不同性质肝组织微波消融对邻近危险脏器损伤的机制研究

Microwave ablation (MWA) plays a more and more important role in the treatment of liver tumor. But MWA of liver tumor adjacent to gallbladder, diaphragm, gastrointestinal tract and other dangerous organs can lead to gallbladder fistula, diaphragm perforation, gastrointestinal perforation and other serious complications. If only in order to reduce complications to decrease ablation range, it can lead to tumor ablated incompletely and increase tumor residual and recurrence rate. Therefore, how to reduce the tumor residual rate and recurrence rate and furthest reduce the occurrence of complications at the same time, it is the problem must be solved clinically.This study tries to establish the pig model of normal liver and liver cirrhosis, and perform MWA on the liver tissue adjacent to diaphragm, gallbladder and intestinal tract. Through monitoring temperature during ablation, and researching CT performance, gross specimen and histopathology of liver tissue and adjacent diaphragm, gallbladder, intestinal tract after MWA, this study discusses the damage mechanism of diaphragm,gallbladder,intestinal tract after MWA,and further research numerous factors which cause the damage of diaphragm, gallbladder,intestinal tract(such as ablation condition,temperature change, histological characteristics of liver tissue and adjacent viscera,etc.). We hope provide more scientific theoretical basis for MWA of liver tumor clinically adjacent to diaphragm,gallbladder,intestinal tract,improve curative effect of MWA of liver tumor adjacent to dangerous organs and reduce the occurrence of complications.

微波消融在肝肿瘤的治疗中起到越来越重要的作用。但对一些邻近胆囊、膈肌、胃肠道等危险脏器的肝肿瘤行微波消融时，可导致胆囊瘘、膈肌穿孔、胃肠穿孔等严重并发症。若仅为了降低并发症而减小消融范围又会导致肿瘤消融不完全，使得肿瘤残留及复发率增加。因此，如何降低肿瘤残留及复发率的同时最大程度降低并发症的发生，是临床必须要解决的问题。本研究拟通过建立猪的正常肝及肝硬化模型，通过对邻近膈肌、胆囊、肠道的正常肝组织和肝硬化组织消融过程中温度的监测，以及对消融后的肝组织及邻近膈肌、胆囊、肠道的CT表现、大体标本及组织病理学的系统研究，探讨微波消融对膈肌、胆囊、肠道的损伤机制，并进一步研究诸多导致膈肌、胆囊、肠道损伤的因素（如消融的条件、温度的变化、肝组织及邻近器官的组织学特性等）。为临床微波消融治疗邻近膈肌、胆囊、肠道的肝肿瘤提供更科学的理论依据，提高微波消融治疗邻近危险脏器的肝肿瘤的疗效，减少并发症的发生。

微波消融在肝肿瘤的治疗中起到越来越重要的作用。但对一些邻近胆囊、膈肌等危险脏器的肝肿瘤行微波消融时,可导致胆囊瘘、膈肌穿孔等严重并发症。若仅为了降低并发症而减小消融范围又会导致肿瘤消融不完全,使得肿瘤残留及复发率增加。因此,如何降低肿瘤残留及复发率的同时最大程度降低并发症的发生,是临床必须要解决的问题。本研究建立猪的正常肝及肝硬化模型,并通过对邻近膈肌、胆囊的不同肝组织行微波消融治疗发现，在相同消融参数条件下猪肝硬化组织的微波消融范围明显小于正常肝组织，肝硬化组织中胆囊以及膈肌严重损伤的发生率有低于正常肝组织的趋势；在相同的组织中，胆囊以及膈肌严重损伤的发生率有随着消融功率的增加而升高的趋势；在相同组织相同的消融条件下，膈肌严重损伤的发生率有高于胆囊发生严重损伤的趋势，尤其是在高功率长时间的消融条件下。消融术后不同组织的对热损伤的修护不同，微波消融术后1周膈肌出现修复性改变，而胆囊的修复从消融术后4周开始。同时研究中观察到当邻近膈肌肺组织内出现渗出改变，胆囊出现明显水肿改变，提示膈肌及胆囊的损伤，应该及时停止消融治疗，防止进一步损伤。本研究为临床微波消融治疗邻近膈肌、胆囊的肝肿瘤提供更科学的理论依据, 有利于提高微波消融治疗邻近危险脏器的肝肿瘤的疗效, 减少并发症的发生。项目资助发表SCI论文4篇。培养硕士研究生3名，博士研究生2名，其中2名已经取得硕士学位，3名在读。项目各项支出基本与预算相符，剩余经费计划用于本项目研究后续支出