经动脉导管灌注高温生理盐水肝段热凝固的可行性评估  

Feasibility Study on Hepatic Segmental Ablation by Transcatheter Intraarterial Hyperthermic Infusing Physiological Saline

作　　者：叶强[1] 郑家平[2] 汝复明[1] 张家兴[1] 俞翔耀[3] 童乾纲[1] 奚顺法[1] 顾伟中[1] 

机构地区：[1]上海市第十人民医院介入科,上海200072 [2]浙江省肿瘤医院介入放射科,浙江杭州310022 [3]上海市第十人民医院病理科,上海200072

出　　处：《世界肿瘤杂志》2006年第1期1-4,F0002,共5页Tumour Journal of the World

基　　金：同济大学医科发展基金资助（项目编号1500219005）

摘　　要：目的 评价经动脉导管灌注高温生理盐水肝段热凝固的效果。方法 实验猪12头，随机分为实验组（n=6）和对照组（n=6）。实验组选用球囊导管阻断肝段动脉血流进行热灌注，对照组高热灌注时不阻断肝动脉血流。根据热灌注的温度每组再随机均等分为45℃、50℃、55℃（导管流出温度）3个亚组，每亚组各2头。热灌注14d，将实验猪全部处死，取出肝脏进行病检。结果 热灌注后2wk，12头实验猪均存活，处死实验猪，取出肝脏，实验组共取得四个热凝固灶，50℃、55℃亚组各两个。病灶局限于目标肝段，呈契形，尖端指向肝门，基底远高肝门，与邻近肝段分界清楚，由内向外见三层结构，分别为凝固坏死区、炎性反应区和纤维化区。对照组和试验组45℃亚组肝脏未见典型热凝固坏死。结论 经球囊导管阻断肝动脉血流，高温灌注高于50℃生理盐水，并维持10min，可使目标肝段发生彻底凝固性坏死。Objective To evaluate feasibility study on hepatic segmental ablation by transcatheter hyperthermic infusing saline. Methods The experimental pigs （n=12） were randomly divided into experimental group （n=6） and control group （n=6）. The hepatic segmental artery was occluded in experimental group. All experimental pigs were infused 780ml saline warmed to 45℃, 50℃,and 55℃, flow rate lml above for lasting 10min. Total 12 pigs were sacrificed and the livers were fetched to observe pathologically. Results Four coagulation necrosis lesions which limited in segmental liver wcrc found in 50℃, 55℃ subgroups of experimental group while not found in both 45℃ subgroups in the experimental group and all in the control group. The typical three layers of hyperthermic coagulation necrosis were seen histopathologically, yellow cheese necrosis, inflammation congestion strip, and fibrosis strip from inner to outer, respectively. Conclusions above 50℃, lasting 10 minutes by occluding hepatic artery hyperthermic peffusion can cause coagulation necrosis in the perfusion areas.

关 键 词：热灌注 肝癌 热凝固坏死 猪 病理学 经动脉导管灌注 高温生理盐水 肝段热凝固 

分 类 号：R735.7[医药卫生—肿瘤]