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目的确定高剂量不可逆电穿孔(IRE)消融术是否对正常肝组织诱发了热效应。材料与方法在本试验前获得动物保护和使用委员会批准。在间隔1cm直径1.3cm的圆形平板电极间施加电流,由一个4人团队对22个活体猪肝脏施行IRE消融术(n=78)。在可变电压(1500~2900V)下,施加心电门控IRE脉冲(n=40~360)。测量消融中心地带的终末温度与消融时间、能量参数、大体病理及病理组织学检查中体现的治疗结果的相关性。采用4-电极IRE阵列(3000V,每对电极90次脉冲)在中心和外围区域产生4区消融并监测其温度。视具体情况,使用多元方差分析的多变量比较和(或)配对t检验和回归分析对数据进行分析。结果在所有IRE平板实验中温度均超过34°C的基线值,与能量剂量(电压值和脉冲数)呈线性相关(R2=0.39),在单变量分析中温度与电压值和脉冲数更具有相关性。因此,在电压2500V和脉冲为270时,平均温度高达(86±3)℃。脉冲数为90或更高,电压为2500V时,消融产生的温度会达到50℃或更高,产生经典的大体病理和组织学上的热凝固效应(致密核、流动细胞质)。对于低剂量IRE(比如,2100V,90次脉冲),温度会始终低于45℃,仅可发现与IRE相关的病理产物(如肿胀的血窦、脱水细胞、出血渗出物)。在使用4-电极阵列时,电极表面温度是(54.2±6.1)℃,消融边缘带温度是(38.6±3.2)℃。结论在某些高强度条件下,IRE会产生充足的热量诱发“白区”热凝效应。这种效应在某种条件下对肿瘤的破坏有作用,需要更进一步地认识临床电极的热特性,对能量参数要有充分的认识和理解,以避免无意识地损伤消融区周围对热效应敏感的重要结构。
Objective To determine whether high-dose irreversible electroporation (IRE) ablation induced a thermal effect on normal liver tissue. Materials and methods Animal protection and use committee approval prior to this test. Current was applied across circular plate electrodes 1 cm in diameter and 1.3 cm apart, and 22 live pig livers were subjected to IRE ablation (n = 78) by a 4-person team. The ECG-gated IRE pulse (n = 40 ~ 360) was applied at variable voltage (1500 ~ 2900V). Measurement of ablation center temperature of the terminal zone and ablation time, energy parameters, gross pathology and histopathological examination revealed the treatment results. A 4-electrode IRE array (3000V, 90 pulses per electrode) was used to create a 4-zone ablation in the central and peripheral regions and monitor its temperature. Multivariate ANOVA multivariate and / or paired t-tests and regression analysis were used to analyze the data, as appropriate. Results Baseline values exceeding 34 ° C in all IRE plate experiments were linearly correlated with the energy dose (voltage and pulse number) (R2 = 0.39) and in univariate analysis the temperature was more dependent on the voltage value and number of pulses Correlation. Therefore, at a voltage of 2500V and a pulse of 270, the average temperature is as high as (86 ± 3) ° C. The pulse number is 90 or higher, and at 2500 V, ablation produces a temperature of 50 ° C or higher, resulting in classical gross pathology and histological thermal coagulation effects (dense nuclei, mobile cytoplasm). For low dose IREs (eg, 2100V, 90 pulses), the temperature will always be below 45 ° C, and only pathologic products associated with IRE (such as swollen sinusoids, dehydrated cells, hemorrhagic exudates) may be detected. With the 4-electrode array, the electrode surface temperature was (54.2 ± 6.1) ° C and the ablation margin temperature was (38.6 ± 3.2) ° C. Conclusion Under certain high-intensity conditions, IRE produces sufficient heat-induced “white zone” thermocoagulation. This effect under certain conditions on the destruction of the tumor have a role in the need to further understand the thermal characteristics of clinical electrodes on the energy parameters to have a full understanding and understanding in order to avoid unintentional damage to the thermal zone around the thermal sensitivity of sensitive structure.