Teague B D, Court F G, Morrison C P, Kho M, Wemyss-Holden S A, Maddern G J
University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville Road, Woodville, South Australia 5011, Australia.
Br J Surg. 2004 Feb;91(2):178-83. doi: 10.1002/bjs.4400.
Local ablation has been proposed for treatment of liver tumours. Cryoshock, a variant of the systemic inflammatory response syndrome (SIRS), is a potentially fatal complication of cryoablation caused by systemic release of necrotic breakdown products from ablated liver. The proinflammatory cytokines tissue necrosis factor (TNF) alpha and interleukin (IL) 1 are important mediators of this response. This study assessed the risk of SIRS complicating electrolytic liver ablation by measuring circulating levels of inflammatory cytokines, other inflammatory markers and clinical markers of organ function.
Electrolytic liver ablation was performed in 16 pigs and four pigs served as controls. Platelet count, and serum levels of urea, creatinine, liver enzymes, C-reactive protein (CRP), TNF-alpha and IL-1beta were measured before treatment and for 72 h after the procedure.
There were significant dose-related increases in CRP and alanine aminotransferase levels with liver electrolysis. There was no significant derangement in renal function or platelet count following ablation. A rise in serum TNF-alpha and IL-1beta levels was not associated with liver electrolysis.
There was no evidence of organ failure or significantly raised levels of proinflammatory cytokines as a result of liver electrolysis, suggesting that this is a safe procedure for liver ablation.
局部消融已被提议用于治疗肝脏肿瘤。冷冻休克是全身炎症反应综合征（SIRS）的一种变体，是由消融肝脏中坏死分解产物的全身释放引起的冷冻消融潜在致命并发症。促炎细胞因子组织坏死因子（TNF）α和白细胞介素（IL）1是这种反应的重要介质。本研究通过测量循环炎症细胞因子水平、其他炎症标志物和器官功能的临床标志物，评估了电解肝脏消融并发SIRS的风险。
对16头猪进行电解肝脏消融，4头猪作为对照。在治疗前及术后72小时测量血小板计数以及血清尿素、肌酐、肝酶、C反应蛋白（CRP）、TNF-α和IL-1β水平。
随着肝脏电解，CRP和丙氨酸转氨酶水平有显著的剂量相关增加。消融后肾功能或血小板计数无明显紊乱。血清TNF-α和IL-1β水平的升高与肝脏电解无关。
没有证据表明肝脏电解会导致器官衰竭或促炎细胞因子水平显著升高，这表明电解肝脏消融是一种安全的肝脏消融方法。
