【摘要】：目的:評(píng)估微波消融后離體人肝泡型肝包蟲病灶及其病灶周圍肝組織形態(tài)學(xué)變化,選擇臨床微波治療泡型肝包蟲病最佳消融時(shí)間與功率的組合。方法:收集到11例泡型肝包蟲病患離體肝臟,5例為單一病灶,6例為多發(fā)病灶。病肝通過CT測(cè)量初略估計(jì)其大小以及其鈣化程度。將病肝對(duì)半剖開,在其中半份病肝上選取病灶與病灶周圍肝組織交界點(diǎn)對(duì)其實(shí)施60w功率微波消融,作為對(duì)照組的另一半不作處理,通過作用不同時(shí)間(0min、5min、間斷10min),分別收集兩半肝不同距離(1cm、2cm、3cm)標(biāo)本,使用HAE分級(jí)評(píng)判標(biāo)準(zhǔn),通過石蠟切片觀察光鏡下其與對(duì)照組不同的病理變化。結(jié)果:這次研究病肝共計(jì)11例,實(shí)施微波消融11例,11例病灶體積占病肝體積均大于40%。在病理切片下觀察到包蟲病灶組織向病灶方向在距離消融點(diǎn)1cm處消融5min后即呈現(xiàn)泡球蚴的生發(fā)層解離脫落,HAE分級(jí)II級(jí)變化。距離消融點(diǎn)2cm及3cm處未發(fā)現(xiàn)其與對(duì)照組有差異。肝包蟲病灶周圍組織向正常肝組織方向不同距離呈現(xiàn)不同程度的細(xì)胞脫水、排列紊亂、邊界不清、細(xì)胞核皺縮、染色質(zhì)固縮、細(xì)胞膜破裂,胞漿漏出,胞漿嗜酸性增強(qiáng)、胞漿融合、胞漿紅染加深均質(zhì)化。尤以1cm處表現(xiàn)為甚,5min時(shí)即出現(xiàn)部分細(xì)胞膜破裂,胞漿漏出,細(xì)胞脫水,肝血竇增寬,再次消融5min后細(xì)胞形態(tài)變化明顯加劇,出現(xiàn)廣泛胞漿融合,整個(gè)視野轉(zhuǎn)變?yōu)橐黄|(zhì)的紅色,呈現(xiàn)典型細(xì)胞凝固性壞死現(xiàn)象。當(dāng)在距離2cm處取組織,5min時(shí),肝細(xì)胞稍有脫水,部分細(xì)胞膜破裂,肝血竇略增寬。再次消融5min后,可見肝細(xì)胞核藍(lán)染加深,相比未消融組的,細(xì)胞核的形狀欠圓潤。核內(nèi)染色質(zhì)著色顯示其排列與未消融組有差異(染色質(zhì)固縮、染色加深)。部分細(xì)胞膜破裂,胞漿漏出。肝血竇進(jìn)一步增寬。細(xì)胞邊界稍欠清,胞漿輕微融合(n=8),細(xì)胞嗜酸性稍增強(qiáng)(n=8),紅染略加深(n=8)。當(dāng)距離增至3cm時(shí),兩次時(shí)間消融的結(jié)果相同,可見細(xì)胞排列情況,細(xì)胞核形態(tài)、大小,細(xì)胞質(zhì)內(nèi)容物形態(tài)與對(duì)照組均未見明顯差異。結(jié)論:微波消融60W,10min組合可使病灶至少1cm內(nèi)的泡球蚴呈現(xiàn)HAE分級(jí)II級(jí)改變,使病灶周圍肝組織2cm內(nèi)呈現(xiàn)凝固性壞死變化,可選60W,10min作為臨床微波消融治療泡型肝包蟲組合。
[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，

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