EnSite-NavX三维标测系统指导下去肾交感神经术的实验研究

目的 探讨EnSite-NavX三维标测系统指导下去肾交感神经术的安全性及有效性.方法 选用健康广西巴马小型猪6只,在EnSite-NavX三维标测系统指导下建立腹主动脉及肾动脉的三维立体模型,然后将心脏电生理射频消融导管送入双侧肾动脉主干,在主干内由远至近心端选取6个点并标记,其中一侧放电消融,对侧不消融作对照.随访6个月,观察建模及并发症情况,采用ELISA法测定双侧肾组织去甲肾上腺素的含量,H-E染色观察消融侧肾交感神经毁损情况.结果 6只小型猪均顺利完成建模及一侧去肾交感神经术,1只术后出现下肢皮下血肿;无肾动脉狭窄、血栓形成及夹层等并发症.消融侧肾组织去甲肾上腺素含量(170.13±52.60) ng/g低于未消融侧(429.86±131.43) ng/g,差异有统计学意义(P＜0.05).消融侧肾交感神经未见完整的神经外膜,轴突减少.结论 EnSite-NavX三维标测系统指导下能清楚建立腹主动脉及肾动脉的三维立体模型,并在NavX导航下,无需透视或肾动脉造影即可完成去肾交感神经术,能安全、有效地去肾交感神经.

EnSite-NavX three-dimensional mapping-guided renal sympathetic denervation: an experimental study

Objective To explore the safety and efficiency of the renal sympathetic denervation under the guidance of EnSite-NavX three-dimensional mapping. Methods Six healthy Guangxi Bama minipigs underwent renal sympathetic denervation under the guidance of EnSite-NavX three-dimensional mapping were observed. To construct a three-dimensional model of abdomens aorta and renal artery under the guidance of EnSite-NavX three-dimensional mapping, a radiofrequency ablation catheter was passed into bilateral main renal artery and six points were selected and marked in the trunk from far to near the heart. One side of the renal artery was ablated, and the other was compared without ablation. The minipigs were followed up six months after the procedure .The renal tissue norepinephrine(NE) content were detected by ELISA. Results The six minipigs were modeled and finished the unilateral renal sympathetic denervation, one of them occurred subcutaneous hematoma after operation. None of the six minipigs had the complication of renal artery stenosis, thrombopoiesis, dissection etc. The renal tissue norepinephrine(NE) content of the experimental side was significantly lower than the compared side, with statistically difference(P<0.05). Conclusion We can construct clearly a three-dimensional model of abdomens aorta and renal artery under the guidance of EnSite-NavX three-dimensional mapping, and finish the sympathetic denervation safely and effectively without fluoroscopy and renal arteriography under the navigation of NavX.