Habib VesOpen消融导管治疗小型猪模拟门静脉癌栓的安全性研究

摘要

目的：探索射频消融（RFA）导管治疗门静脉癌栓（PVTT）的安全性。方法将10头实验小型猪分为3组：A组（n=6）直接行正常门静脉RFA治疗；B组（n=2）先行门静脉球囊封堵，然后行门静脉新鲜血栓RFA治疗；C组（n=2）先建立PVTT模型，待门静脉血栓机化后行门静脉RFA治疗。术后1、3、4周作MRI检查，4周后处死动物作病理学检查。结果 A组动物在功率5 W条件下接受RFA治疗0．6～3．6 min，MRI检查及1个月后病理学检查均未发现明确异常。 B组动物RFA后MRI检查提示门静脉区损伤较A组明显，术后1、3、4周内膜MRI检查提示门静脉水肿逐渐减轻；术后1个月病理学检查证实邻近肝组织损伤严重。C组在功率7 W条件下接受RFA治疗1．5 min，术后MRI检查未见消融区明显水肿，病理学检查可见机化的血栓坏死、血管内皮细胞受损。结论采用Habib VesOpen双极RFA导管治疗PVTT，应根据PVTT严重程度选择合适的RFA功率与时间。PVTT较轻时采用大功率、短时间RFA可能较安全，PVTT较重时改用小功率、长时间RFA更为安全可靠。%Objective To explore the safety of Habib VesOpen bipolar radiofrequency ablation (RFA) catheter used in the treatment of portal vein tumor thrombus (PVTT). Methods A total of 10 miniature pigs were randomly divided into 3 groups. Group A(n=6):RFA of normal portal vein was directly performed;group B (n=2): balloon obstruction of the portal vein was performed first, which was followed by RFA for the fresh thrombus in the portal vein; group C (n=2): PVTT model was established first, and RFA of the portal vein was carried out when the portal thrombus became organized. MRI examination was employed at one, 3 and 4 weeks after RFA; the animals were sacrificed 4 weeks after RFA and pathological examination of portal vein was performed. Results Pigs of group A received portal vein RFA under the condition of 5 W power for 0.6-3.6 min. No obvious abnormality was detected by MRI and pathological examination , which were performed one month after the treatment. In the pigs of group B , MRI performed after RFA showed that the damage of portal vein area was more serious than that in the pigs of group A;abdominal MRI examination performed at one, 3 and 4 weeks after RFA showed that the portal venous edema was gradually decreased;pathological examination at one month after RFA demonstrated serious injury of adjacent liver tissue. Pigs of group C received portal vein RFA under the condition of 7 W power for 1.5 min; no obvious edema of the ablated area was observed on MRI performed after RFA , and pathological examination revealed organized thrombus necrosis and va scular endothelial cell damage. Conclusion When Habib VesOpen bipolar RFA catheter is used for the treatment of PVTT, the RFA power and time should be properly selected according to the severity of PVTT. In order to ensure a safer procedure, high power and short ablation time should be used when the severity of PVTT is mild, while low power and longer ablation time are recommended when the PVTT is more severe.