Prat F, Ponchon T, Berger F, Chapelon J Y, Gagnon P, Cathignol D
Department of Digestive Diseases, Hôpital E. Herriot, Lyon, France.
Gastroenterology. 1991 May;100(5 Pt 1):1345-50.
Tissue damage during shock-wave lithotripsy is presumably secondary to cavitation phenomena involving the collapsus of gas bubbles in a fluid. To enhance shock-wave-related hepatic lesions, intravascular gas microbubbles were administered. Three groups of eight rabbits each received either 500 shock waves focused on the right hepatic lobe (group 1), gas microbubbles as a mixture of 50 cm3 of air with 50 cm3 of gelatin infused through an arterial catheter (group 2), or 500 shock waves and gas microbubbles simultaneously (group 3). In group 1, two animals had two to three subcapsular hepatic hematomas (diameter, less than 5 mm) and five had one to five intraparenchymal hematomas (less than 1 mm). In group 2, a moderate liver congestion was observed in three animals. In group 3, all animals had numerous subcapsular and intraperenchymal hematomas (2-30 mm). The hematomas were centered around the portal spaces, associated with lacunae (0.5-5 mm in diameter). Hematomas were also present on the anterior wall of intraabdominal organs. It was concluded that intravascular infusion of gas microbubbles into the path of a shock-wave generator dramatically enhances tissue damage. This technique, potentially useful in the treatment of hepatic tumors, needs refinement to confine lesions in a more uniform pattern to the targeted parenchyma.
冲击波碎石术期间的组织损伤可能继发于涉及流体中气泡塌陷的空化现象。为了增强与冲击波相关的肝脏损伤，给予血管内气体微泡。三组，每组八只兔子，分别接受聚焦于右肝叶的500次冲击波（第1组）、通过动脉导管注入的50 cm³空气与50 cm³明胶的混合气体微泡（第2组），或同时接受500次冲击波和气体微泡（第3组）。在第1组中，两只动物有两到三个肝包膜下血肿（直径小于5 mm），五只动物有一到五个肝实质内血肿（小于1 mm）。在第2组中，三只动物观察到中度肝充血。在第3组中，所有动物都有大量肝包膜下和肝实质内血肿（2 - 30 mm）。血肿以门静脉周围为中心，伴有腔隙（直径0.5 - 5 mm）。腹腔内器官前壁也有血肿。得出的结论是，向冲击波发生器路径内血管内注入气体微泡会显著增强组织损伤。这种技术在肝肿瘤治疗中可能有用，需要改进以将损伤更均匀地局限于目标实质。
