氩等离子体凝固术不同喷凝时间对猪肝门部Glisson系统一级分支损伤的研究

Study on the damage of primary branches of the Glisson system in the hepatic portal by argon plasma coagulation with different spraying time

目的探讨氩等离子体凝固术(APC)不同喷凝时间对猪肝门部Glisson系统一级分支(G1)损伤的影响。方法选择50只健康家猪(7~14个月),雌性27只,雄性23只,体质量(100.0±9.5)kg。采用随机数字法将所有猪(肝脏)分为5组,A组、B组、C组、D组、E组,每组10只,分离制备G1模型,分别APC喷凝1、2、3、4、5 s。比较各组损伤情况、最大损伤面积、最大损伤深度以及三联管(门静脉第一分支、肝内胆管第一分支、肝动脉第一分支)损伤情况。依据三联管是否损伤将猪分为三联管损伤组(n=23)与对照组(n=27,无三联管损伤)。比较两组最大损伤面积、最大损伤深度等。结果APC喷凝后,G1表面出现圆形或椭圆形损伤,呈现黄褐色、褐色、焦化和缺损等改变,显微镜下苏木精-伊红染色切片可见G1的鞘膜缺损,鞘膜下纤维组织断裂,小血管及小胆管结构不完整,出现"烧伤痕"及G1内三联管损伤等,且喷凝中心点损伤较重。制备的50个G1模型中随着喷凝时间增加,最大损伤面积也增加,二者呈正相关(r=0.89,P<0.001),最大损伤深度与喷凝时间呈正相关(r=0.95,P<0.001)。A组、B组、C组、D组、E组的三联管损伤分别为0、2、5、6、10只,G1内三联管损伤的只数随着喷凝时间增加而增加。三联管损伤组APC喷凝时间、最大损伤面积和最大损伤深度均高于对照组,差异均有统计学意义(均P<0.05)。结论APC对肝门部G1的损伤程度与喷凝时间呈正相关,G1内三联管损伤与最大损伤面积、最大损伤时间、APC喷凝时间有关。

Objective To investigate the effect of different spray-coagulation time of argon plasma coagulation(APC)injury on the Glisson system primary branche(G1)in the hepatic portal of pigs.Methods Fifty clean healthy domestic pigs(27 females and 23 males,aged 7 to 14 months)were selected,with the body weighted(100.0±9.5)kg.They were randomly divided into five groups(A,B,C,D,and E),with 10 pigs in each group.G1 models were made and sprayed by APC for 1,2,3,4,and 5 seconds.The damage,maximum damage area,maximum damage depth,and damage of the three branches of the Glisson system(the first branches of the portal vein,intrahepatic bile duct,and hepatic artery)were compared among the groups.The pigs were divided into two groups based on whether the three branches were damaged or not:the three-branch damage group(n=23)and the control group(n=27).The maximum damage area and maximum damage depth were compared between the two groups.Results After the APC spraying,circular or elliptical damage appeared on the surface of the G1,with changes such as yellow-brown color,brown color,charred appearance,and defects.Under the microscope,G1 capsule was found to be deficient,the fibrous tissue beneath the capsule was ruptured,and the structures of small blood vessels and small bile ducts were incomplete."Burn marks"and damage to the three branches of the Glisson system in G1 were also observed,and the damage was more severe at the center of the spray-coagulation.As the spray-coagulation time increased,the maximum damage area of the G1 model also increased,and the two were positively correlated(r=0.90,P<0.001).The maximum damage depth was also positively correlated with spray-coagulation time(r=0.97,P<0.001).The numbers of pigs with damage to the three branches of the Glisson system in Groups A-E were 0,2,5,6,and 10,respectively,and the number of pigs with damage increased with the spray-coagulation time.In the three-branch damage group,the spray-coagulation time,maximum damage area,and maximum damage depth were all higher than those in the control group(without three-branch damage),and the differences were statistically significant(all P<0.05).Conclusion The degree of damage to G1 caused by APC is positively correlated with the spray-coagulation time,and damage to the three branches of the Glisson system in G1 is related to the maximum damage area,maximum damage depth,and APC spray-coagulation time.