Fegrachi S, Molenaar I Q, Klaessens J H, Besselink M G, Offerhaus J A, van Hillegersberg R
Department of Surgery, University Medical Center Utrecht, The Netherlands.
Department of Surgery, University Medical Center Utrecht, The Netherlands.
Eur J Surg Oncol. 2014 Aug;40(8):1000-7. doi: 10.1016/j.ejso.2013.11.001. Epub 2013 Nov 12.
To determine the impact of radiofrequency ablation (RFA) in pancreas after two-week follow-up.
RFA is a novel treatment strategy in patients with unresectable locally advanced pancreatic cancer. The histological effect and risk of postoperative complications has not been systematically addressed in an in-vivo animal model.
In a porcine model (n = 6), RFA was performed via laparotomy with previously determined optimal settings using a bipolar probe with 30 mm active length, at 30 W until a total energy of 15 KJ was administered. The probe was inserted in the pancreas at 10 mm distance from duodenum and portomesenteric vessels (PMV). RFA nearby duodenum was performed under continuous duodenal cooling using 100 ml/min saline of 5 °C. During two weeks the clinical condition was evaluated daily including blood analyses. After two weeks, total pancreatoduodenectomy was performed and the obtained tissue histopathologically assessed.
No mortality occurred during or after RFA. Two animals had a serum amylase increase more than threefold the pre-intervention value without clinical manifestations. Histopathologic assessment showed total ablation within the ablation zone, with loss of normal pancreatic acinar cell outlines and necrosis. In one animal, focal necrosis of duodenal submucosa was seen and in another animal focal fibrosis in the muscular layer of the superior mesenteric vein without clinical manifestations.
No major morbidity and no mortality was seen during a period of two weeks after RFA with previously validated RFA settings including duodenal cooling and 10 mm distance to PMV. Future clinical studies should confirm safety of RFA using the settings established here.
通过两周的随访确定射频消融（RFA）对胰腺的影响。
RFA是不可切除的局部晚期胰腺癌患者的一种新型治疗策略。体内动物模型尚未系统地探讨其组织学效应和术后并发症风险。
在猪模型（n = 6）中，通过剖腹术使用预先确定的最佳设置，采用有效长度为30 mm的双极探头，以30 W进行RFA，直至给予总能量15 KJ。将探头插入距十二指肠和门静脉肠系膜血管（PMV）10 mm处的胰腺中。在持续十二指肠冷却下，使用5℃的100 ml/min生理盐水对十二指肠附近进行RFA。在两周内每天评估临床状况，包括血液分析。两周后，进行全胰十二指肠切除术，并对获得的组织进行组织病理学评估。
RFA期间及之后均未发生死亡。两只动物的血清淀粉酶升高超过干预前值的三倍，但无临床表现。组织病理学评估显示消融区内完全消融，正常胰腺腺泡细胞轮廓消失且出现坏死。在一只动物中可见十二指肠黏膜下层局灶性坏死，在另一只动物中可见肠系膜上静脉肌层局灶性纤维化，但均无临床表现。
在采用包括十二指肠冷却和距PMV 10 mm距离等先前验证的RFA设置进行RFA后的两周内，未观察到严重并发症和死亡。未来的临床研究应证实使用此处确定的设置进行RFA的安全性。
