Radiofrequency ablation of rabbit liver in vivo: effect of the pringle maneuver on pathologic changes in liver surrounding the ablation zone.
Radiofrequency ablation of rabbit liver in vivo: effect of the pringle maneuver on pathologic changes in liver surrounding the ablation zone.
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DOI：
10.3348/kjr.2004.5.4.240
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发表时间：
2004-10
影响因子：
4.8
通讯作者：
Kim JS
中科院分区：
文献类型：
--
作者：
Kim SK;Lim HK;Ryu JA;Choi D;Lee WJ;Lee JY;Lee JH;Sung YM;Cho EY;Hong SM;Kim JS
目的：探讨Pringle手法(阻断肝动脉和门静脉)对兔肝脏消融区周围肝血管、胆管和肝实质的病理变化的影响。用50W、480 kHz的单极射频发生器和带有四个尖头的15号可扩展电极在24只兔体内建立射频消融区，消融时间为7min。电极尖端放置在靠近肝门的肝实质内，电极尖端远端1 cm。射频消融组(n=12只)和非Pringle动作组(n=12只)进行射频消融。射频消融后即刻、3d(急性期)、7d(亚急性期早期)、2周(亚急性期晚期)各处死动物3只。切除消融区，观察消融区周围肝血管、胆管和肝实质的一系列病理变化。Pringle法发现门静脉血栓形成3例(急性期2例，急性期1例)，消融区邻近胆管扩张1例(亚急性期晚期1例)，消融区附近梗塞3例(亚急性期2例，亚急性期晚期1例)。未行Pringle手术的消融者肝脏未见上述变化。光镜下可见Pringle法消融后肝小叶中心充血、肝窦充血、肝窦和中性粒细胞粘连、肝细胞空泡化和气泡化改变较非Pringle法消融组明显(p<；0.05)，消融区周围门静脉、胆管和肝实质的病理改变较射频消融组更为严重。因此，我们建议使用Pringle手法进行射频消融时应非常谨慎，以避免不必要的热损伤。
We wished to evaluate the effect of the Pringle maneuver (occlusion of both the hepatic artery and portal vein) on the pathologic changes in the hepatic vessels, bile ducts and liver parenchyma surrounding the ablation zone in rabbit livers. Radiofrequency (RF) ablation zones were created in the livers of 24 rabbits in vivo by using a 50-W, 480-kHz monopolar RF generator and a 15-gauge expandable electrode with four sharp prongs for 7 mins. The tips of the electrodes were placed in the liver parenchyma near the porta hepatis with the distal 1 cm of their prongs deployed. Radiofrequency ablation was performed in the groups with (n=12 rabbits) and without (n=12 rabbits) the Pringle maneuver. Three animals of each group were sacrificed immediately, three days (the acute phase), seven days (the early subacute phase) and two weeks (the late subacute phase) after RF ablation. The ablation zones were excised and serial pathologic changes in the hepatic vessels, bile ducts and liver parenchyma surrounding the ablation zone were evaluated. With the Pringle maneuver, portal vein thrombosis was found in three cases (in the immediate [n=2] and acute phase [n=1]), bile duct dilatation adjacent to the ablation zone was found in one case (in the late subacute phase [n=1]), infarction adjacent to the ablation zone was found in three cases (in the early subacute [n=2] and late subacute [n=1] phases). None of the above changes was found in the livers ablated without the Pringle maneuver. On the microscopic findings, centrilobular congestion, sinusoidal congestion, sinusoidal platelet and neutrophilic adhesion, and hepatocyte vacuolar and ballooning changes in liver ablated with Pringle maneuver showed more significant changes than in those livers ablated without the Pringle maneuver (p < 0.05) Radiofrequency ablation with the Pringle maneuver created more severe pathologic changes in the portal vein, bile ducts and liver parenchyma surrounding the ablation zone compared with RF ablation without the Pringle maneuver. Therefore, we suggest that RF ablation with the Pringle maneuver should be performed with great caution in order to avoid unwanted thermal injury.