| Objectives: To evaluate the ablation effect of hydrochloride acid and the dependence relationship among density dosage and range of ablation. To assess the safety of hydrochloride acid injection for therapy using a large-animal model and examine pathologic changes. To assess the safety and efficacy of percutaneous hydrochloride acid injection for therapy of carcinoma.Methods: 1. Test of pig livers:1.1 Put the liver into 37℃ NS, then we injected difference dosage of HCL to liver by a extension tube to a syringe filled with difference density HCL. The ablation diameters were recorded at 0',10',30', 1 hour ,12hour,24hour. The livers containing the lesion were placed in 10% formalin solution for histological examination. We also injected 50% acetic acid and ethanol as the control group. 2.Test of animals: The pigs were fixed and we observed the liver and lungs, written down the site of puncture, the direction and depth of insertion. Guided by US, We inserted a PTC into liver or lungs, then injected 1ml 18% HCL at the speed of 12ml/hour by a micro-dosage injection pump. Ablation evolution was examined over time, the animals were killed at 24hour, 1 week, 4 week, 8 week. 3.Observation of patients: Written informed consent was obtained from each patient before the percutaneous hydrochloric acid injection for therapy. The patient was instructed fast for 4-6 hours. Meperidine hydrochloride (10mg) or fortanodyn (100mg) and valium (10mg) were injected intramuscalarly 30' before PHAIT. The patient with lung cancer also take codeine 30mg.Under the guidence of CT, we used our own lase-guided instrument to fix the site of puncture. After enjioning the patient to hold breath, we inserted percutaneously an 18-20cm-long PTC needle into the center of the tumor. After the insertion, the needle was connected by means of an extension tube to a syringe filled with 18% HCL, adjust the speed to 12ml/hour through a micro-dosage injection pump. The initially estimated volume of HCL for injection in our study was calculated with V=[4/3π(R+0.5)3]/15.We would inject an additional 0.1-0.5ml if the patient did not report discomfort after injection of the estimated volume. Injection was discontinued if intravasation of HCL into vessel or out of tumor. After injection, the needle was left in place for 2-3 minutes and then slowly withdraw to reduce HCL reflux along the needle track. Patients were followed up 3-7 days later with dynamic helical CT with contrast agent enhancement. If viable tumor was found in the treated area, another therapy was performed. Afterward, CT were performed every 1-2 months. The side effects of percutaneous hydrocholiric acid injection fortherapy were assessed by means of changes in symptomsand signs, as well as with biochemical assays.Results: 1.The coagulation effect of HCL in liver: 1.1 After injection, at difference time, the coagulation effect of HCL in liver. After injected 36%HCL1ml, the mean diameters at 0', 10', 30', 1hour, 12hour, 24hour was 0.58±0.01,0.75±0.17,1.68±0.21,3.0±0.14,5.35±0.24,5.35±0.24cm.There was significant difference between diameters at 10',30',1 hour,12 hour (p<0.05), but no difference between 0',10', 12 hour, 24 hour (p>0.05). We also found the border became well demarcated 12 hours after injection. The coagulation area was like globe or so with gyeyish white in color macroscopically. Microscopy revealed completely necrosis within the greyish white region. 1.2 The coagulation effect of different density of HCL in liver. The mean diameters produced by 1ml 4.5%,9%,18%,36%HCL were 1.90±0.08,2.60±0.29,3.08±0.17,5.35±0.24cm.There was significant difference between everyone (p<0.05). 1.3 The coagulation effect of different dosage of HCL in liver. The mean diameters produced by 18% HCL of 0.2, 0.4, 0.6, 0.8,1ml were 0.83±0.15,1.27±0.21,1.97±0.15,2.60±0.26,3.08±0.17 cm. There was significant difference between everyone (p<0.05). 1.4 The comparison of coagulation effect produced by 18% HCL, 50% acetic acid, ethanol. The mean diame...
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