• 1. 第三軍醫(yī)大學(xué)西南醫(yī)院全軍肝膽外科研究所,中國人民解放軍西南肝膽外科醫(yī)院(重慶400038);;
  • 2. 解放軍324醫(yī)院(重慶400020);

目的  探討超聲引導(dǎo)下活體犬肝注射不同劑量的醋酸高滲氯化鈉液(acetic acid hypertonic saline solution,AHS)后行射頻消融(RFA),觀察犬肝一次性毀損體積的變化。
方法  使用LDRF-120S多極RFA系統(tǒng)聯(lián)合AHS對(duì)活體犬肝行RFA。健康成年雜種犬30只,隨機(jī)分為5組(n=6)。A組: 注射2 ml AHS后立即行RFA; B組: 注射2 ml AHS后延時(shí)5 min行RFA; C組: 注射4 ml AHS后立即行RFA; D組: 注射4 ml AHS后延時(shí)5 min行RFA; E組: 注射6 ml AHS后立即行RFA。
結(jié)果  5組間平均起始阻抗差異無統(tǒng)計(jì)學(xué)意義(P gt;0.05); 5組間平均消融時(shí)間差異有統(tǒng)計(jì)學(xué)意義(F=83.831,P<0.001),LSD-t檢驗(yàn)分析各組間兩兩比較差異有統(tǒng)計(jì)學(xué)意義(P<0.001),在觀察范圍內(nèi)E組平均消融時(shí)間最長; 5組間平均毀損直徑差異有統(tǒng)計(jì)學(xué)意義(F=53.488,P<0.001),在觀察范圍內(nèi)E組平均毀損直徑最大,LSD-t檢驗(yàn)分析除D與E組間差異無統(tǒng)計(jì)學(xué)意義(P gt;0.05)外,其余各組間兩兩比較差異有統(tǒng)計(jì)學(xué)意義(P<0.001); 網(wǎng)狀纖維染色顯示凝固壞死區(qū)及其鄰近的正常肝組織均可見血管內(nèi)血栓形成; E組在AHS注射過程中出現(xiàn)不同程度的外溢; A、B、C及D組14 d內(nèi)無動(dòng)物死亡,E組死亡4只。
結(jié)論  活體犬肝局部注射AHS 4 ml后延時(shí)5 min行RFA即可達(dá)到較理想的毀損體積。

引用本文: 孫海,馬寬生,張豐深,李廷軍,歐霞,王曙光. 超聲引導(dǎo)下犬肝注射醋酸高滲氯化鈉混合液對(duì)射頻消融毀損體積的影響. 中國普外基礎(chǔ)與臨床雜志, 2007, 14(5): 547-550. doi: 復(fù)制

1.  張志堅(jiān). 肝癌的射頻消融治療 [J]. 中華實(shí)用外科學(xué)雜志,2004; 24(8)∶ 465.
2.  范林軍, 馬寬生, 何振平, 等. 射頻消融治療大肝癌的安全性和近期療效 [J]. 中國普外基礎(chǔ)與臨床雜志, 2002; 9(4)∶ 265.
3.  陳利平, 李寧. 肝癌的射頻治療 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(4)∶ 482.
4.  Frieser M, Haensler J, Schaber S, et al. Radiofrequency ablation of liver tumors: how to enlarge the necrotic zones? [J]. Eur Surg Res, 2004; 36(6)∶ 357.
5.  Lee JM, Kim YK, Kim SW, et al. Combined radiofrequency ablation and acetic acid hypertonic saline solution instillation: an in vivo study of rabbit liver [J]. Korean J Radiol, 2004; 5(1)∶ 31.
6.  馬寬生. 肝癌的局部消融治療及進(jìn)展 [J]. 肝膽外科雜志, 2005; 13(4)∶ 250.
7.  嚴(yán)昆, 王艷濱, 陳敏華, 等. 172例肝癌射頻消融治療預(yù)后因素分析 [J]. 中華醫(yī)學(xué)雜志, 2005; 85(33)∶ 2322.
8.  Lee JM, Kim SH, Han JK, et al. Ex vivo experiment of saline-enhanced hepatic bipolar radiofrequency ablation with a perfused needle electrode: comparison with conventional monopolar and simultaneous monopolar modes [J]. Cardiovasc Intervent Radiol, 2005; 28(3)∶ 338.
9.  馬寬生, 陳敏, 黃小蘭, 等. 一次定位多點(diǎn)穿刺法在射頻消融治療肝癌中的應(yīng)用 [J]. 中華肝膽外科雜志, 2003; 9(4)∶ 199.
10.  Kim SK, Rhim H, Kim YS, et al. Radiofrequency thermal ablation of hepatic tumors: pitfalls and challenges [J]. Abdom Imaging, 2005; 30(6)∶ 727.
11.  Goldberg SN, Saldinger PF, Gazelle GS, et al. Percutaneous tumor ablation: increased necrosis with combined radio-frequency ablation and intratumoral doxorubicin injection in a rat breast tumor model [J]. Radiology, 2001; 220(2)∶ 420.
12.  Lee JM, Kim YK, Kim SW, et al. Combined treatment of radiofrequency ablation and acetic acid injection: an in vivo feasibility study in rabbit liver [J]. Eur Radiol, 2004; 14(7)∶ 1303.
13.  張盟輝, 孔憲炳, 王巧玲, 等. 射頻消融聯(lián)合亞砷酸局部治療對(duì)兔肝VX2腫瘤MVD和VEGF表達(dá)的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(1)∶ 19.
14.  Lubienski A, Du M, Lubienski K, et al. Radiofrequency thermal ablation: increase in lesion diameter with continuous acetic acid infusion [J]. Cardiovasc Intervent Radiol, 2005; 28(6)∶789.
15.  Burdío F, Güemes A, Burdío JM, et al. Large hepatic ablation with bipolar saline-enhanced radiofrequency: an experimental study in in vivo porcine liver with a novel approach [J]. J Surg Res, 2003; 110(1)∶ 193.
16.  Ahmed M, Weinstein J, Liu ZJ, et al. Image-guided percutaneous chemical and radiofrequency tumor ablation in an animal model [J]. J Vasc Interv Radiol, 2003; 14(8)∶ 1045.
17.  Kurokohchi K, Watanabe S, Masaki, et al. Comparison between combination therapy of percutaneous ethanol and radiofrequency ablation and radiofrequency ablation alone for patients with hepatocellular carcinoma [J]. World J Gastroenterol, 2005; 11(10)∶ 1426.
18.  Ahmed M, Monsky WE, Girnum G, et al. Radiofrequency thermal ablation sharply increases intratumoral liposomal doxorubicin accumulation and tumor coagulation [J]. Cancer Res, 2003; 63(19)∶ 6327.
19.  任正剛. 原發(fā)性肝癌的射頻毀損治療的進(jìn)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(1)∶ 5.
20.  Tamai T, Seki T, Imamura M, et al. Development of local necrosis, side-effects and histopathological study after hepatic injection of acetic acid solutions [J]. International Hepatology Communications, 1997; 6(3)∶ 153.
21.  Liang HL, Yang CF, Pan HB, et al. Small hepatocellular carcinoma: safety and efficacy of single high-dose percutaneous acetic acid injection for treatment [J]. Radiology, 2000; 214(3)∶ 769.
  1. 1.  張志堅(jiān). 肝癌的射頻消融治療 [J]. 中華實(shí)用外科學(xué)雜志,2004; 24(8)∶ 465.
  2. 2.  范林軍, 馬寬生, 何振平, 等. 射頻消融治療大肝癌的安全性和近期療效 [J]. 中國普外基礎(chǔ)與臨床雜志, 2002; 9(4)∶ 265.
  3. 3.  陳利平, 李寧. 肝癌的射頻治療 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(4)∶ 482.
  4. 4.  Frieser M, Haensler J, Schaber S, et al. Radiofrequency ablation of liver tumors: how to enlarge the necrotic zones? [J]. Eur Surg Res, 2004; 36(6)∶ 357.
  5. 5.  Lee JM, Kim YK, Kim SW, et al. Combined radiofrequency ablation and acetic acid hypertonic saline solution instillation: an in vivo study of rabbit liver [J]. Korean J Radiol, 2004; 5(1)∶ 31.
  6. 6.  馬寬生. 肝癌的局部消融治療及進(jìn)展 [J]. 肝膽外科雜志, 2005; 13(4)∶ 250.
  7. 7.  嚴(yán)昆, 王艷濱, 陳敏華, 等. 172例肝癌射頻消融治療預(yù)后因素分析 [J]. 中華醫(yī)學(xué)雜志, 2005; 85(33)∶ 2322.
  8. 8.  Lee JM, Kim SH, Han JK, et al. Ex vivo experiment of saline-enhanced hepatic bipolar radiofrequency ablation with a perfused needle electrode: comparison with conventional monopolar and simultaneous monopolar modes [J]. Cardiovasc Intervent Radiol, 2005; 28(3)∶ 338.
  9. 9.  馬寬生, 陳敏, 黃小蘭, 等. 一次定位多點(diǎn)穿刺法在射頻消融治療肝癌中的應(yīng)用 [J]. 中華肝膽外科雜志, 2003; 9(4)∶ 199.
  10. 10.  Kim SK, Rhim H, Kim YS, et al. Radiofrequency thermal ablation of hepatic tumors: pitfalls and challenges [J]. Abdom Imaging, 2005; 30(6)∶ 727.
  11. 11.  Goldberg SN, Saldinger PF, Gazelle GS, et al. Percutaneous tumor ablation: increased necrosis with combined radio-frequency ablation and intratumoral doxorubicin injection in a rat breast tumor model [J]. Radiology, 2001; 220(2)∶ 420.
  12. 12.  Lee JM, Kim YK, Kim SW, et al. Combined treatment of radiofrequency ablation and acetic acid injection: an in vivo feasibility study in rabbit liver [J]. Eur Radiol, 2004; 14(7)∶ 1303.
  13. 13.  張盟輝, 孔憲炳, 王巧玲, 等. 射頻消融聯(lián)合亞砷酸局部治療對(duì)兔肝VX2腫瘤MVD和VEGF表達(dá)的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(1)∶ 19.
  14. 14.  Lubienski A, Du M, Lubienski K, et al. Radiofrequency thermal ablation: increase in lesion diameter with continuous acetic acid infusion [J]. Cardiovasc Intervent Radiol, 2005; 28(6)∶789.
  15. 15.  Burdío F, Güemes A, Burdío JM, et al. Large hepatic ablation with bipolar saline-enhanced radiofrequency: an experimental study in in vivo porcine liver with a novel approach [J]. J Surg Res, 2003; 110(1)∶ 193.
  16. 16.  Ahmed M, Weinstein J, Liu ZJ, et al. Image-guided percutaneous chemical and radiofrequency tumor ablation in an animal model [J]. J Vasc Interv Radiol, 2003; 14(8)∶ 1045.
  17. 17.  Kurokohchi K, Watanabe S, Masaki, et al. Comparison between combination therapy of percutaneous ethanol and radiofrequency ablation and radiofrequency ablation alone for patients with hepatocellular carcinoma [J]. World J Gastroenterol, 2005; 11(10)∶ 1426.
  18. 18.  Ahmed M, Monsky WE, Girnum G, et al. Radiofrequency thermal ablation sharply increases intratumoral liposomal doxorubicin accumulation and tumor coagulation [J]. Cancer Res, 2003; 63(19)∶ 6327.
  19. 19.  任正剛. 原發(fā)性肝癌的射頻毀損治療的進(jìn)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(1)∶ 5.
  20. 20.  Tamai T, Seki T, Imamura M, et al. Development of local necrosis, side-effects and histopathological study after hepatic injection of acetic acid solutions [J]. International Hepatology Communications, 1997; 6(3)∶ 153.
  21. 21.  Liang HL, Yang CF, Pan HB, et al. Small hepatocellular carcinoma: safety and efficacy of single high-dose percutaneous acetic acid injection for treatment [J]. Radiology, 2000; 214(3)∶ 769.