经皮冷冻猪肺的影像学和病理学研究

背景与目的 肺癌已成为最常见死因的恶性肿瘤之一,对不能手术切除的肺癌,冷冻是一种安全可选择的消融治疗手段,但肺为含气组织,与冷冻肝脏、胰腺等实体器官不同,在理论上冷冻范围很难超过肿瘤边缘.本研究旨在通过正常猪肺模型实验了解不同冷冻-复温循环对肺部组织坏死范围的影响并探讨经皮冷冻肺治疗的技术方案.方法 采用6只平均体重为23 kg的正常西藏小型猪作为模型.在CT引导下选择猪肺上叶1点和下叶2点作为靶点,使用直径为1.7 mm的冷冻探针分别插入肺叶各靶点做经皮穿刺冷冻.左肺行冷冻10 min、复温5 min共2个周期的冷冻-复温循环;右肺先行冷冻5 min、复温5 min的2个冷冻-复温循环,然后行冷冻10 min、复温5 min的第3个冷冻一复温循环.左右肺的实验条件和实验方法均相同.实验中,观察CT影像下冰球的形态学变化.分别取冷冻后4h、3 d和7 d的猪肺标本,观察其大体形态及其在光镜下的组织学变化.结果 猪肺冷冻过程中随着时间的延长和循环次数的增加,冰球逐渐增大;无论2个或3个冷冻-复温循环,所产生的冷冻范围("假定坏死区")在大体标本上均超过CT上冷冻过程中显示的冰球大小;冷冻后随着时间延长,组织学坏死区逐步增大,3天及以后,假定坏死区即为组织学坏死区.结论 经皮冷冻肺可以达到有效破坏靶组织的目的;在技术上,肺冷冻以3个冷冻-复温循环为佳;冷冻范围不强求冷冻"1 cm安全边缘".上述研究结果对于简化冷冻治疗过程及减少并发症具有临床价值..

Imaging and Pathological Features of Percutaneous Cryosurgery on Normal Lung Evaluated in a Porcine Model

Background and objective Lung cancer is one of the most commonly occurring malignancies and fre-quent causes of death in the world. Cryoablation is a safe and alternative treatment for unresectable lung cancer. Due to the lung being gas-containing organ and different from solid organs such as liver and pancreas, it is difficult to achieve the freezing range of beyond the tumor edge 1 cm safety border. The aim of this study is to examine the effect of different numbers of freeze cycles on the effectiveness o...