty in locating the pancreas in one case, other surgical procedures were smooth and 18 ablations were performed totally (10 in liver and 8 in pancreas). CT scans showed quasi-circular low density lesions in the liver and pancreas, and the maximum diameter of the ablation area in liver and pancreas was 2.8±0.3 cm, 1.8±0.2 cm respectively. There was no free intraperitoneal gas, ascites or pleural effusion. The level of blood amylase increased at 6 hours after operation and the peak value occurred within 12-24 hours. The level of hepatic transaminase had a mild elevation. The rearing group showed transient food refusal and activity reduction after the operation, but all returned to normal within 1-2 days. No fever, vomiting or other abnormalities occurred. Puncture path burn, adjacent organ damage and bleeding was not observed except for one case of gastric wall burns during pancreas ablation. Pathology showed massive coagulative necrosis and peripheral bleeding area in the liver ablation center, and diffuse focal necrosis in the tissue of the pancreatic ablation area. ConclusionEUS-MWA is safe and feasible for porcine liver and pancreas, which can be used for the treatment of human liver and pancreatic diseases in the future.