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目的 通过建立活体小型猪精准肝切除模型来评估超声引导下射频消融肝蒂毁损在精准肝切除中应用的可行性及可重复性并探索该项技术的操作难点.方法 选取健康的广西巴马小型猪6头,每头猪均选取3个肝段(3、5、6段)作为目标肝段,超声引导下紧贴目标肝段血管插入冷循环电极进行肝蒂毁损,根据缺血边界离断肝实质,完整切除肝段.观察动物术后存活情况、动物肝功能变化、肝段血管血流指标以及肝段门静脉、动脉、胆管病理变化.不同时点数据比较采用t检验.结果 术后病死率及并发症发生率为0,所有动物术后14 d肝功能均恢复正常.15个肝段显色效果明显.射频消融后所有目标肝段门静脉的血流速度为0 cm/s,动脉的血流速度为(28±18) cm/s,较射频前的(10.2±3.0)cm/s和(60±17) cm/s降低(t=14.439、5.502,P=0.000).所有保留肝段的门静脉及动脉射频前、射频后、术后14 d血流速度无明显变化.连续切片显微观察,肝段门静脉、动脉及胆管平均毁损长度分别为(1.6±0.4)cm、(1.2±0.4)cm、(1.7±0.3)cm.结论 超声引导下射频消融肝蒂毁损技术安全、可靠、操作简便.为避免损伤邻近肝蒂,电极插入部位距肝蒂分叉处的垂直距离至少为1.5 cm.

Objective To demonstrate the ablation of segmental glissonian pedicle by ultrasoundguided radiofrequency in precision liver resection in porcine model.Methods The study was carried out on 6 Bama miniature pigs.Coagulative desiccation of the vessels feeding the segment to be resected was induced by introduction of a “cooled-tip” radiofrequency electrode under intraoperative ultrasound guidance at the Ievel of the vessels.Then,an area of marked discoloration on the surface of the liver became obvious.Liver parenchymal transection followed without any form of hepatic inflow occlusion.Three segments ( segment 3,5,and 6) were resected on each pig.The criteria studied the local and general tolerance,the change of blood flow parameters of each segmental arterial and portal branches,and the microscopic appearance of the segmental arterial,portal and biliary tract branches. Using t test as the statistical methods.Results Postoperative mortality and morbidity were 0 and all serum parameters hnd normalized by 14 days.Demarcation area was obtained in 15 segments.The flow rate of the resected segmental portal branches was 0 cm/s after radiofrequency and the value of the arterial branches was ( 28 ± 18 ) cm/s which was significantly lower than pre-radiofrequency,which were ( 10.2 ±3.0) cm/s and (60 ± 17) cm/s (t =14.439,5.502 ; P =0.000).There was no significant difference in the flow rate of the remnant segmental arterial and portal branches among pre-radiofrequency,post-radiofrequency and 14 days after operation.On microscopic observation,the mean ablated length of segmental portal,arterial and biliary tract branches were ( 1.6 ± 0.4) cm,( 1.2 ± 0.4 ) cm,and ( 1.7 ± 0.3 ) cm respectively.Conclusions The ablation of the segmental glissonian pedicle by ultrasound-guided radiofrequency is quick,safe and effective.The probe needs to be away from vessels feeding segments 1.5 cm at least to avoid thermal injuries.