Laeseke Paul F, Sampson Lisa A, Brace Chris L, Winter Thomas C, Fine Jason P, Lee Fred T
Department of Radiology, University of Wisconsin, Madison, WI 53792-3252, USA.
AJR Am J Roentgenol. 2006 May;186(5 Suppl):S249-54. doi: 10.2214/AJR.04.1240.
Radiofrequency ablation of hepatic tumors can lead to thermal injury of surrounding structures. Both saline and 5% dextrose in water (D5) have been used to displace these surrounding structures before radiofrequency ablation. The purpose of this study was to determine the relative effectiveness of these two fluids for protecting the diaphragm and lung during radiofrequency ablation.
Ten female domestic swine (mean weight, 45 kg) underwent radiofrequency ablation at open surgery. Group 1 (n = 12 lesions) was pretreated with peritoneal D5 before radiofrequency ablation. Group 2 (n = 11 lesions) was pretreated with peritoneal 0.9% saline. A 2.7-mm spacer was placed between the liver surface and diaphragm in groups 1 and 2. Group 3 (n = seven lesions) served as a control group with no pretreatment regimen. Group 4, an additional control group (n = eight lesions), consisted of animals pretreated with D5 in which a larger spacer was used. After radiofrequency ablation, the animals were sacrificed and the liver, diaphragm, and lung were removed. The extent of thermal injury to the surface of each organ was recorded.
The animals in the D5 and saline pretreatment groups experienced fewer diaphragm injuries than the control animals (D5, p = 0.02). The smallest lesions in the lung and diaphragm were in the D5 group, followed by the saline and control groups (diaphragm, p = 0.0001; lung, p = 0.13). Diaphragm lesions were significantly smaller in the D5 and saline groups than in the control group (p = 0.0001 and 0.01, respectively).
Instillation of D5 into the peritoneal cavity before hepatic radiofrequency ablation decreases the risk and severity of diaphragm and lung injuries compared with no pretreatment or pretreatment with 0.9% saline in this animal model. Pretreatment with D5 may increase both the safety of and the number of patients eligible for treatment with thermal therapies.
肝脏肿瘤射频消融可导致周围结构的热损伤。在进行射频消融之前，生理盐水和5%葡萄糖溶液（D5）均已被用于推移这些周围结构。本研究的目的是确定这两种液体在射频消融过程中对保护膈肌和肺的相对有效性。
10只雌性家猪（平均体重45千克）在开放手术中接受射频消融。第1组（12个病灶）在射频消融前用腹腔内D5进行预处理。第2组（11个病灶）用腹腔内0.9%生理盐水进行预处理。第1组和第2组在肝脏表面和膈肌之间放置一个2.7毫米的间隔物。第3组（7个病灶）作为未进行预处理方案的对照组。第4组为另一个对照组（8个病灶），由用D5预处理且使用更大间隔物的动物组成。射频消融后，处死动物并取出肝脏、膈肌和肺。记录每个器官表面的热损伤程度。
D5和生理盐水预处理组的动物发生膈肌损伤的情况少于对照组动物（D5，p = 0.02）。肺和膈肌中最小的损伤发生在D5组，其次是生理盐水组和对照组（膈肌，p = 0.0001；肺，p = 0.13）。D5组和生理盐水组的膈肌损伤明显小于对照组（分别为p = 0.0001和0.01）。
在此动物模型中，与不进行预处理或用0.9%生理盐水预处理相比，在肝脏射频消融前向腹腔内注入D5可降低膈肌和肺损伤的风险及严重程度。用D5预处理可能会提高热疗的安全性以及适合接受治疗的患者数量。
