离体猪胰腺钬激光消融的实验研究  

Holmium laser ablation of porcine pancreas in vitro

作　　者：邢铃 王东[1] 王凯旋[1] 张晓兰[1] 张华高[2] 金震东[1] 

机构地区：[1]第二军医大学长海医院消化内科,上海200433 [2]第二军医大学长海医院临床流行病学与循证医学中心,上海200433

出　　处：《中华胰腺病杂志》2014年第2期103-106,共4页Chinese Journal of Pancreatology

基　　金：上海市科委基金资助（11DZ1921605）

摘　　要：目的 探讨不同能量、频率、时间的钬激光对离体猪胰腺的消融范围,建立钬激光对离体猪胰腺消融的回归方程,为临床内镜超声引导下钬激光对胰腺肿瘤的消融治疗提供实验基础.方法 根据预实验确定钬激光能量、时间、频率3个参数可取值的范围,每个参数分别取5个数值,设计一个包含125种不同组合的随机化表,每个组合参数进行一次离体猪胰腺的消融实验,共125次.应用内镜超声探头观察消融灶的声像图,测量消融范围,切下消融部位组织行病理检查.结果 超声见消融部位呈云雾状高回声区.肉眼观消融灶截面近似椭圆球体,中间为碳化,外层为灰白色坏死区域.镜下见消融灶中间为“水池样”空腔,周围为胰腺组织凝固性坏死区,外周有炎症细胞浸润,边缘为正常的胰腺组织.钬激光的作用时间、频率、能量均呈正方向影响消融范围,其中频率影响最大,其次是时间,再次是能量,且差异均具有统计学意义（P值均＜0.01）,最优的参数组合是25 s,25 Hz,1.8J.建立一个包含能量、时间及频率的回归方程,ln（消融体积）=β0＋β1×时间＋β2×频率＋β3×能量（β为回归系数）.结论 钬激光作用于离体猪胰腺可产生明显的组织坏死,所建立的钬激光消融回归方程可指导临床实践.Objective To investigate the effects of different energy, frequency and time of holmium laser on the ablated porcine pancreas in vitro, and to establish an ablation regression equation of holmium laser, in order to provide the experiment foundation for EUS-guided holmium laser ablation of pancreatic carcinoma. Methods According to pilot study, the range of energy, frequency and time of holmium laser was determined, and five values were chosen for the individual three parameters, therefore, a randomize table including 125 combinations （sample capacity） according to the various combinations of every parameter was constructed, then every combination of holmium laser was used for porcine pancreas ablation in vitro. EUS was applied to determine the ablation site and measure the ablation extent, and pathological evaluation was performed. Results Sonographic images showed hyperechoic cloudy area in the ablation site. It was observed that the ablation body was an approximately oval area, the middle part was carbonized area, and the out layer was grey - white necrosis area. Microscopic examination showed there was pool - like cavity in the middle of ablation site, and it was surrounded by coagulation necrosis of pancreatic tissue, and the out layer was inflammatory cells infiltration. Normal pancreatic tissue was found in the margin. The energy, frequency and time of holmium laser were positively associated with the ablation extent, and the frequency was the main factor, followed by time and energy. The difference was statistically significant （P〈0.01）. The best combination was 25 s, 25 Hz, 1.8 J. An ablation regression equation was created, which was In （ablationvolume） = β0 ＋ β1× lime ＋β2 × frequency ＋ β3 × energy. Conclusions The huhnium laser can produce obvious tissue necrosis in porcine pancreas in vitro; the established holmium laser ablation regression equation can be the guidance tbr clinical practice.

关 键 词：胰腺 钬 激光 消融技术 猪 

分 类 号：R735.9[医药卫生—肿瘤]