DSA引导下犬肾微波消融局部损伤作用的实验研究  

Experimental research on local renal injury of dog with microwave ablation guided by DSA

作　　者：林剑平[1] 先正元[2] 石荣书[3] 张高峰[4] 李先浪[4] 

机构地区：[1]鄂尔多斯市中心医院放射科,内蒙古017000 [2]遵义医学院影像系 [3]遵义医学院附属医院介入中心 [4]遵义医学院附属医院CT室

出　　处：《介入放射学杂志》2008年第9期651-653,共3页Journal of Interventional Radiology

摘　　要：目的探讨DSA引导下微波消融治疗肾脏病变的效果、安全性及保存部分肾功能的可行性。方法对肾盂内注入30%泛影葡胺的新鲜离体猪肾和行动脉肾盂造影的活犬肾进行微波消融。将犬分为消融测温、双肾单点消融、单肾双点消融组。消融测温组消融后即时DSA造影,取病理。双肾单点消融与单肾双点消融组消融后即时与10d后DSA造影,取尿常规、血常规、肾功能和病理检查。结果①离体实验均显示肾盂挛缩显著,70W、3min功率消融易产生尿漏。②活体实验DSA示局部血液供应消失,残余肾功能与消融面积相关。急性期病理结果示肾皮质、肾髓质、肾盂细胞急性损伤。慢性期DSA示肾消融区大小无明显变化,消融区外大血管及肾组织血供正常,残余肾功能存在,无尿漏。右肾上极消融与周围脏器产生粘连。肾大体标本示肾被膜增厚。显微镜下显示凝固性坏死,边界纤维组织增生。结论微波消融能有效地灭活局部肾组织,对残余肾的功能保留效果好;无大血管损伤,慢性期无尿漏发生,较易引起肾周围组织粘连。Objective To explore the efficiency, complications and probability of preserving part renal function by local renal microwave ablation. Methods The fresh pig renal pelvis full filled with 30% diatrizoate meglumine and the dogs kidney taken arterial pyelography were both ablated with microwave. Dogs were divided into three groups： measuring temperature after ablation group, single point ablation both on the two kidneys group and double points ablation on unilateral kidney group. In measuring temperature after ablation group, DSA and pathology were performed immediately after ablation. In the other groups, DSA with blood and urine samplings were taken for routine tests including renal function right after the ablation and 10 days later. Results Experiment in vitro showed conspicuous renal pelvic contraction and convolution. The group under power rate of 70, 3 min produced urine leak easily. Preliminary test in vivo with DSA showed the disappearance of local kidney blood supply. The residual renal function was related to areas of necrosis. Acute stage pathology revealed acute renal cortex medulla and pelvic cells injury. DSA of chronic stage showed no change in size of the area of ablation. The blood supply of necrotic areas was not restored. The residual kidney possessed the excretion contrast medium with no urine leaks. Upper pole of right kidney adhered with adjacent tissue, together with thickened covering. Pathology revealed fibrous proliferation around the coagulative necrosis. Conclusion Microwave ablation can inactivate the local renal tissue, and, effectively preserve the big blood vessels and function of residual kidney. No urine leaks occurred in chronic stage but easily to produce adhesions with adjacent tissue.

关 键 词：微波消融 肾损伤 肾功能 并发症 数字减影 血管造影 

分 类 号：R692[医药卫生—泌尿科学]