射频热凝保脾技术预处理脾脏断面的组织学变化

摘要

Objective To observe the histological variation of the spleen cross-section after Radiofrequency (RF), and the influence of heat coagulation zone and its surrounding tissue after different RF time.Methods 12 pigs were ran-domly divided into observation group A, observation group B and the control group with 4 pigs in each group.Thermal co-agulation was established by multi point RF electrode in the midpoint of long axis perpendicular to the long axis of the spleen.RF time in Observation A and B groups were 2 and 5 min, the control group was not given energy.After wandering spleen, to observe the splenic tissue of coagulation band edge every 1 cm in group A and B, and the width of 3 mm of splenic tissue in control group, totally 5 tablets.Tissue morphology was observed with electron microscope and optical mi-croscope with HE staining;apoptosis was detected by TUNEL method, then apoptosis index was calculated.Results HE staining showed that the tissue necrosis of coagulation, cell structure totally destroyed;coagulation band around the splenic tissue no necrosis, no endovascular thrombosis formation, except the splenic sinus rupture.Related changes of RF thermo-coagulation hemostasis was observed in 2, 4 cm from coagulation band edge with transmission electron microscope in the ob-servation A and B groups.Reversible cell injury, hemorrhage, inflammatory exudation, and number of apoptotic cells in group A were lighter than those in group B.The apoptosis index in group B with 0, 1, 2 cm from coagulation, were higher than those in group A and control group, all P<0.01;apoptosis index in group A with 1, 2 cm from the coagulation, were higher than those in control group, all P<0.05.Conclusions The RF thermocoagulation is based on the spleen organiza-tion protein coagulation degeneration, blood vessels and sinusoidal thrombosis, vascular occlusion.The longer of RF time, the more serious of the damage surrounding spleen tissue.%目的：观察射频热凝保脾技术预处理脾脏断面的组织学变化，以及不同射频时间对热凝带及其周围组织的影响。方法12只小型猪随机分为观察A组、观察B组和对照组各4只，均于脾脏长轴中点垂直于脾脏长轴通过多点插入射频电极建立热凝带，观察A、B组射频时间分别为2、5 min，对照组不给予能量。切除脾脏后，观察A、B组自热凝带边缘每隔1 cm、对照组于射频针边缘迅速切取宽3 mm的脾组织，共取5片。透射电镜下及HE染色后光学显微镜下观察组织形态，TUNEL法检测细胞凋亡。结果 HE染色后光学显微镜下可见热凝带组织发生凝固性坏死，细胞结构完全被破坏；热凝带周围脾组织未见坏死，血管腔内未见血栓形成，仅见脾窦扩张、破裂。透射电镜下可见观察A、B组分别在距离热凝带边缘2、4 cm处出现射频热凝止血的相关改变，观察A组热凝带旁相同距离的脾组织在细胞可逆性损伤程度、出血及炎性渗出、凋亡细胞数量等方面均轻于观察B组。观察B组距离热凝带0、1、2 cm组织的细胞凋亡指数均高于观察A组、对照组，P均＜0．01；观察A组距离热凝带1、2 cm组织的细胞凋亡指数均高于对照组，P均＜0．05。结论射频热凝保脾技术预处理脾脏断面的组织学基础是脾组织蛋白凝固变性，血管及血窦内血栓形成，血管闭塞；射频时间越长，周围脾组织损伤和细胞凋亡越重。