双极射频活检针在肝粗针活检止血的研发与初步应用  

Development and preliminary application of abipolar radiofrequency biopsy needle in hemostasis after liver coarse needle biopsy in pigs

作　　者：诸佳玮 陈强 王辉阳 蒋天安[1] Zhu Jiawei;Chen Qiang;Wang Huiyang;Jiang Tian'an(Department of Ultrasound Medicine,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Zhejiang CuraWay Medical Technology Co.,Ltd.,Hangzhou 310018,China;Department of Ultrasound Medicine,People's Hospital of Zhenhai District,Ningbo 315202,China)

机构地区：[1]浙江大学医学院附属第一医院超声医学科,杭州310003 [2]浙江伽奈维科技有限公司,杭州310018 [3]宁波市镇海区人民医院超声科,宁波315202

出　　处：《中华医学超声杂志（电子版）》2024年第1期69-74,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家重大科研仪器研制项目(82027803);国家自然科学基金面上项目(81971623)。

摘　　要：目的探讨新研发双极射频活检针在肝脏粗针活检后止血的有效性和操作性能,并与明胶海绵填塞方式进行对照研究。方法利用16 G活检针对5只家猪的4片肝叶分别行超声引导下粗针活检,首先在无止血措施下进行作为对照组,记录活检后出血量及出血时间。随后,在各穿刺点旁1 cm,再次行穿刺活检,并分别用双极射频活检针和明胶海绵填塞进行止血,其中使用双极射频活检针的射频组分别采用3组参数,输出功率和针头作用区温度分别为40 W,70℃;30 W,90℃以及40 W,90℃,记录止血操作时间、活检后出血量及出血时间。采用Tukey-Kramer事后检验比较4种不同止血方式的实验组和对照组的操作时间、活检后出血量及出血时间的差异。结果明胶海绵组及3种不同消融参数射频组操作时间为(172.00±28.87)s、(11.40±0.75)s、(12.20±0.80)s、(10.00±0.84)s,射频组操作时间明显短于明胶海绵组(P均=0.005,差值的95%置信区间:81.793~239.407 s、79.085~240.51 s、79.998~244.002 s)。但是,所有止血操作组较其邻近未止血针道的对照组的出血量、出血时间均显著减少,差异均具有统计学意义(出血量:P=0.003、=0.001、<0.001、=0.001,差值的95%置信区间:12.339~31.309 g、15.9~31.964 g、20.331~31.145 g、16.718~32.318 g;出血时间:P=0.018、0.003、0.004、0.003,差值的95%置信区间:22.6~135.0 s、44.4~108.4 s、48.2~135.8 s、56.5~147.4 s),明胶海绵组以及3种射频组彼此间出血量、出血时间比较,差异均无统计学意义(P均>0.05),均能起到较好地针道止血效果。结论双极射频活检针能够安全、便捷地对肝脏粗针活检后进行止血,且比明胶海绵填塞操作简便、可靠,具有临床应用价值。Objective To investigate the efficacy and serviceability of a novel bipolar radiofrequency biopsy needle for hemostasis after hepatic core needle biopsy by comparing it with gelatin sponge packing.Methods Ultrasound-guided 16 G biopsy was performed on the four liver lobes of five pigs.First,the bleeding volume and bleeding time after biopsy were recorded without hemostasis.Subsequently,at 1 cm beside each puncture point,puncture biopsy was performed again,and a bipolar radiofrequency biopsy needle and gelatin sponge were used to stop bleeding.The bipolar radiofrequency biopsy needle used three sets of parameters:the output power and temperature of the needle action area were 40 W and 70℃,30 W and 90℃,and 40 W and 90℃,respectively.Operation time,post-biopsy bleeding volume,and bleeding duration were recorded.The differences in these indicators between the experimental group and control group were compared using the Tukey-Kramer post hoc test.Results The average operation time of the gelatin sponge group and the radiofrequency group with different ablation parameters was(172.00±28.87)s,(11.40±0.75)s,(12.20±0.80)s,and(10.00±0.84)s,respectively.The operation time of the radiofrequency group was significantly shorter than that of the gelatin sponge group(P=0.005 for all;95%confidence interval[CI]:81.793-239.407,79.085-240.51,and 79.998-244.002,respectively).However,the bleeding volume and bleeding time of all hemostatic operations were significantly lower than those of the adjacent non-hemostatic needle tracts(bleeding volume:P=0.003,=0.001,<0.001,and=0.001,respectively;95%CI:12.339-31.309 g,15.9-31.964 g,20.331-31.145 g,and 16.718-32.318 g,respectively;bleeding time:P=0018,0.003,0.004,and 0.003,95%CI:22.6-135.0 s,44.4-108.4 s,482.-135.8 s,and 56.5-147.4 s,respectively).There was no significant difference in bleeding volume or bleeding time between the gelatin sponge group and the radiofrequency group with different ablation parameters(P>0.05).Conclusion Porcine hepatic core needle biopsy can be safely perfo

关 键 词：肝活检 射频消融 出血 超声引导 动物实验 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575[医药卫生—诊断学]