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目的研究冷冻胆囊侧肝脏的安全性与有效性。方法对靠近胆囊0.5 cm处3只实验兔的肝脏进行氩氦刀消融,观察7 d后肝脏消融区与胆囊的形态及病理学改变,以及血清转氨酶在冷冻后各时段的变化。结果消融7 d后肝脏脏面形成黄色类圆形坏死灶,平均直径为(2.25±0.35)cm。消融区与腹壁(2/3)、膈肌(1/3)、肠系膜(1/3)、胃壁(1/3)和结肠(1/3)发生粘连。1/3实验兔出现胆囊穿孔。光镜下可见广泛肝组织坏死。肝组织结构不完整,肝小叶轮廓隐约可见,肝索和肝板崩解断裂呈空网状,肝窦局部充血、局部有大量退变炎性细胞浸润和少量崩解红细胞,核溶解。1/3实验兔胆囊壁全层坏死,肌层崩解,黏膜消失,坏死区内可见大量均一红染物质。血清谷草转氨酶(AST)及谷丙转氨酶(ALT)水平均在术后显著升高,其中AST呈一过性升高,在术后第7d恢复至正常水平。结论冷冻可有效消融肝脏组织,且可能引起胆囊穿孔。
Objective To study the safety and efficacy of frozen gallbladder liver. Methods The liver of 3 experimental rabbits near the gallbladder at 0.5 cm was ablated by argon-helium cryoablation. The morphological and pathological changes of ablation zone and gallbladder at 7 d were observed, and the changes of serum aminotransferases at different time points after freezing were observed. Results After 7 days of ablation, the liver showed a yellowish round necrosis with a mean diameter of (2.25 ± 0.35) cm. Ablation and abdominal wall (2/3), diaphragm (1/3), mesentery (1/3), stomach wall (1/3) and colon (1/3) adhesions. 1/3 experimental rabbit appeared gallbladder perforation. Light microscope shows a wide range of liver tissue necrosis. Liver tissue structure is incomplete, lobule outline looming, hepatic cord and hepatic plate disintegration fracture was empty mesh, sinusoidal local congestion, a large number of locally degenerative inflammatory cell infiltration and a small amount of disintegration of red blood cells, nuclear dissolution. 1/3 experimental rabbit gallbladder wall full-thickness necrosis, myometrial disintegration, mucosal disappearance of necrotic area can be seen a large number of homogeneous red dye material. Serum AST and ALT levels were significantly increased after surgery, in which AST was transiently increased and recovered to normal level on the 7th day after operation. Conclusion Frozen can effectively ablate liver tissue, and may cause gallbladder perforation.