Siddiqui Imran A, Latouche Eduardo L, DeWitt Matthew R, Swet Jacob H, Kirks Russell C, Baker Erin H, Iannitti David A, Vrochides Dionisios, Davalos Rafael V, McKillop Iain H
Division of HPB Surgery, Dept. Surgery, Carolinas Medical Center, Charlotte, NC, USA.
School of Biomedical Engineering and Mechanics, Virginia Polytechnic and State University, Blacksburg, VA, USA.
HPB (Oxford). 2016 Sep;18(9):726-34. doi: 10.1016/j.hpb.2016.06.015. Epub 2016 Jul 26.
Irreversible electroporation (IRE) offers an alternative to thermal tissue ablation in situ. High-frequency IRE (H-FIRE), employing ultra-short bipolar electrical pulses, may overcome limitations associated with existing IRE technology to create rapid, reproducible liver ablations in vivo.
IRE electrodes (1.5 cm spacing) were inserted into the hepatic parenchyma of swine (n = 3) under surgical anesthesia. In the absence of paralytics or cardiac synchronization five independent H-FIRE ablations were performed per liver using 100, 200, or 300 pulses (2250 V, 2-5-2 μs configuration). Animals were maintained under isoflurane anesthesia for 6 h prior to analysis of ablation size, reproducibility, and apoptotic cell death.
Mean ablation time was 230 ± 31 s and no EKG abnormalities occurred during H-FIRE. In 1/15 HFIRE's minor muscle twitch (rectus abdominis) was recorded. Necropsy revealed reproducible ablation areas (34 ± 4 mm(2), 88 ± 11 mm(2) and 110 ± 11 mm(2); 100-, 200- and 300-pulses respectively). Tissue damage was predominantly apoptotic at pulse delivery ≤200 pulses, after which increasing evidence of tissue necrosis was observed.
H-FIRE can be used to induce rapid, predictable ablations in hepatic tissue without the need for intraoperative paralytics or cardiac synchronization. These advantages may overcome limitations that restrict currently available IRE technology for hepatic ablations.
不可逆电穿孔（IRE）为原位热组织消融提供了一种替代方法。高频IRE（H-FIRE）采用超短双相电脉冲，可能克服与现有IRE技术相关的局限性，从而在体内实现快速、可重复的肝脏消融。
在手术麻醉下，将IRE电极（间距1.5厘米）插入猪（n = 3）的肝实质中。在无麻痹剂或心脏同步的情况下，每只肝脏使用100、200或300个脉冲（2250 V，2-5-2 μs配置）进行5次独立的H-FIRE消融。在分析消融大小、可重复性和凋亡细胞死亡之前，动物在异氟烷麻醉下维持6小时。
平均消融时间为230±31秒，H-FIRE期间未发生心电图异常。在1/15的H-FIRE中记录到轻微肌肉抽搐（腹直肌）。尸检显示消融区域可重复（分别为34±4平方毫米、88±11平方毫米和110±11平方毫米；分别为100、200和300个脉冲）。在脉冲传递≤200个脉冲时，组织损伤主要为凋亡，之后观察到组织坏死的证据增加。
H-FIRE可用于在肝组织中诱导快速、可预测的消融，而无需术中使用麻痹剂或心脏同步。这些优点可能克服限制当前可用IRE技术用于肝脏消融的局限性。
