摘要
目的 探讨射频消融 (RFA)脾脏治疗继发性脾肿大和脾功能亢进的可行性和有效性。方法 2 6只健康杂种狗分为Ⅰ组 (对照组 ,n =4)为对照组、Ⅱ组 (脾静脉结扎 ,n =10 )和Ⅲ组 (脾静脉结扎 +RFA ,n =12 )为治疗组。Ⅱ、Ⅲ组通过结扎脾静脉主干和脾静脉属支引起继发性脾大和脾亢模型 ,3周末Ⅲ组剖腹行脾脏RFA。RFA后观察动物并发症 ,行外周血小板计数、CT和组织病理学检查。结果 全组动物无死亡和并发症。脾静脉结扎后可以成功建立脾肿大和血小板减少、红细胞减少的脾亢模型。RFA后的脾脏CT病灶呈节段性毁损 ,包括高密度的坏死区和低密度的梗死区 ;梗死区在RFA后 4～ 6周内消失。RFA毁损灶包括凝固性坏死和广泛的血栓性梗死灶 ;梗死灶逐渐吸收、纤维化 ,坏死灶被包裹 ;血管闭塞、脾窦消失和组织少血管化等“残脾实性变”改变是残脾缩小和纠正脾亢的重要病理学变化。结论 RFA治疗实验性脾大和脾亢是可行和有效的 ,具有临床应用前景。脾脏RFA后特殊的影像学和病理学改变也可作为临床疗效观察和随访的重要指标。
Objective To investigate the feasibility and effectiveness of radiofrequency ablation (RFA) for the treatment of secondary splenomagely and hypersplenism in dog. Methods Twenty six healthy mongrel dogs were randomly divided into 3 groups, the first group ( n =4) as control, the second group ( n =10) and third group ( n =12), both undergoing ligation of the splenic vein and its collateral branches to induce congestive splenomegaly and hypersplenism. At the end of the third week, radiofrequency thermal ablation of spleen was performed in the third group via laparotomy. Enhanced CT scan, peripheral blood cell counts and observation of histopathological changes of the spleen were performed regularly. RFA related complications following RFA procedure were observed. Results There were no death and complications in experimental dogs. Models of thrombocytopenia, erythropenia and splenomegaly were established successfully by ligation of splenic veins. The CT findings revealed that the segmental RFA lesions included hyperintense zone of coagulative necrosis and more extensive peripheral hypointense infarcted zone. The infarcted zone could be absorbed and subsequently disappeared between 4 and 6 weeks after RFA. The histopathological changes of splenic lesions caused by RF thermal energy also included necrotic and thrombotic infarcted lesions. Infarcted lesion was gradually absorbed and fibrosed and meanwhile, the necrosis was encapsulated. Occluded vessels, disappearance of normal splenic sinuses and sparsely neovascularized vessels were the most important pathological changes occurring in viable remnant spleen, which was called as 'consolidated transformation'. This pathological transformation underlies the shrinkage of remnant spleen and correction of secondary hypersplenism. Conclusion RFA is feasible and effective for experimental splenomegaly and hypersplenism and is potential for clinical application. The unique radiological and pathological changes after splenic RFA could be used as a significant
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2003年第14期1250-1253,共4页
Journal of Third Military Medical University
基金
全军"十五"医学科研计划重点课题 ( 0 2Z0 0 5)
关键词
射频消融
脾脏
脾功能亢进
脾肿大
狗
radiofrequency ablation
spleen
hypersplenism
splenomegaly
dog
