冷循环射频消融人离体肾癌的实验研究

Cool-tip radiofrequency ablation for renal cell carcinoma in vitro

目的:探讨射频消融对人离体肾癌消融坏死范围、形态及周围组织的影响,为临床应用提供理论依据。方法:12例行后腹腔镜下肾根治切除术的肾癌患者(肿瘤最大径≤3.2cm)的肾脏,根据消融的组织及时间设置为四组:5min正常肾组(A组,12例次)、5min肾癌组(B组,6例次)、12min正常肾组(C组,12例次)及12 min肾癌组(D组,6例次)。标本送入病理科后,给予不同时间射频消融,肉眼下观察射频消融时的状态、正常肾组织和肿瘤组织消融坏死范围及集合系统完整性。随后制作病理切片,观察消融组织的病理改变。结果:1射频消融时的组织外表面温度升高,组织皱缩、内陷,并有热气泡顺针道溢出;2正常肾组织射频消融灶的形态为围绕射频针的椭球形,长轴平行射频针,小于3.2cm肾肿瘤组织消融灶形态为肿瘤原始形状,包膜形成肿瘤和正常肾组织的明显分界;3与C组相比,A组射频消融直径显著减小(P<0.01),B组的消融范围不一致,小于2cm的肿瘤消融直径为肿瘤最大径,大于2cm的肿瘤消融直径为2cm,D组消融直径为肿瘤最大径;4集合系统损伤2例,见于针尖靠近集合系统小于5mm的肾脏。结论:5min射频消融对于小于3.2cm的肿瘤不能保证彻底消融,而12 min射频消融能够完全有效的达到杀灭肿瘤的目的;包膜完整时,形成"高压锅"效应,小于3.2cm的肿瘤可以任何角度进针;包膜不完整时,手术时尽可能保证射频针与肿瘤的长轴吻合,如为肾脏腹侧、中心部位的肿瘤,腹腔镜辅助射频消融可能更合适;当肿瘤靠近集合系统时,尤其压迫肾盂或肾盏的肿瘤,集合系统可能会受到损伤,可行集合系统冷水灌注保护;消融组织表面温度升高,对于肿瘤毗邻肠道、脾脏等器官时,腹腔镜手术辅助可能更加安全。

Objective :To i nvesti gate the i nfl uence of radi ofrequency ablati on on the ablati on necrosis range ,for m and surroundi ng tissue of hu man vitro ki dney carci no ma ,i n order to provi de theoretical basis for cli nical applicati on . Methods :1 2 cases of ki dney of renal cell carci no ma patients by laparoscopic retroperitoneal radical nephrecto my (the maxi mu m dia meter of tu mor ≤3.2 c m),which were rando ml y di vi ded i nto 5 mi n nor mal ki dney group (group A, 1 2 cases /ti mes ),5 mi n renal carci no ma group (group B ,6 cases /ti mes ),1 2 mi n nor mal ki dney group (group C , 1 2 cases )and 1 2 mi n renal carci no ma group (group D ,6 cases /ti mes ).After the speci mens bei ng sent to Pathol ogy Depart ment ,we gave the m radi ofrequency ablati ons for different ti me ,observed the state duri ng radi ofre quency ablati on ,ablati on necrosis range of nor mal ki dney tissue and tu mor tissue and the i ntegrity of collecti on syste m by macroscopic observati on .Then made the pathol ogical slices and observed the pathol ogical chan-ges of the ablati on issue .Results :①The outer surface te mperature of the tissue rises duri ng radi ofrequency ablati on , tissue shri nks ,si nks ,and there are hot bubbles overfl o wi ng al ong the needle track ;②The patterns of nor mal ki dney tissue radi ofrequency ablati on lesi on is the elli psoi dal around RF needle ,l ong axis parallels to RF needle ,the ki dney tu mor tissue ablati on lesi on less than 3.2 c mis the ori gi nal shape of tu mor morphol ogy ,the capsule for mati on obvi-ous boundary of tu mor and nor mal ki dney tissue ;③Co mpared with group C ,radi ofrequency ablati on range of group A decreased si gnificantl y (P <0.01 ).The ablati on range of group B is not consistent ,less than 2 c mi n dia meter of tu mor ablati on maxi mu mtu mor dia meter ,tu mor ablati on dia meter greater than 2 c m,the ablati on dia meter of group D is the maxi mal tu mor dia meter ;④There are 2 cases of collecti on syste mi nj ury ,which are observed i n the ki dney of needle ti p cl ose to collecti on syste m of less than 5 mm.Conclusions :5 mi nutes of radi ofrequency ablati on cannot ensure co mpletel y ablate the tu mors wich are less than 3.2 c m,1 2 mi nutes of ablati on is suitable for the tu mor with the maxi mu m dia meter of less than 3.2 c m;when co mplete capsule ,for mi ng the "pressure cooker"effect ,less than 3.2 c m of the tu mors can be any angle needle ;when i nco mplete capsule ,ensure the RF needle and tu mor axis over-lap as far as possi ble ,such as renal ventral or central tu mor ,laparoscopic radi ofrequency ablati on may be more ap-propriate ;when the tu mor is cl ose to collecti on syste m,it may be da maged ,the collecti on syste m col d perfusi on can be used to protect it ;if the tu mor is adj acent to the organs such as bo wel ,spleen ,laparoscopic surgery may be safer .