胆管内冷盐水灌注冷却预防肝血流阻断合并射频消融术中胆管损伤的研究  

Efficacy of intraductal cooling to prevent the bile duct injury during radiofrequency ablation associated with hepatic blood occlusion

作　　者：李静怡[1] 苏永辉[2] 蔡潮农[2] 郭辉[3] 林宇静[4] 

机构地区：[1]珠海市人民医院超声科,519000 [2]中山大学附属第五医院普外科 [3]中山大学附属第五医院超声科 [4]中山大学附属第五医院病理科

出　　处：《中华超声影像学杂志》2014年第5期443-446,共4页Chinese Journal of Ultrasonography

基　　金：广东省医学科研基金项目（B2013158）

摘　　要：目的 评价活体兔肝予肝血流阻断合并射频消融（radiofrequency ablation,RFA）术中行胆管内冷盐水灌注冷却（intraductal chilled saline perfusion,ICSP）对胆管的保护作用.方法 新西兰大白兔16只,分为2组：ICSP组于RFA术前行胆总管置管,于RFA术中夹闭入肝血流,并经胆总管置管行ICSP;非ICSP组仅于RFA术中夹闭入肝血流.术中射频针针尖距肝门部主胆管距离约5 mm.RFA术后行超声造影比较两组消融灶大小;术后6周超声观察兔肝内胆管结构,并取肝大体标本,对两组消融灶旁主胆管行病理学检查以比较损伤程度.结果 RFA术后超声造影示两组间消融灶大小差异无统计学意义（P＞0.05）,RFA术后6周超声检查示非ICSP组胆管扩张较为明显（P＜0.05）,病理学检查示非ICSP组主胆管损伤程度较严重（P ＜0.05）.结论 行入肝血流阻断合并肝脏RFA时,采用ICSP能有效预防术中胆道热损伤.Objective To explore the efficacy of intraductal chilled saline perfusion （ICSP） to reduce the thermal bile duct injury during the treatment of radiofrequency ablation （RFA） associating with occlusion of hepatic blood supply in rabbits.Methods 16 healthy New Zealand white rabbits were divided into 2 groups.Rabbits of the ICSP group were placed tubes in the common bile duct after laparotomy,and ICSP was performed during the RFA procedure accompanied with hepatic blood occlusion.While for rabbits of the non-ICSP group,hepatic blood occlusion and RFA were performed without ICSP.RFA electrodes were placed about 5 mm away from the hilus hepatis approximately.Contrast-enhanced ultrasonography （CEUS） was administrated to evaluate the sizes of the ablative zones after the procedure.On post-procedure 6 week,ultrasonography was prerformed to evaluate the changes of the biliary structure,and liver specimens of rabbits wcrc obtained for histopathologic observation of main bile ducts.Results Post-procedure CEUS examination showed that there was no significant difference in the size of the ablative zone between the groups （P 〉0.05）.On post-procedure 6 week,rabbits of the ICSP group appeared with biliary dilatation more frequently by ultrasonography （P 〈0.05）,and a higher degree of the injury of main bile duct by histopathologic observation （P 〈0.05）.Conclusions In treatment of RFA accompanied with hepatic blood occlusion,RFA-induced bile duct injury may be decreased significantly with ICSP.

关 键 词：超声检查 微气泡 导管消融术 胆管损伤 胆管内冷却 

分 类 号：R735.7[医药卫生—肿瘤]