射频消融技术在腹腔镜解剖性肝切除动物模型中的应用

目的评价在腹腔镜解剖性肝切除动物模型中应用射频消融（radiofrequency ablation,RFA）技术进行肝段定位、入肝血流阻断以及辅助肝实质离断的可行性、有效性和安全性。方法 20头猪选取不同肝段分别完成2个实验。第1个实验中,20头猪随机分为2组,分别为门静脉RFA辅助组（超声引导下肝段门静脉系统定位及RFA辅助肝段血流阻断下腹腔镜肝段切除）和常规腹腔镜切除组（常规腹腔镜肝段切除）,每组10头。第2个实验中,20头猪重新按随机数字表随机分为2组,分别为RFA辅助肝实质离断组（RFA辅助肝实质离断腹腔镜左外叶肝切除）和常规腹腔镜肝叶切除组（常规腹腔镜左外叶切除）,每组10头。比较手术时间、术中出血量和切除肝段重量。结果第1个实验中,9头猪完成超声引导下肝段门静脉系统RFA辅助腹腔镜肝段切除,常规腹腔镜切除组10头猪完成手术。门静脉RFA辅助组和常规腹腔镜切除组手术时间分别为（74±16）min和（104±28）min（t=-2.821,P=0.012）,术中出血量分别为（84±20）ml和（114±32）ml（t=-2.416,P=0.027）。第2个实验中,RFA辅助肝实质离断组和常规腹腔镜肝叶切除组手术均顺利完成,2组手术时间无统计学差异（136±26）min vs.（124±18）min,t=1.200,P=0.246],术中出血量有统计学差异（110±36）ml vs.（164±50）ml,t=-2.772,P=0.013]。结论超声引导下肝段门静脉系统RFA辅助肝段入肝血流阻断后行腹腔镜肝段切除有助于缩短手术时间和减少术中出血量;RFA辅助肝实质离断的腹腔镜肝左外叶切除与常规腹腔镜肝叶切除相比在不增加手术时间的基础上可以减少术中出血。

Radiofrequency Ablation for Laparoscopic Anatomical Hepatectomy in Porcine Model

Objective To assess the feasibility, efficacy and safety of laparoscopic anatomical hepatectomy in a porcine model by using radiofrequency ablation to determine the surgical area, occlude the inflow, and assist the division of liver parenchyma. Methods Totally 20 pigs were enrolled into this study for two experiments. In the first experiment, the animals were randomly divided into radiofrequency ablation and conventional laparoscopy groups with 10 in each. In the radiofrequency ablation group, under ultrasound guidance, we positioned the lower hepatic portal vein, and then performed hepatic segmentectomy with the assistance by radiofrequency ablation for liver inflow occlusion. While in the conventional laparoscopy group, hepatic segmentectomy was carried out with a routine laparoscopic procedure. In the second experiment, the pigs were re-divided into two groups randomly to receive hepatic lobectomy with radiofrequency ablation-assisted laparoscopy or conventional laparoscopy respectively （radiofrequency ablation and conventional laparoscopy groups, 10 in each）. In both the experiments, the results of the two procedures were compared. Results In the first experiment, the segmentectomy was completed in the 9 pigs from the radiofrequency ablation group and 10 from the conventional laparoscopy group. The operation time was （74 ± 16） rain and （ 104 ± 28） rain, respectively （ t = - 2. 821, P = 0. 012）, and intraoperative blood loss was （84 ±20） ml and （ 114 ±32） ml, respectively （t = - 2. 416, P = 0. 027）. In the second experiment, hepatic lobectomy was completed in all the animals of both the groups, and significant difference was detected in intraoperative blood loss but not operation time between the two groups （110 ± 36） ml vs. （164 ± 50） ml, t = -2. 772, P --0. 013, and（ 136 ± 26） min vs. （ 124 ± 18） rain, t = 1. 200, P = O. 246 ]. Conclusions Under ultrasound guidance, it is effective for reducing operation time and intraoperative blood loss to employ radiofrequency ablation-assisted inflow occlusion in the hepatic portal vein. For laparoscopic hepatic lobectomy, with radiofrequency ablation, intraoperative blood loss is reduced though operation time remains the same.