Ex vivo human bile duct radiofrequency ablation with a bipolar catheter
Ex vivo human bile duct radiofrequency ablation with a bipolar catheter
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DOI：
10.1007/s00464-017-5984-0
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发表时间：
2018-06-01
影响因子：
3.1
通讯作者：
Brugge, William R.
中科院分区：
文献类型：
--
作者：
Atar, Mustafa;Kadayifci, Abdurrahman;Brugge, William R.
原发性和继发性胆管肿瘤的管理仍然是一个主要的临床挑战。这些肿瘤的射频消融（RFA）是可行的，但射频能量对人胆总管（CBD）和周围组织的影响尚未研究。该初步研究旨在确定正常人CBD中射频能量与消融深度之间的关系，该研究是在因胰腺囊肿或肿块切除的新鲜离体人胆胰组织上进行的。该研究在切除后15分钟内进行。将双极Habib射频消融导管置于完整CBD的中间，并通过射频消融仪在90秒内施加三种不同（5、7、10 W）的功率设置。进行大体和组织学检查。通过显微镜观察CBD凝固性坏死的深度以及RFA对CBD壁和周围胰腺组织的影响。对三个部位施加5 W功率，RFA仅引起局限于CBD粘膜的局灶性上皮坏死。5个部位照射7和10W，均出现凝固性坏死。显微镜下，坏死是透壁的，涉及副胆管腺体，并扩展到周围的胰腺组织在这些案件中的4个。宏观上，RFA导致周围白黄色变化，延伸约2 cm的CBD。5W的双极射频能量应用导致CBD壁的有限消融。然而，7和10 W产生组织坏死，其延伸穿过CBD壁并进入周围胰腺组织。内镜下胆道射频消融是一种有效的局部胆道组织消融技术，但使用高能量可能会损伤周围组织。
Management of the primary and secondary tumors of the bile ducts still remains as a major clinical challenge. Radiofrequency (RF) ablation (RFA) of these tumors is feasible but the effect of RF energy on the human common bile duct (CBD) and surrounding tissues has not been investigated. This pilot study aimed to determine the relationship between RF energy and the depth of ablation in the normal human CBD.The study was performed on fresh ex vivo human biliary-pancreatic tissue which had been resected for a pancreatic cyst or mass. The study was conducted within 15 min after resection. A bipolar Habib RFA catheter was placed into the middle of the intact CBD, and three different (5, 7, 10 W) power settings were applied over a 90-s period by an RF generator. Gross and histological examinations were performed. The depth of coagulation necrosis in CBD and the effect of RFA on CBD wall and surrounding pancreas tissue were determined by microscopic examination.The study included eight tissue samples. 5 W power was applied to three sites and RFA caused only focal epithelial necrosis limited to the CBD mucosa. 7 and 10 W were applied to five sites and coagulation necrosis occurred in all cases. Microscopically, necrosis was transmural, involved accessory bile duct glands, and extended to the surrounding pancreatic tissue in four of these cases. Macroscopically, RFA resulted in circumferential white-yellowish color change extending approximately 2 cm of the CBD.Bipolar RF energy application with 5 W resulted in limited ablation on CBD wall. However, 7 and 10 W generated tissue necrosis which extended through the CBD wall and into surrounding pancreas tissue. Endoscopic biliary RFA is an effective technique for local biliary tissue ablation but the use of high energy may injure surrounding tissue.