胆管灌注对兔肝射频消融术中胆道热损伤的保护作用  

Efficacy of Intraductal Perfusion to Prevent Bile Duct Thermal Injury during Radiofrequency Ablation in Rabbits

作　　者：郭辉[1] 林宇静[2] 蔡潮农[3] 卢吴柱[1] 冼建忠[1] 刘夏磊[3] 张百萌[3] 

机构地区：[1]中山大学附属第五医院超声科,广东珠海519000 [2]中山大学附属第五医院病理科,广东珠海519000 [3]中山大学附属第五医院普外3科,广东珠海519000

出　　处：《中山大学学报（医学科学版）》2014年第3期459-464,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科研基金(B2013158)

摘　　要：【目的】探讨活体兔肝于射频消融(RFA)术中行顺行性胆管内冷盐水灌注冷却(ICSP)及逆行性ICSP对主胆管免受热损伤的保护作用差异性。【方法】健康雄性新西兰大白兔20只随机分为2组(每组10只)。顺行组动物于RFA术前开腹行外周胆管置管,并于RFA术中经外周胆管置管行ICSP。逆行组动物于RFA术前开腹行胆总管置管,并于RFA术中经胆总管置管行ICSP。RFA术中射频针尖定位于距肝门部主胆管约0.5 cm处。RFA术后10周对实验兔行X线胆管造影观察胆道系统改变情况,并取兔肝脏大体标本对主胆管行病理分析,比较顺行组与逆行组间主胆管损伤程度的差异性。【结果】RFA术后10周胆道造影示逆行组胆道狭窄或扩张、胆汁瘘发生率高于顺行组(P<0.05),病理检查示逆行组主胆管损伤程度较为严重(P<0.01)。【结论】相比于传统方式行逆行性ICSP,于RFA术中行顺行性ICSP对主胆管能起到更稳定的冷却保护作用。[Objective] To determine the difference of protective efficacy to reduce the thermal injury of central bile duct between antegrade intraductal chilled saline perfusion （ICSP） and retrograde ICSP during radiofrequency ablation （RFA） procedure in rabbits.[Methods] 20 healthy New Zealand white rabbits were randomly divided into 2 groups （n =10）.Rabbits of the antegrade group were placed tubes in the peripheral bile duct after laparotomy,and antegrade ICSP was performed during the RFA procedure ; while rabbits belonging to the retrograde group were placed tubes in the common bile duct after laparotomy,and retrograde ICSP was employed during the process.RFA electrodes were placed about 0.5 cm away from the hilus hepatis approximately.On post-procedural Week 10,X-ray cholangiography was administrated to determine changes of the bile ducts,and specimens of central bile ducts were achieved for histopathologic observation.[Results] On post-procedural Week 10,cholangiography showed the changes of the bile ducts occurred more frequently in the retrograde group than in the antegrade group （P ＜ 0.05）,and histopathologic observation showed the injury of the central bile ducts in the retrograde group was more serious （P ＜ 0.01）.[Conclusion] Compared with traditional retrograde ICSP,RFA-induced bile duct injury may be minimized more effectively with antegrade ICSP.

关 键 词：射频消融 胆道损伤 胆道内冷却 

分 类 号：R657.4[医药卫生—外科学]