| ObjectiveTo evaluate the validity, safety and utility of percutaneous radiofrequency ablation(RFA) combined with percutaneous ethanol injection(PEI) with different style in in vivo rabbit liver.Method1. Grouping define: Twenty-four New Zealand White rabbits were included in this study and divided into four groups: group A:RFA before PEI(n=6), RFA (1cm mono-electrode, maintain 3 minutes RFA ) before PEI 1.5ml;group B:PEI before RFA(n=6) , PEI 1.5ml before RFA (1cm mono-electrode, maintain 3 minutes RFA ); group C: RFA (1cm mono-electrode, maintain 3 minutes RFA) only (n=6);group D: PEI (1.5ml) only(n=6).2. Observation indicators:1) The general live conditions after RFA and PEI.2) The serum ALT,AST and Cr were tested before the procedure and on the 1th day,3th day and 7th day after the procedure.3) The size, shape and the enhanced state of ablation zone on contrast-enhanced CT after the procedure.4) The resistance, current, volume of coagulated necrosis, isoperimetric ratio and energy requirement per unit of each group including RFA.5) All the rabbits were killed 7 days post-procedure, then extracting the liver specimens to observe pathology change and cell apoptosis. Results1. The quality of life post-procedure of each groupAfter the procedure, all of experimental animals in each group felt anorexy apparently. They were in depression, drowsiness, moved little and all recovered after 3 days. One animal in group B and group C were dead within 24 hours respectively. One died of anesthetic accidents and another died of acute liver failure. We complemented the rabbits timely.2. Liver function and renal function of each group2.1 ALT: The ALT level pre-procedure in each group were A=39.5±31μ/L, B=44.8±32μ/L, C=48.7±26μ/L and D=83.8±64μ/L, variations of each group had no statistically significant in each group(P>0.05). The 1th day's ALT level post-procedure in each group were A=257.1±140μ/L, B=169.5±89μ/L, C=188.7±69μ/L and D=157.8±112μ/L and it elevated apparently 1th day's after the procedure in each group and decreased from 3th day's post-procedure, which were A=90±30μ/L, B=147.7±91μ/L, C=94.8±38μ/L and D=68±27μ/L respectively. The 7th day's ALT level was 127±103μ/L in group B and it was higher than the other 3 groups. The differences of ALT level between 7th day post-procedure and pre-procedure in group B was statistically significant(P<0.05). The differences of the 7th day's ALT level between each group was statistically significant(P<0.05).2.2 AST: The AST level pre-procedure in each group were A=131.2±214μ/L, B=122.5±199μ/L, C=54.8±58μ/L, D=58.7±43μ/L, variations of AST level pre-procedure in each group had no statistically significant(P>0.05). The 1th day's AST level post-procedure were A=518.8±381μ/L, B=350.5±433μ/L, C=230.5±117μ/L and D=251.7±212μ/L and it elevated apparently and decreased from 3th day post-procedure, which were A=40±8μ/L, B=115±83μ/L, C=39±16μ/L and D=25.5±11μ/L respectively. The 7th day's AST level post-procedure were A=454.8±58μ/L, B=254.3±484μ/L, C=21.5±7.4μ/L, D=21.5±7.3μ/L respectively. The 1th day's AST level post-procedure in group C was higher than pre-procedure(P<0.05). The 3th day's AST level in group B was significantly higher than group A and group C(P<0.05).2.3 Cr: The Cr level pre-procedure in each group were A=76.1±16μmol/L, B=72.5±13μ mol/L, C=110.8±58μmol/L and D=74±10.7μmol/L, variations of Cr level pre-procedure in each group had no statistically significant(P > 0.05). The 1th day's Cr level post-procedure in each group were A=63±8.3μmol/L, B=93.5±37.9μmol/L, C=113±45.4μmol/L, D=84.5±11.7μmol/L respectively. The 3th day's Cr level post-procedure in group D was 84.5±10.6μmol/L which was significantly higher than pre-procedure(P<0.05), and the other 3 groups were A=72.8±7.5μmol/L, B=75.8±18.4μmol/L, C=76.2±19.1μmol/L respectively. The variations of 3th day's Cr level post-procedure of each group had no statistically significant difference(P>0.05). The 7th day's Cr level post-procedure in group D was 51±8.9μmol/L, which was significantly lower than pre-procedure(P<0.05).3. The size, shape, isoperimetric ratios and image finding of each groupThe longest diameter of each group were A=20.7±4.2mm, B=24.1±4.4mm, C=12.4±1.6mm, D=7.7±2.3mm, the shortest diameter were A=18.5±2.3mm, B=21.4±4.0mm, C=11.1±1.4mm, D=5.1±1.5mm and the volume of coagulated necrosis were A=3130±1250mm3, B=5879±2607mm3, C=767±173mm3, D=146±83mm3 respectively. Variations between each group were statistically significant(P < 0.01). The longest diameter and the shortest diameter of group B were significantly larger than group C and group D. The height and volume of coagulated necrosis of group B were significantly larger than the other 3 groups(P<0.01). The shape of ablation zone of group B was the most closest to sphere. Isoperimetric ratios of each group were A=96.6±0.85%, B=98.5±0.93%, C=98.0±3.3%, D=93.0±6.3% respectively, there were no statistically significant between each group. Non-enhanced CT images of ablation zone in group B and group C showed a round hypoattenuating area, and in group A and group D it showed an elliptic or irregular hypoattenuating area. The imaging findings of different PEI combinded with RFA were resemblance. No-enhanced central necrosis zone was surrounding with no-enhanced zone in 23 cases, but one was surrounding with enhanced zone.4. The resistance, current and energy requirement per unit of each groupThe resistance and current of group A were 127.8±19.5?, 0.39±0.07mA, group B were 170.7±12.8?, 0.29±0.05mA and group C were 126.7±12.5?, 0.38±0.04mA respectively. The resistance of group B were significantly larger than group A and group C(P<0.01). The current of group B were significantly lower than group A and group C(P<0.05). The energy requirement per unit of group A was 12.3±8.9W/cm3, group B was 7.0±5.7W/cm3 and group C was 41.6±13.4W/cm3. The energy requirement per unit of group C were significantly higher than group A and group B(P<0.01).5. Gross specimen and pathology observationCarbonation zone in center of ablation zone in group B was larger than group A and group C and tissue destruction was more obviously. Group D had no carbonation zone in center of ablation zone. Typical coagulation necrosis emerged in center of ablation zone and apoptosis increased in transitional zone in each group. The shapes of coagulation necrosis and apoptosis caused by different ablation methods were identical basically. Destruction of tissue structure and celluar morphology was shown in center of ablation zone along with degenerated, shrunken hepatocytes, pyknotic nuclei and lots of cell necrosis debris. Peripheral zone was surrounding with fibrohistiocytic accrementition and inflammatory cell infiltration. With the brown-color dyeing nucleus, the apoptosis cell became shrunken and around, cytoplasmic concentration and pyknosis.Conclusion1. The volume of coagulated necrosis of group PEI-RFA was significantly larger than the other 3 groups.2. The energy requirement per unit of group PEI-RFA were the lowest in each group.The shape of ablation zone of group PEI-RFA was the most closest to the sphere and it's isoperimetric ratios was the most highest.3. Non-enhanced CT images of ablation zone in group PEI-RFA and group RFA showed a round hypo-attenuating area, and in group RFA-PEI and group PEI it showed an elliptic or irregular hypo-attenuating area. No-enhanced central necrosis zone was surrounding with no-enhanced zone in most cases, but few was surrounding with enhanced zone.4. The shapes of coagulation necrosis and apoptosis caused by different PEI combinded with RFA were same. Typical coagulation necrosis emerged in center zone and apoptosis increased in peripheral zone.5. With little influence to liver function and renal function and less complications, combined PEI before RFA was relatively safety and validity. |
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