探讨应用射频电极针治疗较大肝肿瘤布针模式比较  

The ablation effect of parallel method versus crossed method of multiple radiofrequency electrodes placement in the treatment of liver tumor

作　　者：赵堃 姜安娜[1] 王红[1] 白秀梅[1] 王凇[1] 武昊 杨薇[1] 严昆[1] 陈敏华[1] ZHAO Kun;JIANG Anna;WANG Hong;BAI Xiumei;WANG Song;WU Hao;YANG Wei;YAN Kun;CHEN Minhua(Department of Ultrasound,Key laboratory of Carcinogenesis and Translational Research(Ministry of Education),Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所超声科、恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《介入放射学杂志》2020年第9期907-912,共6页Journal of Interventional Radiology

基　　金：国家自然科学基金(81773286);首都卫生发展科研专项项目(2018-2-2154);首都临床特色应用研究与成果推广项目(Z151100004015186)。

摘　　要：目的临床探讨平行法及交叉法两种布针模式在肝脏肿瘤RFA的效果差异,寻找最佳布针方案。方法采用Celon射频治疗仪及200T30电极针2根,应用离体牛肝进行RFA实验。布针方式分为两种,平行法布针即两组消融区的布针点连线呈"="型,交叉法布针即两组消融区的布针点连线呈"x"型。设置布针点的最短距离(2 cm,2.5 cm,3 cm)及输出功率(20 W,25 W,30 W)分别消融并比较。消融结束后1 h取材,测量并记录大体病理标本消融凝固区形态、范围、长径、短径及交界处凹陷深度。镜下观察不同组消融区交界处病理组织学改变。结果应用25 W功率,布针点距离为2 cm、2.5 cm及3 cm时,两种模式布针的凝固范围均随着布针点距离增加而增大,而交界处凹陷深度亦随着距离的增加而增大,距离3 cm时,融合不佳。当针尖距离固定时,两种模式的长径相似,未见明显差异,而平行法的短径显著长于交叉法的短径[2 cm:(4.64±0.21)cm比(3.84±0.38)cm,P=0.003;2.5 cm:(5.15±0.25)cm比(4.20±0.40)cm,P=0.011;3 cm:(5.96±0.39)cm比(5.12±0.52)cm,P=0.020]。当功率固定时,平行法与交叉法的长径相似,差异未见统计学意义,而平行法短径显著长于交叉法短径[20 W:(4.70±0.26)cm比(4.13±0.15)cm,P=0.033;25 W:(5.15±0.25)cm比(4.20±0.40)cm,P=0.011;30 W:(5.27±0.40)cm比(4.50±0.26)cm,P=0.027]。当针距为2.5 cm和3 cm时,平行法的交界处凹陷深度明显短于交叉法[2.5 cm:(1.04±0.23)cm比(1.94±0.32)cm,P=0.007;3 cm:(2.09±0.18)cm比(3.53±0.64)cm,P=0.001]。不同功率下,平行法的交界处凹陷深度同样短于交叉法[20 W:(1.61±0.56)cm比(3.60±0.53)cm,P=0.011;25 W:(1.04±0.23)cm比(1.94±0.32)cm,P=0.007;30 W:(0.90±0.44)cm比(1.83±0.15)cm,P=0.010]。结论两种布针模式的凝固范围均随着针距和功率的增加而增大,平行法的短径均长于交叉法,交界处凹陷距离均短于交叉法,提示平行布针法优于交叉布针法,在射频过程中更能融合形成有效�Objective To compare the ablation effect of parallel method of multiple radiofrequency ablation(RFA)electrodes placement with that of crossed method of RFA electrodes placement in animal liver,in order to find out the optimal scheme of RFA electrodes placement.Methods The experiment was performed on bovine liver in vitro by using Celon RFA therapeutic instrument and two electrode needles(200 T30).Two patterns of needle arrangement(parallel method and crossed method)were adopted.In the parallel group the electrode needles were placed in the form of"=",while in the crossed group the electrode needles were placed in the form of"X".The shortest distances between the electrodes were set at 2 cm,2.5 cm and 3 cm respectively,and the output powers were set at 20 W,25 W and 30 W respectively.RFA with different combination of above two parameters was separately performed on the specimens.Sampling was collected one hour after RFA.The shape,extent,long diameter,short diameter and depth of depression at the juction area of ablated coagulation region were measured and recorded.The pathological and histologic changes at the juction area of ablation region were examined under microscopy.Results When 25 W power was applied and the shortest distances of the electrodes were 2 cm,2.5 cm and 3 cm respectively,the ablation zones and the depth of depression of the juction area in both groups were increased with the increasing of the distance between the electrodes.When the shortest distance was 3 cm,the ablation zones were not fused well.When the shortest distances were fixed,the long-axis diameters of the ablation zones in two groups were similar with no obvious difference,while the short-axis diameters of the ablation zones in the parallel group was significantly larger than that in the crossed group,regardless of the shortest distance of the electrodes was 2 cm(4.64±0.21 cm versus 3.84±0.38 cm,P=0.003),2.5 cm(5.15±0.25 cm versus 4.20±0.40 cm,P=0.011)or 3 cm(5.96±0.39 cm versus 5.12±0.52 cm,P=0.020).When the power was fixed,the

关 键 词：肝肿瘤 射频消融 平行布针 交叉布针 

分 类 号：R735.7[医药卫生—肿瘤]