国产超脉冲铥激光消融手术在离体猪肾中的实验研究  

Experimental study of domestic thulium laser ablation for the ablative surgical treatment of isolated porcinekidneys

作　　者：呼中杰 黄元彬 陶淑瑶 马爽 马鑫淼 李先承[1] Hu Zhongjie;Huang Yuanbin;Tao Shuyao;Ma Shuang;Ma Xinmiao;Li Xiancheng(Department of Urology,The Second Hospital of Dalian Medical University,Dalian 116000,China)

机构地区：[1]大连医科大学附属第二医院泌尿外科,大连116000

出　　处：《中华泌尿外科杂志》2024年第5期366-371,共6页Chinese Journal of Urology

基　　金：辽宁省应用基础研究计划项目(2023JH2-101300124)。

摘　　要：目的评估国产超脉冲铥激消融手术在离体猪肾中的有效性。方法取42个新鲜猪肾;将每个猪肾在肾门处沿矢状面剖开,再分别沿冠状面剖开后分为4块。共获取肾组织168块,选取其中162块分为54个组,每组3块。每组分别以不同消融方式(单针法、双针法)、消融功率(4、5、6W)、消融模式(连续、低能高频模式、高能低频模式)、消融时间(10、15、20s)进行消融,测量并记录消融区长径、短径及厚径大小。对包埋组织进行切片及HE染色,分析消融灶镜下病理学特征。计算消融灶体积及球度系数(Φ),通过析因设计及单因素方差分析对消融灶体积及球度系数进行统计学分析。结果大体标本示:单针法消融灶切面呈椭圆形,内含黑色碳化区与灰白色坏死区,界限清晰,外围肾组织粉红色,消融灶与正常组织分界明显;双针法则形成一大椭圆内包含两个小椭圆形消融灶,结构与单针法相似。光镜下:消融灶中心为“空洞状”碳化区;其外为凝固坏死区,细胞染色加深、体积缩小、排列紊乱,细胞核疏松、核固缩,部分细胞核裂解消融。消融方式(P<0.001)、消融模式(P<0.001)、消融时间(P<0.001)以及消融功率(P<0.001)均显著影响消融灶体积。随着进针数量增加、消融时间延长,消融功率越大;连续模式较脉冲模式消融灶体积更大。单针法消融时,在连续模式、消融时间20s、消融功率6W条件下产生最大的消融灶体积(259.56mm^(2));双针法消融时,在连续模式、消融20s、消融功率6W条件下,产生最大的消融灶体积(452.00mm^(2))。对球度系数的分析结果显示,单针法消融时,在连续模式、消融功率4W、消融时间15s条件下,球度系数最大(Φ=0.76);而在高能低频模式、消融时间10s、消融功率6W条件下,球度系数最小(Φ=0.56),消融灶形态更接近于椭圆体形。双针法消融时,在连续模式、消融时间10s、消融功率5W条件下,消融灶�Objective Evaluation of the effectiveness of domestic ultrapulsed thulium laser ablation of isolated porcine kidneys.Methods Forty-two fresh porcine kidneys were taken.One porcine kidney was dissected along the sagittal plane at the renal hilum,and then dissected along the coronal plane and divided into four pieces.A total of 168 pieces of renal tissues were obtained,of which 162 pieces were selected for the domestic hyperpulsed thulium laser ablation of isolated porcine kidneys using the single-needle method and the double-needle method,respectively.The ablation was carried out with different ablation modes(single-needle and double-needle methods),ablation power(4,5,and 6 W),ablation modes(continuous,low-energy and high-frequency mode,and high-energy and low-frequency mode),and ablation time(10,15,and 20 s).The size of the ablation area in terms of the long diameter,the short diameter,and the thick diameter were measured and recorded.The embedded tissues were sectioned and stained with HE to study the microscopic pathological characteristics of the ablation foci.The ablation foci volume and sphericity coefficient(Q)were calculated,and the ablation foci volume and sphericity coefficient were statistically analyzed by analytic factorial design and one-way ANOVA.Results The gross specimen showed that the single-needle ablation foci were elliptical in shape,containing black carbonized areas and gray-white necrotic areas with clear boundaries,and the peripheral renal tissues were pink,and the ablation focus was clearly demarcated from the normal tissues.The double-needle ablation foci were a large ellipse containing two small ellipse ablation foci,and the structure was similar to that of the single-needle method.Under the light microscope,the center of the ablation focus was a"cavity-like"carbonized area,outside of which was an area of coagulation necrosis,with deepened cell staining,reduced cell volume,disorganized arrangement,loose nuclei,nuclear consolidation,and some cell nuclei were cleaved and ablated.Ablation

关 键 词：肾肿瘤 铥激光 动物实验 消融 单针法 双针法 球度系数 

分 类 号：R699[医药卫生—泌尿科学]