Ritz Joerg-P, Lehmann Kai S, Isbert Christoph, Reissfelder Christoph, Albrecht Thomas, Stein Thomas, Buhr Heinz J
Department of General, Vascular and Thoracic Surgery, University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
J Surg Res. 2006 Jun 15;133(2):176-84. doi: 10.1016/j.jss.2005.09.028. Epub 2005 Dec 19.
Only monopolar systems have thus far been available for radiofrequency ablation of liver tumors, whose application is restricted because of the incalculable energy flow, reduction of electrical tissue conduction, and limited lesion size. The aim of this study was to evaluate a novel internally cooled bipolar radiofrequency application device under in vivo conditions and to compare the effect of this system on lesion size when combined with hepatic arterial microembolization or complete hepatic blood flow occlusion.
In a porcine liver model, RFA (60 W, 12 min) was performed with either normal (n = 12), partially interrupted (arterial microembolization via a hepatic artery catheter n = 12) or completely interrupted hepatic perfusion (Pringle's maneuver, n = 12). RFA parameters (impedance, power output, temperature, applied energy) were determined continuously during therapy. RFA lesions were macroscopically assessed after liver dissection.
Bipolar RFA induced clinical relevant ellipsoid thermal lesions without complications. Hepatic inflow occlusion led to a 4.3-fold increase in lesion volume after arterial microembolization and a 5.8-fold increase after complete interruption (7.4 cm(3)versus 31.9 cm(3)versus 42.6 cm(3), P < 0.01).
The novel bipolar RFA device is a safe and effective alternative to monopolar RFA-systems. Interrupting hepatic perfusion significantly increases lesion volumes in bipolar RFA. This beneficial effect can also be achieved in the percutaneous application mode by RFA combined with arterial microembolization via a hepatic artery catheter.
迄今为止，仅有单极系统可用于肝脏肿瘤的射频消融，由于能量流难以计算、电组织传导降低以及病灶大小受限，其应用受到限制。本研究的目的是在体内条件下评估一种新型内部冷却双极射频应用设备，并比较该系统与肝动脉微栓塞或完全肝血流阻断联合使用时对病灶大小的影响。
在猪肝模型中，分别采用正常灌注（n = 12）、部分中断灌注（通过肝动脉导管进行动脉微栓塞，n = 12）或完全中断肝灌注（Pringle手法，n = 12）进行射频消融（60 W，12分钟）。治疗过程中连续测定射频消融参数（阻抗、功率输出、温度、施加能量）。肝切除后对射频消融病灶进行宏观评估。
双极射频消融产生了临床相关的椭圆形热损伤，无并发症。肝血流阻断导致动脉微栓塞后病灶体积增加4.3倍，完全中断后增加5.8倍（7.4 cm³对31.9 cm³对42.6 cm³，P < 0.01）。
新型双极射频消融设备是单极射频消融系统的一种安全有效的替代方案。在双极射频消融中，中断肝灌注可显著增加病灶体积。通过经皮应用模式，将射频消融与经肝动脉导管进行的动脉微栓塞相结合，也可实现这种有益效果。
