论文部分内容阅读
目的探讨肝癌氩氦刀冷冻治疗并发出血的原因,探索出血防治方法。方法将VX2肿瘤细胞株移植于45只大白兔肝内建立实验性肝肿瘤模型,对45只荷瘤兔的61个肿瘤进行氩氦刀治疗,观察出血的发生;术后3 d对大白兔进行320排CT增强扫描,观察治疗靶区血流灌注情况。结果(1)61个肿瘤中出血阳性判定者6个,出血发生率为9.8%。有3个肿瘤是因为冰球破裂出血,其中2个肿瘤位于同一只大白兔肝上(该2个肿瘤中的1个第2次氩氦刀时因为进针过深,导致肿瘤本身及毗邻肿瘤的冰球破裂出血),另1例是氩氦刀结束时,冰球尚未完全融化,拔刀时用力过猛导致冰球破裂出血。其余3例中,1例是在冻融过程中由于用力牵拉冰球,导致冰球与正常肝组织连接处撕裂出血;2例是在氩氦刀结束后,冰球融化,穿刺通道出血。(2)术后3 d行CT扫描发现治疗靶区小血管闭塞,大血管血流正常。结论肝癌氩氦刀作为一种微创技术,仍有出血的风险存在。出血的时间主要发生在围手术期,与不规范操作及操作过急有关,术后24 h后治疗靶区小血管闭塞,死亡风险较低。
Objective To investigate the causes of hemorrhage caused by cryoablation of argon-helium knife in hepatocellular carcinoma (HCC) and to explore the methods of prevention and treatment of hemorrhage. Methods VX2 tumor cell lines were transplanted into the liver of 45 rabbits to establish experimental hepatic tumor model. The 61 tumors of 45 tumor-bearing rabbits were treated with argon-helium knife, and the occurrence of hemorrhage was observed. The rabbits were performed 3 days after operation 320 row CT enhanced scan to observe the therapeutic target blood perfusion. Results (1) Six out of 61 tumors were found to be hemorrhagic positive, with a bleeding rate of 9.8%. Three tumors were due to ruptured puck, two of which were located on the same rabbit liver (one of the two had an over-injected needle during the second cryo-knife, leading to the tumor itself and adjacent tumor Ice puck rupture bleeding), the other case is the end of the argon-helium knife, the puck has not yet completely melted, pull the knife too hard to cause hockey puck bleeding. In the remaining 3 cases, 1 case was forced to pull the ice hockey during the process of freezing and thawing, resulting in the torn bleeding of the ice hockey and the junction of the normal liver tissue. In 2 cases, the ice hock melted and the bleeding of the puncture channel occurred after the end of the argon-helium knife. (2) The CT scan of 3 days after operation found that the treatment of small vessel occlusion of the target area, the normal blood flow of large vessels. Conclusion Hepatocarcinoma cryo-helium knife as a minimally invasive technique, there is still the risk of bleeding. Bleeding time mainly in the perioperative period, and non-standard operation and operation of acute related to the target 24 h after treatment of small vessel occlusion, the lower the risk of death.