可弯曲水冷微波消融针经气管猪肺外周消融的相关性研究  

Research of Flexible Bronchoscopy-guided Water-cooled Microwave Ablation of Peripheral Porcine Lung

作　　者：袁海宾 潘玉均 朱莉[3] 陶广昱 孙加源[2,4] 李红[2] YUAN Hai-bin;PAN YU -jun;ZHU Li;TAO Guang-yu;SUN Jia-yuan;LI Hong(Department of Emergency,Shanghai Chest Hospital,Shanghai Jiaotong University;Department of Endoscopy,Shanghai Chest Hospital,Shanghai Jiaotong University;Department of Radiology,Shanghai Chest Hospital,Shanghai Jiaotong University;Department of Pulmonary Medicine,Shanghai Chest Hospital,Shanghai Jiaotong University)

机构地区：[1]上海交通大学附属胸科医院急诊科 [2]上海交通大学附属胸科医院内镜室 [3]上海交通大学附属胸科医院放射科 [4]上海交通大学附属胸科医院呼吸内科

出　　处：《中国医学计算机成像杂志》2019年第4期405-409,共5页Chinese Computed Medical Imaging

基　　金：上海交通大学多学科交叉项目培育(医工)No.YG2017QN66;上海市卫生和计划生育委员会卫生行业临床专项No.20184Y0219~~

摘　　要：目的:探讨可弯曲水冷微波消融(MWA)针经气管镜引导下在猪肺外周消融的研究。方法:采用国产可弯曲2450MHz水冷循环MWA针经气管镜引导下对新鲜离体猪肺外周组织作消融,根据不同输出功率(50、60、70、80W)和不同消融时间(3、5、8min)分组,每项设定参数下重复3次消融;消融后沿靶支气管管腔切开消融的外周肺组织,测量消融灶的长径(Dl)、短径(Ds),进行多重线性回归分析,测定决定系数(R^2)。最后在活体猪肺上测试消融效果及安全性评估。结果:随着输出功率增加(50-80w),Dl、Ds逐渐增大(P<0.01);随着消融时间的增加(3-8min)Dl,Ds也逐渐增大(P<0.01)。功率、时间与Dl、Ds均存在多重线性关系,测定决定系数(R^2)分别为0.91和0.85,提示模型的拟合效果好,建立了评分模型用于参数设定后预测消融范围的大小。同时离体消融病灶在80W×8min时累及胸膜。活体猪肺上顺利引起消融病灶且未发生并发症。结论:经气管镜引导下可弯曲水冷微波消融技术在外周肺组织中可根据不同参数(功率、时间)的选择达到理想的消融范围大小且安全性尚良好,可能成为临床上一种有效的外周肺组织的微创消融方法。推荐消融功率80W以内,时间5min以内避免严重支气管胸膜瘘。Purpose:To explore the feasibility of the ablation of peripheral porcine lung using flexible bronchoscopy-guided water-cooled microwave ablation(MWA)needle.Methods:Flexible bronchoscopy-guided 2450MHz water-cooled MWA needle was used to the ablation of fresh and isolated pig lungs under the guidance of bronchoscope.According to the parametric set of power and ablation time,the experiments were divided into groups of 50w,60w,70w,80w and groups of 3min,5min,8min.And three times of ablation were repeated under each set parameter.After ablation,the ablated peripheral lung tissue was incised along the target bronchial lumen,and the long diameter(Dl)and short diameter(Ds)of the lesion were measured,respectively.Multiple linear regression analysis was employed with the determination coefficient of R2.Finally,the efficacy and safety of ablation were tested on the live pig lungs.Results:As the power increased(50~80w),Dl and Ds gradually increased(P<0.01);Dl and Ds also gradually increased with the increase of ablation time(3~8min)(P<0.01).There was a multiple linear relationship between power,time and Dl,Ds.The determination coefficients(R^2)of 0.91 and 0.85,indicated that the model shad a good fitting effect,respectively.A scoring model was established for predicting the size of the ablation range after parameter setting.There were no complications,which suggesting a success of the lung ablation in vivo.Conclusion:The flexible bronchoscopy-guided water-cooled MWA technique can achieve the ideal ablation range according to different parameters(power and time)in the peripheral lung tissue.It could become a more effective and safer method of minimally-invasive ablation of peripheral lung tissue than the percutaneous ablation.It is recommended that the power for avoiding severe bronchopleural fistula be less than 80w and ablation time be less than 5 minutes.

关 键 词：可弯曲 气管镜 微波消融针 外周猪肺组织 

分 类 号：R563[医药卫生—呼吸系统]