摘要目的 比较冷冻治疗、氩等离子凝固治疗(APC)及热射频对大鼠局部皮肤的损伤情况,探讨消融术对全身炎症反应及局部组织损伤的影响.方法 将48只健康雄性SD大鼠按随机数字表法分为冷冻组、APC组、热射频组和假手术组,前3组分别对大鼠皮肤进行冷冻、氩等离子凝固及热射频治疗,假手术组仅进行剃毛处理,术后1、3、5、7和28 d检测大鼠血清肿瘤坏死因子(TNF)-α、皮肤转化生长因子(TGF)-β1平均吸光度值与阳性细胞之乘积、瘢痕厚度及第5天HE染色结果.结果 (1)血清TNF-α:术后24 h,冷冻组、APC组、热射频组间差异无统计学意义(均P＞0.05),但均明显高于假手术组(均P＜0.05).第7天,冷冻组TNF-α最高为(146±8)ng/L,高于假手术组(t=3.88,P＜0.05).(2)皮肤TGF-β1平均吸光度值与阳性细胞之乘积:热射频组(105.3 ±16.4)、APC组(58.8±12.8)和冷冻组(36.4±2.8)之间两两比较差异均有统计学意义(均P＜0.05).APC组、热射频组与假手术组(34.1±1.7)相比,差异均有统计学意义(均P＜0.05).(3)第5天HE染色:热射频组皮肤炎症损伤最严重,APC组及冷冻组损伤各有差异(=0.91,P＞0.05).(4)皮肤瘢痕厚度:热射频组最厚为(612±98)μm,APC组为(362±120) μm,两者比较差异有统计学意义(t=4.54,P＜0.05),冷冻组及假手术组均未见瘢痕形成.结论 冷冻、APC、热射频3种方法对局部皮肤可造成不同的损伤及炎症反应,炎症因子反应规律因处理方法不同而异,冷冻治疗组的炎症反应和瘢痕形成均明显轻于热射频及APC治疗.

abstractsObjective To compare the impact of different methods of ablation,i.e.cryotherapy,argon plasma coagulation (APC) and radiofrequency,when applied to the skin of rats,on the systemic inflammatory response and local tissue damage.Methods Forty-eight healthy male SD rats were randomly divided into 4 groups:cryotherapy,APC,radiofrequency,and sham procedure.Cryotherapy,APC and catheter ablation were applied to the skin of the rats in the 3 groups respectively,while the sham-operated animals underwent shaving only.The animals were assessed after 1,3,5,7,and 28 days.The serum level of TNF-α was measured.TGF-β1 positive cells in the skin and the thickness of the scar tissue were assessed at the corresponding times,while HE-stained sections collected on the 5th day were examined.Results When the levels of serum TNF-α were compared after 24h,there were no significant differences among the cryotherapy,APC,and radiofrequency groups (cryotherapy and APC,cryotherapy and radiofrequency,APC and radiofrequency,t values were 0.23,0.22,and 1.53,respectively,all P ＞ 0.05),but the levels in each of these 3 groups were significantly higher than that in the sham-operated group(t values were-4.83,-4.63,and-3.24,respectively,all P ＜ 0.05).When the levels of TNF-α were compared after 7d,the cryotherapy group showed the highest(146 ± 8 ng/L),significantly higher than that in the sham-operated group (t value 3.88,P ＜ 0.05).The multiplication values of the average optical density and TGF-β1 positive cells in the rat skin among the radiofrequency(105.3 ± 16.4),APC(58.8 ± 12.8),and cryotherapy(36.4 ± 2.8)groups were significantly different(all P ＜ 0.05).The difference was also significant between the APC and the radiofrequency groups compared to the sham operation(34.1 ± 1.7)group (t values were 6.02 and 8.81,respectively,both P ＜ 0.05).HE staining of sections of the rat skin after 5 days showed that,radiofrequency resulted in the most serious injury to the skin,while the damage resulting from APC and cryotherapy varied,but was not significantly different (t value 0.91,P ＞ 0.05).The radiofrequency group showed the highest value (612 ± 98 μm)in the thickness of the scar tissue on the skin,which was significantly higher than that of the APC group(362 ± 120 μm,t value 4.54,P ＜0.05),while there was no scar formation in response to cryotherapy or sham operation.Conclusion Cryotherapy,APC and radiofrequency,when applied locally to the skin,caused different types of injury and had different effects on inflammation.The response of inflammation varied with different processing methods.Cryotherapy resulted in significantly lower response compared to either radiofrequency or APC when the inflammatory response was assessed after 5 days and the scar formation after 28 days.