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背景与目的肺癌已成为最常见死因的恶性肿瘤之一,对不能手术切除的肺癌,冷冻是一种安全可选择的消融治疗手段,但肺为含气组织,与冷冻肝脏、胰腺等实体器官不同,在理论上冷冻范围很难超过肿瘤边缘。本研究旨在通过正常猪肺模型实验了解不同冷冻-复温循环对肺部组织坏死范围的影响并探讨经皮冷冻肺治疗的技术方案。方法采用6只平均体重为23kg的正常西藏小型猪作为模型,在CT引导下选择猪肺上叶1点和下叶2点作为靶点,使用直径为1.7mm的冷冻探针分别插入肺叶各靶点做经皮穿刺冷冻。左肺行冷冻10min、复温5min共2个周期的冷冻-复温循环;右肺先行冷冻5min、复温5min的2个冷冻-复温循环,然后行冷冻10min、复温5min的第3个冷冻-复温循环。左右肺的实验条件和实验方法均相同。实验中,观察CT影像下冰球的形态学变化。分别取冷冻后4h、3d和7d的猪肺标本,观察其大体形态及其在光镜下的组织学变化。结果猪肺冷冻过程中随着时间的延长和循环次数的增加,冰球逐渐增大;无论2个或3个冷冻-复温循环,所产生的冷冻范围(“假定坏死区”)在大体标本上均超过CT上冷冻过程中显示的冰球大小;冷冻后随着时间延长,组织学坏死区逐步增大,3天及以后,假定坏死区即为组织学坏死区。结论经皮冷冻肺可以达到有效破坏靶组织的目的;在技术上,肺冷冻以3个冷冻-复温循环为佳;冷冻范围不强求冷冻“1cm安全边缘”。上述研究结果对于简化冷冻治疗过程及减少并发症具有临床价值。
BACKGROUND AND OBJECTIVE Lung cancer has become one of the most common malignant tumors of the cause of death. For unresectable lung cancer, freezing is a safe and selective method of ablation treatment. However, the lung is a gas-bearing tissue that is different from solid organs such as frozen liver and pancreas , In theory it is hard to surpass the tumor margin in the frozen range. The aim of this study was to investigate the effects of different cycles of freezing-thawing on the extent of lung tissue necrosis and to explore the technical solutions of percutaneous frozen lung therapy. Methods Six normal Tibetan mini-pigs with an average body weight of 23 kg were used as the models. One point of the upper lobe of lung and two points of the lower lobe were selected under CT guidance. Frozen probes with a diameter of 1.7 mm were respectively inserted into the lobes Click to do percutaneous puncture and freezing. Left lung frozen 10min, rewarmed 5min a total of 2 cycles of freezing - rewarming cycle; right lung first frozen 5min, rewarming 5min 2 freeze-thaw cycles, and then frozen 10min, rewarming 5min 3 Frozen - rewarming cycle. The experimental conditions and experimental methods are the same for the left and right lungs. In the experiment, observe the morphological changes of puck under CT image. Porcine lung specimens were collected at 4h, 3d and 7d after freezing, respectively. The gross morphology and histological changes under light microscope were observed. Results The hockey puck gradually increased with the prolongation of the time and the number of cycles in the lung freezing process. The freezing range (“presumed necrosis zone”) produced by the two groups or three freezing- The specimens were more than the size of the puck displayed during the freezing process on CT. As time prolonged after freezing, the histological necrosis area gradually increased. After 3 days and later, it was assumed that the necrosis area was the necrotic area of histology. Conclusion Percutaneous frozen lungs can achieve the purpose of effectively destroying the target tissue. Technically, the lung freezing is better than three freezing-thawing cycles; the freezing range does not require freezing “1cm safety margin”. The above findings are of clinical value to simplify the process of cryotherapy and reduce complications.