超声造影与腹腔镜引导射频经皮凝固治疗闭合性肝外伤比较的实验研究  

Guidance for Percutaneous Radiofrequency Ablation in Treating Closed Hepatic Trauma:Comparison Between Contrast-enhanced Ultrasonography and Laparoscopy

作　　者：李叶阔[1] 王莎莎[1] 朱贤胜[1] 程琦[1] 吴晓岩[1] 霍枫[2] 陈建雄[2] 

机构地区：[1]广州军区广州总医院超声影像科,广州市510010 [2]广州军区广州总医院肝胆外科,广州市510010

出　　处：《中国超声医学杂志》2008年第6期499-502,共4页Chinese Journal of Ultrasound in Medicine

基　　金：广东省自然科学基金(No.06019712)

摘　　要：目的比较超声造影(CEUS)与腹腔镜引导射频经皮凝固治疗闭合性肝外伤的价值。方法采用自制小型撞击器撞击全身麻醉和肝素化状态的24只猪肝区,建立闭合性肝外伤伴活动性出血模型,并随机平均分为两组。两组均采用冷循环式多极射频进行经皮微创凝固治疗。其中一组采用CEUS引导射频针刺入肝实质损伤病灶,另一组采用腹腔镜进行引导。治疗结束后1h,剖腹探查止血效果并剖切新鲜离体肝,比较两组凝固病灶的范围及凝固特征。结果24只猪闭合性肝外伤伴活动性出血模型均成功建立。射频治疗后,所有猪肝活动性出血均被成功控制。两组治疗时间及凝固范围均无统计学差别(P>0.05)。两组凝固灶特点有所不同:CEUS引导组肝内实质病灶凝固较完全,肝表面裂伤部分凝固不全,2例肝表面裂口未完全凝固。腹腔镜组肝表面裂伤凝固较全面,肝实质内病灶凝固不全,3例在肝内局部形成小血肿。结论CEUS和腹腔镜均能准确将射频针引导刺入肝实质损伤病灶,两组凝固灶特点有所不同,临床实践中应根据不同的情况进行选择,以便提高经皮射频凝固止血的效果。Objective To compare contrast-enhanced uhrasonography （CEUS） and laparoscopy in the guidance of percutaneous radiofrequency ablation （PRFA） for treating closed hepatic trauma. Methods Blows was applied to twenty four heparinized and anesthetized domestic pigs, resulted in closed liver trauma. The models were randomly divided into even two groups： CEUS-guided group and laparoscopy guided group. Then PRFA was applied to control hemorrhage from the injured livers in these two groups. The treated pigs were killed humanely one hour after the PRFA treatment. The livers were subjected to histologic examination. Results Twenty four pigs with closed liver trauma with active bleeding were successfully made. Hemostasis was achieved in all treated pigs. No rebleeding was found in the liver in all treated pigs at sacrifice one hour after the PRFA treatment. There were no significent differences in treatment times and ablation scales between the two groups （P 〉 0. 05） . But there were some differences in the two groups., in CEUS-guided group, the injured parenchyma was coagulated in all pigs but not so good on lacerated wound of the hepatic surface in 2 cases. In laparoscopy-guided group, the lacerated wound of the hepatic surface were ablated in all cases but the injured parenchyma was not well coagulated in 3 cases. Conclusions CEUS and laparoscopy can accurately guide the PRFA electrodes to insert into the injured sites of the livers, but there were some different characteristics in the ablation areas in the two groups.

关 键 词：超声造影 腹腔镜 射频消融 肝 创伤 

分 类 号：R445.1[医药卫生—影像医学与核医学] R657.3[医药卫生—诊断学]