肝门部胆管腔内射频消融相关并发症活体实验观察  

Experimental observation in vivo on the complications caused by radiofrequency ablation via the lumen of bile duct in Hilum hepatis

作　　者：周文平[1] 董家鸿[1] 王春晖[2] 刘国平[2] 

机构地区：[1]第三军医大学西南医院肝胆外科研究所,重庆400038 [2]沈阳军区总医院肝胆外科,辽宁沈阳110016

出　　处：《中国现代普通外科进展》2008年第3期191-194,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:观察肝门部胆管腔内射频消融后与射频消融相关的并发症及消融区病理组织学转归。方法:将14条健康狗分为2组,每组7条。在全身麻醉下通过剖腹手术,将13mm长单极电极针裸露部分置入胆管腔内进行射频消融。第1组输出功率10W,消融时间4min;第2组输出功率5W,消融时间8min。每组于消融后3d各处死2条狗,9d各处死1条狗,14d各处死4条狗。观察与射频消融相关的并发症。光学显微镜观察射频消融区病理学转归。结果:1条狗发生门静脉、肝静脉和下腔静脉血栓。1条狗发生胆管结石。所有狗无肝动脉血栓形成,没有发生射频消融所致胆汁漏。射频消融3d时,凝固区内胆管黏膜层和黏膜下层以及肝组织明显坏死。射频消融9d时,凝固区内胆管黏膜层和黏膜下层以及肝组织有炎细胞浸润和部分纤维化。射频消融14d时,凝固区内胆管壁和肝组织明显纤维化。结论:肝门部胆管腔内射频消融后与射频消融相关并发症极少发生。消融区内胆管黏膜层和黏膜下层以及肝组织坏死、炎症细胞浸润并逐渐纤维化。Objective：To observe the complications caused by radiofrequency ablation （RFA） after RFA via the lumen of bile duct in hilum hepatis and the pathological progress of the tissue in ablation zones. Methods： Fourteen healthy dogs were randomly divided into 2 groups with 7 dogseach group. RFA by inserting a 13 mm non-insulated mono-electrode into the lumen of bile duct was performed under general anesthesia on 10 W power output, 4 min ablation duration in group Ⅰ and on 5 W power output, 8 min ablation duration in group Ⅱ. After RFA, 2 dogs were sacrificed in 3 days and 1 dog in 9 days and 4 dogs in 14 days respectively in each group. The complications concerning RFA such as bile leakage, cholelithiasis, hepatic artery thrombosis, portal vein thrombosis, hepatic vein thrombosis1 and vena cava thrombosis were observed. Results： Portal vein thrombosis, hepatic vein thrombosis and vena cava thrombosis occurred in one dog. Cholelithisis occurred in one dos. No hepatic artery thrombosis occurred in all dogs. No bile leakage caused by RFA occurred in all dogs. Obvious necrosis of the mucosal and submucosal layers of the wall of bile duct and hep- atic tissue in coagulation zones occurred in 3 days after RFA. The infiltration of inflammatory cells and partial fibrosis of the mucosal and submucosal layers of bile duct and hepatic tissue occurred in 9 days after RFA. Obvious fibrosis of the wall of bile duct and hepatic tissue occurred in 14 days after RFA. Conclusions： The complications caused by RFA occur seldom after RFA via the lumen of bile duct, The necrosis, the infiltration of inflammatory cells and gradual fibrosis of the mucosal and submucosal layers of bile duct and hepatic tissue occur in ablation zone.

关 键 词：射频消融 胆管 并发症 病理学 动物实验 

分 类 号：R730.41[医药卫生—肿瘤] R735.7[医药卫生—临床医学]