微波消融对泡型肝包虫病灶的处理：基于人肝的离体实验
发布时间：2019-06-29 07:08
【摘要】：目的:评估微波消融后离体人肝泡型肝包虫病灶及其病灶周围肝组织形态学变化,选择临床微波治疗泡型肝包虫病最佳消融时间与功率的组合。方法:收集到11例泡型肝包虫病患离体肝脏,5例为单一病灶,6例为多发病灶。病肝通过CT测量初略估计其大小以及其钙化程度。将病肝对半剖开,在其中半份病肝上选取病灶与病灶周围肝组织交界点对其实施60w功率微波消融,作为对照组的另一半不作处理,通过作用不同时间(0min、5min、间断10min),分别收集两半肝不同距离(1cm、2cm、3cm)标本,使用HAE分级评判标准,通过石蜡切片观察光镜下其与对照组不同的病理变化。结果:这次研究病肝共计11例,实施微波消融11例,11例病灶体积占病肝体积均大于40%。在病理切片下观察到包虫病灶组织向病灶方向在距离消融点1cm处消融5min后即呈现泡球蚴的生发层解离脱落,HAE分级II级变化。距离消融点2cm及3cm处未发现其与对照组有差异。肝包虫病灶周围组织向正常肝组织方向不同距离呈现不同程度的细胞脱水、排列紊乱、边界不清、细胞核皱缩、染色质固缩、细胞膜破裂,胞浆漏出,胞浆嗜酸性增强、胞浆融合、胞浆红染加深均质化。尤以1cm处表现为甚,5min时即出现部分细胞膜破裂,胞浆漏出,细胞脱水,肝血窦增宽,再次消融5min后细胞形态变化明显加剧,出现广泛胞浆融合,整个视野转变为一片均质的红色,呈现典型细胞凝固性坏死现象。当在距离2cm处取组织,5min时,肝细胞稍有脱水,部分细胞膜破裂,肝血窦略增宽。再次消融5min后,可见肝细胞核蓝染加深,相比未消融组的,细胞核的形状欠圆润。核内染色质着色显示其排列与未消融组有差异(染色质固缩、染色加深)。部分细胞膜破裂,胞浆漏出。肝血窦进一步增宽。细胞边界稍欠清,胞浆轻微融合(n=8),细胞嗜酸性稍增强(n=8),红染略加深(n=8)。当距离增至3cm时,两次时间消融的结果相同,可见细胞排列情况,细胞核形态、大小,细胞质内容物形态与对照组均未见明显差异。结论:微波消融60W,10min组合可使病灶至少1cm内的泡球蚴呈现HAE分级II级改变,使病灶周围肝组织2cm内呈现凝固性坏死变化,可选60W,10min作为临床微波消融治疗泡型肝包虫组合。
[Abstract]:Objective: to evaluate the morphological changes of human alveolar hepatic hydatid lesions and their surrounding liver tissue after microwave ablation, and to select the best combination of ablation time and power in clinical microwave treatment of alveolar hepatic echinococcosis. Methods: 11 cases of alveolar hepatic echinococcosis were collected. 5 cases were single lesions and 6 cases were multiple lesions. The size and calcification of the diseased liver were estimated by CT. The diseased liver was cut open in half, and 60 weeks power microwave ablation was performed at the junction of the lesion and the surrounding liver tissue as the other half of the control group. Through different time (0 min, 5 min, intermittent 10min), the specimens of two halves of liver at different distances (1 cm, 2 cm, 3 cm) were collected, and the different pathological changes under light microscope were observed by paraffin section. Results: a total of 11 cases of diseased liver were studied. Microwave ablation was performed in 11 cases. The volume of 11 cases accounted for more than 40% of the volume of diseased liver. Under pathological section, it was observed that after ablation of 5min at the distance of ablation point 1cm in the direction of hydatid lesion, the gerund layer of alveolar echinococcosis was dissociated and exfoliated, and the II grade of HAE grade was changed. There was no difference between 2cm and 3cm at distance ablation point and control group. The surrounding tissues of hepatic echinococcosis showed different degrees of cell dehydration, disordered arrangement, unclear boundary, nuclear shrinkage, chromatin pyknosis, cell membrane rupture, cytoplasmic leakage, enhanced cytoplasm eosinophilic enhancement, cytoplasmic fusion and deepening homogenization of cytoplasm. Especially at 1cm, part of the cell membrane ruptured, the cytoplasm leaked, the cells were dehydrated, the hepatic sinuses widened, and the morphological changes of the cells were aggravated after 5min ablation again, and the whole visual field changed into a homogeneous red, showing typical cell coagulation and necrosis. When the tissue was taken from 2cm and 5min, the hepatocytes were slightly dehydrated, some cell membranes ruptured and the hepatic sinuses widened slightly. After ablation of 5min again, the blue staining of liver nucleus deepened, and the shape of nucleus was not round compared with that of unablation group. Nuclear chromatin staining showed that the arrangement of chromatin was different from that of unablation group (chromatin pyknosis and deepening staining). Part of the cell membrane ruptured and the cytoplasm leaked out. The hepatic sinuses were further widened. The cell boundary was slightly unclear, the cytoplasm was slightly fusion (n 鈮，
本文编号：2507643
[Abstract]:Objective: to evaluate the morphological changes of human alveolar hepatic hydatid lesions and their surrounding liver tissue after microwave ablation, and to select the best combination of ablation time and power in clinical microwave treatment of alveolar hepatic echinococcosis. Methods: 11 cases of alveolar hepatic echinococcosis were collected. 5 cases were single lesions and 6 cases were multiple lesions. The size and calcification of the diseased liver were estimated by CT. The diseased liver was cut open in half, and 60 weeks power microwave ablation was performed at the junction of the lesion and the surrounding liver tissue as the other half of the control group. Through different time (0 min, 5 min, intermittent 10min), the specimens of two halves of liver at different distances (1 cm, 2 cm, 3 cm) were collected, and the different pathological changes under light microscope were observed by paraffin section. Results: a total of 11 cases of diseased liver were studied. Microwave ablation was performed in 11 cases. The volume of 11 cases accounted for more than 40% of the volume of diseased liver. Under pathological section, it was observed that after ablation of 5min at the distance of ablation point 1cm in the direction of hydatid lesion, the gerund layer of alveolar echinococcosis was dissociated and exfoliated, and the II grade of HAE grade was changed. There was no difference between 2cm and 3cm at distance ablation point and control group. The surrounding tissues of hepatic echinococcosis showed different degrees of cell dehydration, disordered arrangement, unclear boundary, nuclear shrinkage, chromatin pyknosis, cell membrane rupture, cytoplasmic leakage, enhanced cytoplasm eosinophilic enhancement, cytoplasmic fusion and deepening homogenization of cytoplasm. Especially at 1cm, part of the cell membrane ruptured, the cytoplasm leaked, the cells were dehydrated, the hepatic sinuses widened, and the morphological changes of the cells were aggravated after 5min ablation again, and the whole visual field changed into a homogeneous red, showing typical cell coagulation and necrosis. When the tissue was taken from 2cm and 5min, the hepatocytes were slightly dehydrated, some cell membranes ruptured and the hepatic sinuses widened slightly. After ablation of 5min again, the blue staining of liver nucleus deepened, and the shape of nucleus was not round compared with that of unablation group. Nuclear chromatin staining showed that the arrangement of chromatin was different from that of unablation group (chromatin pyknosis and deepening staining). Part of the cell membrane ruptured and the cytoplasm leaked out. The hepatic sinuses were further widened. The cell boundary was slightly unclear, the cytoplasm was slightly fusion (n 鈮，
本文编号：2507643
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