ABSTRACT
Objective:To investigate the effect of different spray-coagulation time of argon plasma coagulation (APC) injury on the Glisson system primary branche(G1) in the hepatic portal of pigs.Methods:Fifty clean healthy domestic pigs (27 females and 23 males, aged 7 to 14 months) were selected, with the body weighted (100.0±9.5) kg. They were randomly divided into five groups (A, B, C, D, and E), with 10 pigs in each group. G1 models were made and sprayed by APC for 1, 2, 3, 4, and 5 seconds. The damage, maximum damage area, maximum damage depth, and damage of the three branches of the Glisson system (the first branches of the portal vein, intrahepatic bile duct, and hepatic artery) were compared among the groups. The pigs were divided into two groups based on whether the three branches were damaged or not: the three-branch damage group ( n=23) and the control group ( n=27). The maximum damage area and maximum damage depth were compared between the two groups. Results:After the APC spraying, circular or elliptical damage appeared on the surface of the G1, with changes such as yellow-brown color, brown color, charred appearance, and defects. Under the microscope, G1 capsule was found to be deficient, the fibrous tissue beneath the capsule was ruptured, and the structures of small blood vessels and small bile ducts were incomplete. " Burn marks" and damage to the three branches of the Glisson system in G1 were also observed, and the damage was more severe at the center of the spray-coagulation. As the spray-coagulation time increased, the maximum damage area of the G1 model also increased, and the two were positively correlated ( r=0.90, P<0.001). The maximum damage depth was also positively correlated with spray-coagulation time ( r=0.97, P<0.001). The numbers of pigs with damage to the three branches of the Glisson system in Groups A-E were 0, 2, 5, 6, and 10, respectively, and the number of pigs with damage increased with the spray-coagulation time. In the three-branch damage group, the spray-coagulation time, maximum damage area, and maximum damage depth were all higher than those in the control group (without three-branch damage), and the differences were statistically significant (all P<0.05). Conclusion:The degree of damage to G1 caused by APC is positively correlated with the spray-coagulation time, and damage to the three branches of the Glisson system in G1 is related to the maximum damage area, maximum damage depth, and APC spray-coagulation time.
ABSTRACT
Objective To analyze Glisson system-related complications after percutaneous thermal ablation of liver cancer and the relationship with tumor location.Methods Data of 2 218 case-times of ultrasound-guided percutaneous thermal ablation in 1 879 patients with liver cancer were retrospectively analyzed.Four types were defined according to the relative position between the tumor and Glisson system:Tumor close to the first branch of the portal vein (type Ⅰ),the second branch of the portal vein (type Ⅱ),the third branch of the portal vein (type Ⅲ) and far away from portal vein (type Ⅳ).Types Ⅰ to Ⅲ were classified as close to Glisson system group,while type Ⅳ was classified as far away from Glisson system group.The Glisson system-related complications (cholesteatoma,bile leakage,serious biliary stricture,cholangiobronchial fistula,arterio-venous fistula and arterial aneurysm) were analyzed.Results Glisson system-related severe complications occurred after 20 case-times (20/2 218,0.90 ％) of thermal ablation.The incidence of Glisson system-related severe complications in close to Glisson system group (1.81 ％ [16/886]) was higher than that in far away from Glisson system group (0.30％ [4/1 332],P＜0.001).The incidence of Glisson system-related severe complications of type Ⅰ,Ⅱ,Ⅲ and Ⅳ was 6.35％ (4/63),3.52％ (5/142),1.03％ (7/681) and0.30％ (4/1 332),respectively (P＜0.001).Glisson system-related mild complications included liver function damage (280 case-times),portal thrombosis (156 case-times) and slight cholangiectasis (82 case-times).The incidences of the three Glisson system-related complications mentioned above decreased from type Ⅰ to Ⅳ.Conclusion Percutaneous thermal ablation is safe in treating patients with tumors close to Glisson system.But the risk of incidence of Glisson system-related severe complications is higher when the tumor is close to the more advanced branch of portal vein.