经直肠超声造影引导和监控下前列腺射频消融的实验研究

目的 通过动物实验验证经直肠超声造影引导和监控下行前列腺整体射频消融的可行性及安全性.方法经直肠超声造影引导下,采用内冷却针电极对7只犬前列腺行整体射频消融.通过尿管灌注和膀胱直肠隐窝注入冷蒸馏水双重冷却措施,以期保护尿道和直肠.超声造影显示的消融结果与病理标本所见作对比性分折.结果造影声像图清晰显示热消融灶呈无灌注区.所需整体前列腺消融的平均穿刺次数4.3次(3～6次),平均消融率达96.55%.超卢造影与TTC染色标本显示的消融范围(9.16 ±5.20)cm3对(8.62±3.13)cm3]相关性良好·两者间差别无统计学意义(P=0.583),相关系数r=0.94(P=0.002).膀胱和直肠均未发现热损伤,尿道热损伤范围在1/4周径以内.结论经直肠超声造影引导前列腺整体射频消融是可行的;超声造影监控是获得整体消融的关键;双重冷却技术可有效保护尿道和直肠.

Experimental study of contrast enhanced transrectal ultrasound for monitoring radiofrequency ablation of prostate

Objective To determine the feasibility and safety of radiofrequeney(RF)ablation of entire prostate guided and monitored by contrast-enhanced transrectal ultrasound(CE-TRUS)in canine model.Methods Contrast ultrasound-guided RF ablation of entire prostate was preformed transrectally using Cool-tiptm electrodes in 7 normal canines under general anesthesia.The urethra/bladder and rectum were protected by infusion of cold distilled water through a Foley catheter and injection of cold distilled water into the prostate-rectum space,respectively.CE-TRUS findings were compared with TTC-stained pathologic results.Results All the 7 canines tolerated the ablation procedures.CE-TRUS clearly demonstrated hypoechoic thermal lesions as avascular/nonperfusion areas.The average number acquired for entire prostate ablation was 4.3(3 to 6).The average ablation volume achieved on pathology was 96.55%.There was no statistically significant difference when compared average ablative volumes between CE-TRUS and TTC-stained pathology(9.16±5.20)cm3 vs(8.62±3.13)cm3,P=0.583].The coefficient correlation was 0.94(P=0.002).No thermal related injuries were found in anv of the bladder and rectum.The thermal related inj uries of the urethra were less than 1/4 quadrant.Conclusions It is feasible to ablate the entire prostate using RF thermal energy under CE-TRUS guidance.CE-TRUS plays a key role for achieving entire prostate ablation.The urethra and rectum can be protected by cooling of these structures during the procedure.