Minimizing diaphragmatic injury during radiofrequency ablation: Efficacy of intraabdominal carbon dioxide insufflation
Minimizing diaphragmatic injury during radiofrequency ablation: Efficacy of intraabdominal carbon dioxide insufflation
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DOI：
10.2214/ajr.183.1.1830197
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发表时间：
2004-07-01
影响因子：
5
通讯作者：
Lu, D
中科院分区：
文献类型：
--
作者：
Raman, SS;Aziz, D;Lu, D
OBJECTIVE.我们研究的目的是确定腹腔内注入二氧化碳（CO2）是否能减少邻近组织的损伤。在7只麻醉猪中，使用标准吹入器将17号经皮吹入针插入脐下中线。将3 - 6升CO2注入腹膜空间，以在肝脏和隔膜之间实现至少1 cm的间隔，并通过8-10 mm Hg的压力维持。使用了6个历史对照中的7个对照病变。此外，在该队列的1只动物中创建了5处病变，作为对照。通过荧光透视定位与隔膜分离的肝脏浅表区域进行射频消融，并产生几个直径2 cm的射频损伤。在48小时时处死猪，在剖腹手术时，检查肝脏表面并切片以选择中心在表面1 cm内的病变。检查相应相邻膈肌的热损伤，以确定损伤深度。膈肌损伤按0-III级分级（0，无损伤; I，轻度损伤至三分之一厚度; II，中度损伤至三分之二厚度; III，重度损伤至全厚度）。结果在总共产生的72个损伤中，60个具有距离肝脏表面小于1cm的中心（即，浅表）。在这60处病变中，55处未造成明显的脑损伤，2处造成I级损伤，3处造成III级损伤。相比之下，7/7例既往浅表对照病变和5/5例来自当前队列的浅表射频对照病变造成III级损伤。腹腔内CO2吹入后产生的浅表射频损伤引起的脑损伤显著减少（P < 0.01）。我们已经证明，在猪中，当进行浅表肝脏射频消融时，腹腔内CO2吹入有助于显著减少严重的脑损伤。
OBJECTIVE. The purpose of our study was to determine whether intraperitoneal insufflation of carbon dioxide (CO2) reduces adjacent diaphragmatic injury.MATERIALS AND METHODS. In seven pigs under anesthesia, a 17-gauge percutaneous insufflation needle was inserted in the infraumbilical midline using a standard insufflator. Three to six liters of CO2 was infused into the peritoneal space to achieve at least a 1-cm separation between the liver and the diaphragm and maintained by a pressure of 8-10 mm Hg. Seven control lesions in six historical controls were used. In addition, five lesions were created in one animal from this cohort who served as a control. Superficial areas of liver separated from diaphragm were fluoroscopically targeted for radiofrequency ablation, and several 2-cm-diameter radiofrequency lesions were generated. The pigs were sacrificed at 48 hr, and at laparotomy, the liver surface was inspected and sectioned to select lesions with centers within 1 cm of the surface. The thermal injury to the corresponding adjacent diaphragm was examined to determine the depth of injury. Diaphragmatic injury was graded on a scale from 0 to III (0, no injury; I, mild injury to one-third thickness; II, moderate injury to two-thirds thickness; III, severe injury to full thickness.)RESULTS. Of 72 total lesions created, 60 had centers less than I cm from the liver surface (i.e., superficial) at laparotomy. Of these 60 lesions, 55 caused no significant diaphragmatic injury, two caused grade I injury and three caused grade III injury. In comparison, seven of seven historic superficial control lesions and five of five superficial radiofrequency control lesions from the current cohort caused grade III injury. Superficial radiofrequency lesions created after intraperitoneal CO2 insufflation caused significantly less (P < 0.01) diaphragmatic injury.CONCLUSION. We have shown that in pigs, intraperitoneal CO2 insufflation helped significantly reduce severe diaphragmatic injury when superficial hepatic radiofrequency ablation was performed.