Guenther Enric, Klein Nina, Mikus Paul, Botea Florin, Pautov Mihail, Lugnani Franco, Macchioro Matteo, Popescu Irinel, Stehling Michael K, Rubinsky Boris
Biophysics, Inter Science GmbH, Gisikon, Lucerne, Switzerland.
Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, USA.
PeerJ. 2020 Jan 20;8:e7985. doi: 10.7717/peerj.7985. eCollection 2020.
Percutaneous image-guided tissue ablation (IGA) plays a growing role in the clinical management of solid malignancies. Electroporation is used for IGA in several modalities: irreversible electroporation (IRE), and reversible electroporation with chemotoxic drugs, called electrochemotherapy (ECT). It was shown that the combination of electrolysis and electroporation-E2-affords tissue ablation with greater efficiency, that is, lower voltages, lower energy and shorter procedure times than IRE and without the need for chemotoxic additives as in ECT.
A new E2 waveform was designed that delivers optimal doses of electroporation and electrolysis in a single waveform. A series of experiments were performed in the liver of pigs to evaluate E2 in the context of clinical applications. The goal was to find initial parameter boundaries in terms of electrical field, pulse duration and charge as well as tissue behavior to enable real time tissue ablation of clinically relevant volumes.
Histological results show that a single several hundred millisecond long E2 waveform can ablate large volume of tissue at relatively low voltages while preserving the integrity of large blood vessels and lumen structures in the ablation zone without the use of chemotoxic drugs or paralyzing drugs during anesthesia. This could translate clinically into much shorter treatment times and ease of use compared to other techniques that are currently applied.
在实体恶性肿瘤的临床治疗中，经皮影像引导下的组织消融（IGA）发挥着越来越重要的作用。电穿孔在多种IGA方式中得到应用：不可逆电穿孔（IRE），以及与化学毒性药物联合的可逆电穿孔，即电化学疗法（ECT）。研究表明，电解与电穿孔相结合的E2方法能以更高的效率实现组织消融，也就是说，与IRE相比，所需电压更低、能量更低且手术时间更短，并且无需ECT中使用的化学毒性添加剂。
设计了一种新的E2波形，可在单个波形中提供最佳剂量的电穿孔和电解。在猪的肝脏中进行了一系列实验，以评估E2在临床应用中的情况。目标是确定电场、脉冲持续时间和电荷量方面的初始参数界限以及组织行为，以便对临床相关体积进行实时组织消融。
组织学结果表明，单个数百毫秒长的E2波形能够在相对较低的电压下消融大量组织，同时在消融区域内保持大血管和管腔结构的完整性，且在麻醉期间无需使用化学毒性药物或麻痹药物。与目前应用的其他技术相比，这在临床上可能意味着治疗时间大幅缩短且使用更加简便。
