State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China.
World J Gastroenterol. 2011 Dec 7;17(45):5014-20. doi: 10.3748/wjg.v17.i45.5014.
To discuss the safety, feasibility and regularity of destruction to porcine spleen in vivo with congestion and tumescence by microwave ablation (MWA).
Ligation of the splenic vein was used to induce congestion and tumescence in vivo in five porcine spleens, and microwave ablation was performed 2-4 h later. A total of 56 ablation points were ablated and the ablation powers were 30-100 W. The ablation time (1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 min) was performed at a power of 60 W. After ablation, the ablation size was measured in pigs A, C, D and E and spleen resection. In pig B, the ablation size was measured and 2 ablation points were sent for pathology analysis and all tissues were sutured following ablation. Pig B was killed 1 wk later and the ablation points were sent for pathology analysis. Bleeding, tissue carbonization surrounding electrodes, and pathological changes were observed, and the effect on destruction volume relative to different ablation powers, times and positions was analyzed.
The incidence of bleeding (only small am-ounts, < 20 mL) in the course of ablation was 5.4% (3/56) and was attributed to tissue carbonization surrounding electrodes, which also exhibited an incidence of 5.4% (3/56). The destruction volume was influenced by different ablation powers, times and points. It showed that the ablation lesion size increased with increased ablation time, from 1 to 10 min, when the ablation power was 60 W. Also, the ablation lesion size increased with the increase of ablation power, ranging from 30 to 100 W when the ablation time was set to 3 min. A direct correlation was seen between the destruction volume and ablation time by the power of 60 W (r = 0.97542, P < 0.0001, and also between the destruction volume and ablation powers at an ablation time of 3 min (r = 0.98258, P < 0.0001). The destruction volume of zone II (the extra-2/3 part of the spleen, relative to the first or second class vascular branches), which was near the hilum of the spleen, was noteably larger than the destruction volume of zoneI(the intra-1/3 part of the spleen) which was distal from the hilum of the spleen (P = 0.0015). Pathological changes of ablation occurring immediately and 1 wk after MWA showed large areas of coagulation. Immediately following ablation, intact spleen tissues were observed in the areas of coagulation necrosis, mainly around arterioles, and there were no obvious signs of hydropsia and inflammation, while 1 wk following the ablation, the coagulation necrosis was well distributed and complete, as many nuclear fragmentations were detected, and there were obvious signs of hydropsia and inflammation.
In vivo treatment of congestion and tumescence in the spleen using microwave ablation of water-cooled antenna is a safe and feasible method that is minimally invasive.
探讨微波消融(MWA)诱导猪脾淤血肿胀后破坏脾脏的安全性、可行性和规律性。
结扎猪脾静脉以诱导体内淤血肿胀,2-4 小时后进行微波消融。共消融 56 个点,消融功率为 30-100 W。在功率为 60 W 时进行 1、2、3、4、5、6、7、8、9 和 10 min 的消融时间。在猪 A、C、D 和 E 中测量消融后脾脏的大小,并进行脾脏切除。在猪 B 中测量消融大小,并对 2 个消融点进行病理分析,消融后所有组织均进行缝合。猪 B 于 1 周后处死,对消融点进行病理分析。观察出血、电极周围组织碳化和病理变化,并分析不同消融功率、时间和位置对破坏体积的影响。
消融过程中出血(仅少量,<20 mL)的发生率为 5.4%(3/56),归因于电极周围组织碳化,发生率也为 5.4%(3/56)。破坏体积受不同消融功率、时间和点的影响。结果显示,当消融功率为 60 W 时,消融时间从 1 分钟增加到 10 分钟,消融损伤的大小增加。当消融时间设定为 3 分钟时,消融损伤的大小也随着消融功率从 30 增加到 100 W 而增加。在功率为 60 W 时,破坏体积与消融时间呈直接相关(r = 0.97542,P < 0.0001),在消融时间为 3 分钟时,破坏体积与消融功率呈直接相关(r = 0.98258,P < 0.0001)。靠近脾门的脾外 2/3 区(相对于第一或第二级血管分支)的破坏体积明显大于远离脾门的脾内 1/3 区(P = 0.0015)。MWA 即刻和 1 周后的病理变化显示出大面积的凝固。MWA 即刻,在凝固坏死区观察到完整的脾组织,主要围绕小动脉,没有明显的水肿和炎症迹象,而 1 周后,凝固坏死分布均匀且完整,检测到许多核碎片,并有明显的水肿和炎症迹象。
微波水冷天线消融诱导猪脾淤血肿胀的体内治疗是一种安全、可行的微创方法。