家猪常温下耐受入肝血流阻断安全时限的研究

目的　了解家猪在不同条件下肝脏耐受血流阻断的安全时限 ,为临床设计肝脏血流阻断的方法和掌握肝脏血流阻断安全时限提供依据。方法　观察正常家猪在无转流条件下阻断肝血流、门 颈静脉转流条件下肝血流阻断 60、90、12 0min四组动物的肝脏功能状态、组织病理改变和术后存活情况。结果　无转流动物 ,阻断入肝血流 3 0min内出现严重循环功能障碍死亡。门 颈静脉转流动物 ,阻断入肝血流 60、90min ,出现一过性肝功能障碍 ,术后 3d逐步恢复 ,肝组织轻度的变性坏死并长期存活 ;阻断入肝血流 12 0min ,术后出现持续加重的肝脏功能损害 ,肝组织广泛严重水样变性和大片坏死 ,术后 3d动物全部死亡。结论　正常家猪在门 颈静脉转流条件下可耐受入肝血流阻断 90min。     

肛门阻断时肝静脉逆行灌注对维持肝脏活力的重要性

肝切除术中出血是导致病人死亡的主要原因之一.阻断入肝血流(Pringle技术)可以减少术中失血.仅管入肝耐受血流阻断可以超过1小时,但由于肝脏对缺血很敏感,阻断入肝血流会导致肝缺血性损害.长时间肝血流阻断后,肝静脉血流在维持肝代谢功能方面可能起重要作用.作者用猪做实验,研究长时间肝血流阻断中肝静脉逆行灌注在维持肝组织灌注,能量代谢和脂质过氧化中的作用.受试动物分成两组,每组6只.一组仅阻断肝门,用泵将门静脉血流分流至颈外静脉.另一组除阻断肝门外,还同时阻断肝上、下下腔静脉.门静脉、下腔静脉(经髂外静脉)血流经泵分流至颈外静脉.肝血流阻断时间均为60min.分流率前者为300～380ml/min,后一组为500～1200ml/min.实验结束后修补门静脉上干切口,结扎颈外、髂外静脉.结果表明,仅阻断肝门入肝血流的6只动物术后7天均仍存活.而全肝血流阻断组中仅有1只存活7天,3只24小时内死亡,两只分别于术后第2、4天死亡.均死于肝功能衰竭.用激光多普勒血流计测定肝血流量,全肝血流阻断动物肝血流量为5.3±0.5ml/min/100g组织,是阻断血管前的15.3%.再灌流后30分钟,肝血流量为18.7±5.2ml/min/100g组织.单纯阻断肝门组肝血流量是阻断入肝血流前的32.4%(11.3±3.2ml/min/100g).再灌流后30分     

大鼠门静脉转流下耐受入肝血流阻断的安全时限

目的 评估在排除门静脉淤血条件下动物耐受入肝血硫阻断的安全时限。方法 利用大鼠肝脏及肝蒂分支分叶的解剖特点,阻断肝左、中和右叶肝蒂,以尾叶静脉系统作为阻断入肝血流期间门静脉血液的流出道,肝脏复流后切除尾叶。在这一模型上,以阻断入肝血流不同时程后动物7d存活率、肝脏病理组织学改变及肝脏能量代谢功能损害的严重度及可逆性来推断动物耐受常温下入肝血流阻断的安全时限。结果 门静脉转流下阻断入肝血流90min以内,术后7d动物全部存活,其肝脏缺血-再灌流损害以肝窦淤血和肝细胞变性等可逆性病变为主,而肝脏能量代谢功能损害可得以代偿和恢复。阻断入肝血流100、110、120min后动物7d存活率分别为50％、30％和20％,肝脏缺血120min后肝脏缺血-再灌流损害则以大量肝组织坏死为显著特性,其肝脏能量代谢功能严重受损而陷入失代偿状态。结论 大鼠在门静脉轻流时对常温下持续入肝血流阻断的耐受性显著增强,其安全时限是90min。     

肝蒂联合右肝静脉阻断在巨块型肝癌切除中的应用

目的评估肝蒂联合右肝静脉阻断在巨块型肝癌切除中的作用和意义。方法对2003年2月至2006年8月中南大学湘雅二医院肝胆外科收治的138例位于右半肝及中央型的巨大肝癌行肝蒂联合右肝静脉阻断,观察肝脏血流阻断时间、手术时间、术中出血量、术后肝功能的变化及术后并发症。结果135例在肝外游离出右肝静脉并加以阻断,3例以小的心耳钳沿腔静脉方向纵行夹住右肝静脉阻断出肝血流。所有病例右侧均顺利阻断肝蒂。肝脏血流阻断时间平均为(18±6)min,手术时间平均为(180±45)min,术中出血400~1200mL,56例术中未输血。术后无一例发生肝功能衰竭。术后膈下感染2例,胆漏4例,经引流自愈。结论在巨块型肝癌切除中,肝蒂联合右肝静脉阻断技术可以有效地减少术中出血,降低术后肝功能衰竭的发生率。     

大鼠门静脉转流下耐受入肝血流阻断的安全时限

目的 评估在排除门静脉淤血条件下动物耐受人肝血硫阻断的安全时限。方法 利用大鼠肝脏及肝蒂分支分叶的解剖特点，阻断肝左，中和右叶肝蒂，以尾叶静脉系统作为阻断入肝血流期间门静脉血液的流出道，肝脏复流后切除尾叶，在这一模型上，以阻断入肝血流不同时程后动物7d存活率，肝脏病理组织学改变及肝脏能量代谢功能损害的严重诬蔑工及可逆性来推断动物耐受常温下入肝血流阻断的安全时限。结果 门静脉转流下阻断入肝血流90min以内，术后7d动物全部存活，其肝脏缺血-再灌流损害以肝窦淤血和肝细胞变性等可逆性病变为主，而肝脏能量代谢功能损害可得以代偿和恢复，阻断入肝血流100、110、120min后动物7d存活率分别为50%，30%和20%，肝脏缺血120min后肝脏缺血-再灌流损害则以大量肝组织坏死为显特性，其肝脏能量代谢功能严重受损而陷入失代偿状态。结论 大鼠在门静脉轻流时对常温下持续入肝血流阻断的耐受性显增强。其安全时限是90min。     

单侧入肝血流联合肝静脉阻断在复杂肝切除中的应用

目的：探讨单侧入肝血流联合肝静脉阻断技术在复杂肝切除术中的应用价值。
方法：回顾性分析46例巨块型肝癌通过预先解剖、控制患侧入肝血流联合阻断出肝血流行切肝术患者的临床资料。
结果：46例患者均为原发性肝癌,肿瘤平均直径8.3 cm(6~15 cm),肿瘤侵犯1根主肝静脉20例,侵犯2根主肝静脉14例。行右半肝切除16例,右后叶肝切除14例,左半肝切除16例。平均患侧入肝血流阻断时间30 min(10~45 min),平均肝静脉阻断时间20 min(10~30 min)。行肝静脉修补5例。平均术中出血量540 mL(300~1 500 mL)。全组术后发生并发症14例次,均经治疗后痊愈,无死亡病例。
结论：单侧入肝血流联合肝静脉阻断技术在复杂肝切除术中能明显减少术中出血,降低术后肝功能衰竭发生率,是一种安全、可行实用的血流阻断技术。

     

入肝血流阻断对阻塞性黄疸大鼠肝脏能量代谢的影响

目的 探讨阻塞性黄疸大鼠肝脏缺血后能量代谢变化的病理特征及其与动物耐受性的关系。方法 大鼠胆管结扎后１周,在门静脉转流入阻断入肝血流不同时程后观察动物存活率、肝细胞线粒体呼吸活性、肝组织ＡＴＰ含量及动脉血酮体比值。结果 阻断入肝血流３０、６０及９０分钟后１０天动物存活率分别为１００％、１００％及４０％;缺血后肝脏能量代谢功能明显受损,在再灌注后２４小时,阻断入肝血流３０及６０分钟两组动物肝脏能量代谢功能已有明显恢复,而阻断入肝血流９０分钟组肝脏能量代谢功能仍维持在显著低水平。结论 胆道梗阻后１周,大鼠门静脉转流下入肝血流阻断６０分钟以内肝脏能量代谢功能损害可逆,动物安全耐受;而阻断入肝血流９０分钟引起肝脏能量代谢功能不可逆性损害,动物难以安全耐受。     

半肝入肝血流加肝静脉阻断在规则性肝切除术中的应用

目的：探讨半肝入肝血流加肝静脉阻断术在规则性肝切除术中的意义。方法：行半肝入肝血流加肝静脉阻断术42例（A组）、半肝入肝血流阻断术30例（B组）、全肝入肝血流阻断术30例（C组）,比较3组患者的手术时间、术中出血量以及术后第1、3、6天的血清谷丙转氨酶（ALT）、胆红素、白蛋白水平和术后并发症的发生率。结果：术中平均出血量分别为（453.5±87.9）、（612.8±101.6）和（646.7±136.6）mL,A组显著低于B组和C组（P〈0.05）,B组和C组间差异无统计学意义（P〉0.05）,3组患者的手术时间差异无统计学意义（P〉0.05）;A组和B组在术后第3、6天的血清ALT、胆红素水平显著低于C组,而血清白蛋白水平显著高于C组（P〈0.001）,A组和B组间差异无统计学意义（P〉0.05）;A组和B组的术后腹水发生率均显著低于C组（P〈0.01）。结论：半肝入肝血流加肝静脉阻断术可显著减少肝切除术中的出血,减轻术中、术后肝功能的损害,是一种安全、有效的肝切除方法。     

不阻断入肝血流肝段切除术对肝癌患者肝功能的影响

目的 探讨不阻断入肝血流行肝段切除术的安全性及技巧,以及对残肝功能和术后并发症的影响.方法 对同济医院2006年12月至2007年12月68例肝癌患者行肝段切除术,根据术中是否束紧阻断带,将患者分为不阻断入肝血流组(37例)和阻断入肝血流组(31例),采用x2、t检验比较两种手术的情况.结果 术中失血量:不阻断入肝血流组为(400±100)ml;阻断入肝血流组为(350±100)ml,两组比较差异无统计学意义(t=0.717,P＞0.05).术后ALT恢复时间:不阻断入肝血流组为(6±2)d;阻断入肝血流组为(10±3)d,两组比较差异有统计学意义(t=6.006,P＜0.05).术后并发症发生率:不阻断入肝血流组为14%(5/37);阻断入肝血流组为35%(11/31),两组比较差异有统计学意义(t=4.525,P＜0.05).结论 不阻断入肝血流肝段切除术可有效防止肝脏缺血再灌注损伤,降低术后并发症发生率,是安全可行的.     

单侧入肝血流阻断行肝切除术

目的：总结单侧入肝血流阻断在伴有肝硬化的肝叶切除术中的操作方法及其应用价值。方法：回顾28例原发性肝癌伴有肝硬化行肝叶切除术中应用单侧入肝血流阻断方法的经验和体会。结果：28例手术均成功，无并发症发生。本组病人术后肝功能损害及并发症发生率均明显少于入肝血流阻断(Pringle's法)。结论：半肝血流阻断行肝叶切除可保留对侧半肝的正常血供，术后肝功能损害轻，并发症少，且操作简单、安全。     

Efficacy and safety of radiofrequency ablation for perivascular hepatocellular carcinoma without hepatic inflow occlusion

BACKGROUND: The role of radiofrequency ablation (RFA) for perivascular (up to 5 mm from the major intrahepatic portal vein or hepatic vein branches) hepatocellular carcinoma (HCC) is unclear because of possible incomplete tumour ablation and potential vascular damage. This study aimed to evaluate the safety and efficacy of RFA for perivascular HCC without hepatic inflow occlusion. METHODS: Between May 2001 and November 2003, RFA using an internally cooled electrode was performed on 52 patients with perivascular HCC (group 1) through open (n = 39), percutaneous (n = 9), laparoscopic (n = 2) and thoracoscopic (n = 2) approaches. Hepatic inflow occlusion was not applied during the ablation procedure. The perioperative and postoperative outcomes were compared with those of 90 patients with non-perivascular HCC (group 2) treated by RFA during the same period. RESULTS: The morbidity rate was similar between groups 1 and 2 (25 versus 28 per cent; P = 0.844). One patient in group 1 (2 per cent) and two in group 2 (2 per cent) had developed thrombosis of major intrahepatic blood vessels on follow-up computed tomography scan. There were no significant differences between groups 1 and 2 in mortality rate (2 versus 0 per cent; P = 0.366), complete ablation rate for small HCC (92 versus 98 per cent; P = 0.197), local recurrence rate (11 versus 9 per cent; P = 0.762) and overall survival (1-year: 86 versus 87 per cent; 2-year: 75 versus 75 per cent; P = 0.741). CONCLUSION: RFA without hepatic inflow occlusion is a safe and effective treatment for perivascular HCC.     

Lesion progression with time and the effect of vascular occlusion following radiofrequency ablation of the liver

BACKGROUND: The effectiveness of radiofrequency ablation (RFA) under selective vascular occlusion and its effects on architecture and viability of normal liver parenchyma was studied in a porcine model. METHODS: RFA was applied in the liver under general anaesthesia in 18 pigs. Six animals were killed immediately after the procedure and 12 at 24 h. RFA was performed sequentially under four conditions: (1) without vascular occlusion, (2) during occlusion of the hepatic artery, (3) during occlusion of the portal vein and (4) during occlusion of the hepatic artery and portal vein. Liver biopsies from the treated area were stained for conventional histological examination, reduced nicotinamide adenine dinucleotide diaphorase and 5'-nucleotidase activity. RESULTS: Vascular occlusion significantly increased the size of the coagulation centre after RFA. Combined portal venous and arterial occlusion had no additional effect on lesion size compared with venous or arterial occlusion alone. After 24 h, deterioration of viability was observed in the parenchyma up to 3 cm from the coagulated area. CONCLUSION: The efficacy of RFA in liver increases with occlusion of the portal vein or hepatic artery. The extent of secondary heat-induced necrosis in liver parenchyma should be considered for determination of the final size of the ablated area.     

射频联合多齿针无水酒精注射的实验研究

摘要：目的:探讨单纯射频与射频联合多齿针无水酒精注射对活体猪肝脏的消融毁损情况。方法:将健康家猪12头分为2组：A组为射频联合多齿针无水酒精注射组（RFA+EI组）， B组为单纯射频消融组。分别记录每次射频消融达到最高阻抗时的时间及相应功率值，消融完成后均即刻将猪处死，取出肝脏，沿射频针道方向切开毁损灶，观察并测量其毁损范围大小，在每个毁损灶的中心、边缘及距边缘旁1cm处取材送检，观察其病理学变化。 结果:病理检查显示，消融毁损灶中央组织均呈完全性坏死，边缘组织可见变性、坏死、充血、出血、血管腔堵塞及炎性细胞浸润现象，距边缘旁1cm处少量细胞变性和大量白细胞、淋巴细胞浸润，未见有组织坏死。RFA+EI组标本中组织炭化现象普遍较RFA组轻。RFA+EI组毁损灶平均最长直径为（4.7±0.4）cm，RFA组为（4.1±0.2）cm（P<0.05）。RFA+EI组平均射频毁损时间为（9.8±0.9）min，RFA组为（14.7±1.3）min（P<0.05）。结论:射频联合多齿针无水酒精注射具有协同作用，可增大肝组织消融毁损范围，缩短射频消融时间。     

经导管栓塞联合射频消融对兔VX2肝肿瘤的干预效果

目的 探讨经导管动脉栓塞术（TAE）联合射频消融（RFA）对兔VX2肝肿瘤的干预效果。方法 将兔VX2肝肿瘤模型分为4组,每组15只。对TACE+RFA组于TACE治疗15 min后行RFA,TAE+RFA组TAE治疗15 min后行RFA,RFA组仅给予RFA,TACE组仅给予TACE。分别于术前1天及术后3、7天检测血清天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）,术后7天检测肿瘤生长率、肿瘤坏死率及Suzuki评分;术后1、3、7天采用免疫组织化学法检测坏死区或凝固区周围肝组织热休克蛋白70（HSP70）表达,计算肝细胞凋亡指数及增殖指数。结果 TACE+RFA组术后3、7天血清ALT、AST水平均高于其他3组（P均<0.05）。术后7天,TACE+RFA组Suzuki评分高于其他3组,TACE+RFA组、TAE+RFA组肿瘤生长率低于RFA组和TACE组、肿瘤坏死率高于RFA组和TACE组（P均<0.05）。4组术后1、3、7天坏死区或凝固区周围肝组织HSP70表达均逐渐升高,TACE+RFA组术后1、3、7天均高于其他3组,术后1、3天TAE+RFA组均高于TACE组和RFA组（P均<0.05）。4组术后1、3、7天坏死区或凝固区周围肝细胞凋亡指数均逐渐降低,TACE+RFA组术后1、3、7天均高于其他3组,TACE组术后1、3天均高于TAE+RFA组、RFA组（P均<0.05）。4组术后3天肝细胞增殖指数均高于术后1、7天,TAE+RFA组术后1、3、7天均高于其他3组,RFA组术后1、3天均高于TACE+RFA组和TACE组（P均<0.05）。结论 TACE+RFA、TAE+RFA抑制兔VX2肝肿瘤生长效果优于单独应用TACE、RFA;TAE+RFA对肝损伤更小,促进肝细胞增殖、抑制其凋亡的效果更好。     

射频消融治疗继发性脾肿大、脾功能亢进可行性和安全性的实验研究

目的 评价射频消融(RFA)脾脏治疗继发性脾肿大和脾功能亢进的可行性和安全性。方法 14只健康杂种狗随机分为Ⅰ组(脾静脉结扎,n=4)和Ⅱ组(脾静脉结扎 RFA,n=10),通过结扎脾静脉主干和脾静脉属支引起淤血性脾肿大,3周末Ⅱ组剖腹行射频热能毁损脾脏。观察动物脾脏经RFA后的并发症,定期行CT扫描以及切取脾脏观察热毁损后脾脏病灶的影像学和组织病理学变化。结果 全组动物无死亡和并发症。CT显示脾静脉结扎后脾脏明显肿大并可持续2个月以上,RFA后脾脏病灶呈节段性毁损,包括高密度的坏死区和低密度的梗死区——后者称为“旁观者效应”;梗死区在RFA后4—6周内消失,残脾缩小;坏死区改变不明显。射频热能引起脾脏局部组织凝固性坏死和广泛的血栓性梗死形成。梗死区逐渐吸收、纤维化,血管闭塞、纤维素沉积和脾窦消失引起活性脾脏组织结构致密。结论 RFA治疗实验性脾肿大和脾亢是可行和安全的,将来可在开腹或腹腔镜下严格隔离脾脏周围器官后在临床安全实施。     

Radiofrequency ablation followed by resection of malignant liver tumors.

BACKGROUND: Radiofrequency ablation (RFA) has recently been used to treat liver tumors, but few clinical reports have described the pathological characteristics of radiofrequency ablation in human specimens. This study delineates the gross pathologic and histochemical changes induced by RFA in benign and malignant human liver tissue and confirms the tumor necrosis described in early clinical reports. METHODS: Ten patients with metastatic tumors of the liver received a single treatment of ultrasound-guided percutaneous RFA to 12 tumors. Hepatic resection was carried out within 6 weeks of RFA. Specimens were stained with standard hematoxylin and eosin stain followed by oxidative stain to determine if there was evidence of viable tumor within the zone of ablation. RESULTS: Nine of the 12 ablations were resected. Microscopic examination within the zone of ablation showed successful ablation in 8 of the 9 resected ablations. CONCLUSIONS: Percutaneous RFA creates well-circumscribed areas of tumor necrosis with apparent cell death using an oxidative stain. Further investigation is encouraged to determine the clinical effectiveness of radiofrequency ablation in the complete destruction of liver tumors for palliative or curative intent.     

Delayed portal vein thrombosis after experimental radiofrequency ablation near the main portal vein

BACKGROUND: Portal venous blood flow may protect adjacent tumour cells from thermal destruction with radiofrequency ablation (RFA). This study aimed to investigate the local effect of RFA on the main portal vein branch, and the completeness of cellular ablation in its vicinity, with or without a Pringle manoeuvre using a porcine model. METHODS: This was an in vivo study on 23 domestic pigs. RFA using a cooled-tip electrode was performed 5 mm from the left main portal vein branch under ultrasonographic guidance for 12 min with (n = 10) or without (n = 10) a Pringle manoeuvre. Ten pigs were killed 4 h after the procedure to study the early effects of RFA and ten others were killed 1 week later to determine any delayed effect. As a control, sham operations with a Pringle manoeuvre for 12 min were performed on three pigs. The flow velocity changes of portal vein and hepatic artery were measured using Doppler ultrasonography, and the completeness of cellular ablation around the portal vein was assessed qualitatively by histochemical staining and quantitatively by measuring intracellular levels of adenosine 5'-triphosphate (ATP). RESULTS: In the absence of the Pringle manoeuvre, there was no significant change in mean(s.d.) portal vein flow velocity before RFA (20.0(3.5) cm/s) and at 4 h (18.5(2.5) cm/s) (P = 0.210) and 1 week (19.5(2.2) cm/s) (P = 0.500) after the procedure. Gross and histological examination of the portal vein branches showed no damage without the Pringle manoeuvre. In all pigs that underwent RFA with a Pringle manoeuvre, the portal vein was occluded 1 week after the operation; histological examination of the affected portal vein showed severe thermal injury and associated venous thrombosis. The local effect of RFA on the hepatic artery was similar. With intact portal blood flow during RFA, complete ablation of liver tissue around the pedicle was demonstrated by histochemical staining and measurement of the intracellular ATP concentration. CONCLUSION: RFA was safe when applied close to the main portal vein branch without a Pringle manoeuvre, with complete cellular destruction. Use of the Pringle manoeuvre resulted in delayed portal vein and hepatic artery thrombosis and injury to the hepatic artery and bile duct.     

Impact of blood flow occlusion on liver necrosis following thermal ablation

BACKGROUND: Laser, radiofrequency and microwave are common techniques for local destruction of liver tumours by thermal ablation. The main limitation of thermal ablation treatment is the volume of necrosis that can be achieved. Blood flow occlusion is commonly advocated as an adjunct to thermal ablation to increase the volume of tissue necrosis based on macroscopic and histological assessment of immediate or direct thermal injury. This study examines the impact of blood flow occlusion on direct and indirect laser induced thermal liver injury in a murine model using histochemical methods to assess tissue vitality. METHODS: Thermal ablation produced by neodymium yttrium-aluminium-garnet laser (wavelength 1064 nm) was applied to the liver of inbred male CBA strain mice at 2 W for 50 s (100 J). Treatment was performed with and without temporary portal vein and hepatic artery blood flow occlusion. Animals were killed upon completion of the procedure to assess direct thermal injury or at 24, 48 and 72 h to assess the progression of tissue damage. The maximum diameter of necrosis was assessed by vital staining for nicotinamide adenine dinucleotide (NADH) diaphorase. Microvascular changes were assessed by laser Doppler flowmetry, confocal in vivo microscopy and scanning electron microscopy. RESULTS: The direct thermal injury (mean SE) assessed by NADH diaphorase staining was significantly greater following thermal ablation treatment without blood flow occlusion than with blood flow occlusion (3.3 (0.4) mm vs 2.9 (0.3) mm; P = 0.005). Tissue disruption, cracking and vacuolization was more pronounced adjacent to the fibre insertion site in the group treated with thermal ablation combined with blood flow occlusion. There was an equivalent increase in the extent of injury following therapy in both groups that reached a peak at 48 h. The maximum diameter of necrosis in the thermal ablation alone group at 48 h was significantly greater than the thermal ablation combined with blood flow occlusion group (5.8 (0.4) mm vs 5.3 (0.3) mm; P = 0.011). The patterns of microvascular injury were similar in both groups, varying in extent. CONCLUSION: Temporary blood flow inflow occlusion appears to decrease the extent of initial injury measured by vital staining techniques and does not alter the time sequence of progressive tissue injury following thermal ablation therapy.     

肝门部胆管腔内射频消融相关并发症活体实验观察

目的：观察肝门部胆管腔内射频消融后与射频消融相关的并发症及消融区病理组织学转归。方法：将14条健康狗分为2组，每组7条。在全身麻醉下通过剖腹手术刊哿13mm长单极电极针裸露部分置入胆管腔内进行射频消融。第1组输出功率10W，消融时间4min；第2组输出功率5w，消融时间8min。每组于消融后3d各处死2条狗，9d各处死1条狗，14d各处死4条狗。观察与射频消融相关的并发症。光学显微。结果：1条狗发生门静脉、肝静脉和下腔静脉皿栓。1条狗发生胆管结石。所，没有发生射频消融所致胆汁漏。射频消融3d时，凝固区内胆管黏膜层和黏膜下层以及肝组织明显坏死。射频消鼬9d时，凝固区内胆管黏膜层和黏膜下层以及肝组织有炎细胞浸润和部分纤维化。射频消融14d时，凝固区内胆管壁和肝组织明显纤维化。结论：肝门部胆管腔内射频消融后与射频消融相关并发症极少发生。消融区内胆管黏膜层和黏膜下层以及肝组织坏死、炎症细胞浸润并逐渐纤维化。     

Fluorescence spectroscopy accurately detects irreversible cell damage during hepatic radiofrequency ablation

BACKGROUND: A current limitation of hepatic radiofrequency ablation (RFA) is an inability to detect ablation margins in real time. Thermal injury from RFA alters the biochemical properties governing tissue fluorescence. We hypothesized that the changes in hepatic fluorescence measured during hepatic RFA could be used to detect irreversible hepatocyte damage accurately and to determine ablation margins in real time. METHODS: RFA was performed on healthy pig livers and monitored in vivo simultaneously for fluorescence and temperature by a fiberoptic micro-interrogation probe connected to a spectroscopy system. Ablations were stopped based on previously established real-time fluorescence spectral data, not based on temperature or time. To determine where in the ablated tissue cell death occurred, biopsies for transmission electron microscopy were taken from 4 areas of 3 specimens: (1) nonablated liver, (2) hemorrhagic zone/normal liver interface, (3) hemorrhagic zone/coagulated zone interface, and (4) coagulated zone. In vitro fluorescence emission intensity was determined at each biopsy site. RESULTS: Peak hepatic fluorescence intensity occurred at 470 nm and decreased as RFA progressed. Transmission electron microscopy evidence of irreversible hepatocyte damage occurred at the interface of the coagulation zone and the hemorrhagic zone and correlated with a 87.5% +/- 9% decrease in fluorescence emission intensity. Tissue fluorescent changes from thermal injury were unaffected by tissue cooling. CONCLUSION: Fluorescence spectroscopy accurately detected hepatocellular thermal injury from RFA in real time and can detect irreversible cell damage during tissue thermal therapy.