HIFU消融脾脏治疗脾功能亢进动物实验探究.docVIP

HIFU消融脾脏治疗脾功能亢进动物实验探究 　 作者：梅浙川, 刘永军, 廖元江, 李发琪 【摘要】 目的：探讨高强度聚焦超声（HIFU）消融脾脏治疗脾功能亢进的可行性和有效性. 方法： 15只健康成年杂种犬随机分为对照组（A）、脾静脉结扎（SVL）组（B）和SVL+HIFU治疗组（C）. SVL术后3 wk对C组犬开腹行HIFU脾脏消融. 观察3组犬外周血像、脾脏体积、消融后并发症及脾脏病理学变化. 结果：结扎脾静脉主干及主要分支，可形成犬淤血性脾肿大、脾亢. HIFU消融区域可见凝固性坏死，血管闭塞，血栓形成. 坏死能逐渐吸收、纤维化或包裹机化. 无脾脓肿、脾破裂等并发症出现. 消融后脾脏体积明显缩小，外周血红细胞、血小板逐渐恢复正常. 结论：HIFU消融脾脏治疗实验性脾肿大和脾亢是可行和有效的，该技术可以作为临床脾亢治疗的新尝试. 【关键词】 高强度聚焦超声；犬；脾功能亢进；病理学 　　【Abstract】 AIM: To investigate the feasibility and effectiveness of HIFU ablation of spleen for the treatment of hypersplenism. METHODS: Fifteen healthy mongrel dogs were randomly divided into control group (group A), splenic vein ligation （SVL） group (group B), and SVL+HIFU treatment group (group C). Dogs in group C underwent splenic ablation with HIFU under direct vision via laparotomy 3 weeks after SVL. The peripheral blood cell counts, size of spleen, complications and histopathological changes were measured regularly. RESULTS: Thrombocytopenia, erythropenia and splenomegaly were presented in the dogs with SVL. Coagulative necrosis, vascular occlusion, thrombosis of spleen were demonstrated under induction of HIFU irradiation. Lesion was gradually absorbed and fibrosed or encapsulated. No major complications including abscess or rupture of spleen occurred. The size of spleen in group C was obviously smaller than that before therapy. The counts of PLT and RBC in group C increased gradually after therapy. CONCLUSION: HIFU is feasible and effective for experimental splenomegaly and hypersplenism. This method holds promise for future clinical applications in therapy of hypersplenism. 　　【Keywords】 high intensity focused ultrasound; dog; hypersplenism; pathology 　　0引言 　　高强度聚焦超声（high intensity focused ultrasound, HIFU）是近年兴起的一项肿瘤治疗技术，主要通过热效应使靶区内组织温度骤升至65～100℃，使其发生凝固性坏死而发挥治疗作用. 随着研究深入，HIFU的非肿瘤适应证也正在逐步拓宽. 目前国外已有将HIFU用于脾脏破裂止血的动物研究［1］，结果表明通过HIFU可以使出血的脾脏组织发生凝固性坏死而达到止血的目的. 因此，我们设想能否通过HIFU对脾脏进行高温消融从而达到治疗脾亢的目的. 本研究我们使用便携式HIFU治疗仪开腹直视下对脾亢模型犬进行脾脏消融，观察HIFU消融后脾脏的病理学改变、体积及外周血像的变化和并发症的情况，