超声引导经皮激光联合无水乙醇消融兔VX2肝肿瘤的实验研究
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摘要
第一部分兔VX2肝肿瘤模型的建立
目的比较兔VX2肝肿瘤模型建立中开腹瘤块包埋法和超声引导下经皮穿刺种植法的应用，探讨超声成像技术在肿瘤种植及种植后观察评估中的价值。
方法30只新西兰大白兔随机分为两组，每组15只。Ⅰ组接受开腹瘤块包埋法。Ⅱ组接受超声引导下经皮穿刺种植法。种植后分别在7d、14d、21d，对每组5只动物进行常规二维灰阶超声成像，彩色多普勒超声（Color Dopplerultrasonography，CD US），能量多普勒超声（Power Doppler ultrasonography，PD US）,超声造影（Contrast enhanced ultrasonography, CE US）检测。然后将动物处死，取出肝脏，进行病理学观察。
结果种植后21d的观察期内，Ⅰ组和Ⅱ组均存活荷瘤动物13只。采用常规二维灰阶超声成像测量肿瘤大小，从7d至21d， Ⅰ组肿瘤体积从0.30±0.15cm3增长至8.90±2.52cm3,Ⅱ组肿瘤体积从0.28±0.18cm3增长至9.23±2.65cm3，两组间未见显著统计学差异(P>0.05)。CD US、PD US及CE US示，14d前肿瘤的内部和周边可以探查到血流分布，14d后由于肿瘤生长过快，肿瘤内部血供不足，出现组织坏死及液化，血流主要分布在肿瘤边缘部分。
结论在兔VX2肝肿瘤模型建立中，与开腹瘤块包埋法相比，超声引导下经皮穿刺种植法操作简便，创伤小，动物存活率高。两种方法种植的成功率和肿瘤生长变化基本相似。常规二维灰阶超声成像，CD US，PD US及CE US等影像技术能够在肿瘤的种植和评价肿瘤生长及血供特征方面发挥重要的作用。
第二部分超声引导经皮激光消融兔VX2肝肿瘤的实验研究
目的超声引导经皮激光消融(Percutaneous laser ablation，PLA)是在超声引导下经皮将激光光导纤维插入肿瘤内，激光光能转变为热能被组织吸收，从而杀灭肿瘤细胞。现已被认为是目前对肿瘤的局部原位灭活有效的微创介入治疗方法之一，是临床非手术治疗领域中一项有广阔应用前景的技术，可应用于原发性和继发性肿瘤的治疗中。本研究的目的是探讨超声引导经皮激光消融兔VX2肝肿瘤的治疗效果。
方法采用超声引导下经皮穿刺种植法建立兔VX2肝肿瘤模型。60只新西兰大白兔种植VX2肝肿瘤14d后，所存活荷瘤动物随机分为三组。采用ECHOLASER集成激光介入超声系统，输出功率和总能量设置为：Ⅰ组3W1800J；Ⅱ组5W1800J；Ⅲ组7W1800J。消融前及消融后3d，进行常规二维灰阶超声成像、CD US、PD US及CE US观察，组织病理学观察。
结果种植后14d，共存活57只动物，每组19只，均接受PLA治疗。PLA治疗后，常规二维灰阶超声成像示整个消融区表现为低回声，最中心为椭圆形的无回声区，周边包绕着一圈强回声。CE US示：激光消融区内未见超声造影剂灌注。传统二维灰阶超声成像示：Ⅰ组消融区体积（0.65±0.31cm3）较Ⅱ组（0.85±0.38）Ⅲ组（0.89±0.38）小（P<0.05）。CE US显示Ⅰ组消融区体积（0.70±0.29）较Ⅱ组（0.92±0.45）Ⅲ组（0.95±0.39）小（P<0.05）。CD US、PD US和CE US示三组消融区边缘部分存在残留血流信号。大体病理结果示消融区边界清晰，呈类椭圆形，中心为椭圆形的空洞形成，空洞周围包绕着一圈黑色的碳化区，外围为粉白色的“熟肉”样环。HE染色示消融区内细胞呈均匀红染，基本结构消失，消融区边缘出现纤维包裹带。随消融后时间延长纤维包裹带逐步增宽。消融后3d至14d，Ⅰ，Ⅱ和Ⅲ组每组17只动物中分别显示有14，11和12只在消融区内存在残留活性肿瘤组织。
结论超声引导经皮激光消融治疗肝肿瘤作为一种微创技术能有效地杀灭肿瘤细胞，形成凝固性坏死区。其疗效确切，特别是对肝脏的小肿瘤治疗更是安全可靠的。
第三部分超声引导经皮激光联合无水乙醇消融兔VX2肝肿瘤的实验研究
目的探讨超声引导下经皮激光联合无水乙醇消融兔VX2肝肿瘤的作用。
方法采用超声引导下经皮穿刺种植法建立兔VX2肝肿瘤模型。80只新西兰大白兔种植VX2肝肿瘤14d后，所存活荷瘤动物随机分为四组。Ⅰ组：单纯PLA治疗。Ⅱ组：单纯经皮瘤内无水乙醇注射（Percutaneous ethanol injection，PEI）治疗。Ⅲ组：在接受PEI前先行PLA治疗。Ⅳ组：在接受PLA前先行PEI治疗。消融前及消融后3d，进行常规二维灰阶超声成像、CD US、PD US及CE US观察。消融后进行病理学观察和肝功能检查。
结果种植后14d，共存活80只动物，每组20只，均接受消融治疗。消融治疗后3d，Ⅰ组，Ⅲ组和Ⅳ组消融区的边界清楚，形态规则。Ⅱ组的消融区边界不清，形态不规则。CE US示：消融区内未见超声造影剂灌注。传统二维灰阶超声成像示：Ⅳ组消融区体积（2.71±1.21cm3）较Ⅰ组（0.83±0.39cm3），Ⅱ组（0.83±0.58cm3）和Ⅲ组（1.82±0.47cm3）明显增大（P<0.05）。CE US也显示Ⅳ组消融区体积（3.59±1.44cm3）较Ⅰ组（0.92±0.45cm3），Ⅱ组（0.93±0.6cm31）和Ⅲ组（2.18±0.63cm3）明显增大（P<0.05）。CD US和PD US示：Ⅰ组和Ⅱ组消融区边缘部分存在残留病灶，但是Ⅲ组和Ⅳ组消融区内未发现残留病灶。CE US示：Ⅰ，Ⅱ和Ⅲ组消融区边缘部分存在残留血流分布，但Ⅳ组消融区内未发现残留血流。HE染色示四组消融区内凝固性坏死，周围可见纤维包裹带，Ⅳ组的残留肿瘤病灶少于Ⅰ组，Ⅱ组和Ⅲ组。治疗前血清丙氨酸氨基转移酶（ALT）四组无显著性差异（P>0.05），治疗后的1d均显著上升，3d后开始下降，14d基本下降至治疗前水平。
结论超声引导下PLA和PEI联合治疗肝肿瘤能扩大消融区体积和减少消融区内残留血流。PLA前先行PEI疗效更好。
Part1Establish of A VX2Rabbit Liver Tumor Model
Objective: To evaluate technical feasibility and experimental usefulness ofpercutaneous ultrasound-guided implantation of VX2carcinoma in rabbitliver.We compared percutaneous ultrasound-guided implantation and surgicalimplantation in establishing VX2rabbit liver tumor model investigated the valueof ultrasonography in the implantation process and the evaluation.
Methods: Thirty New Zealand rabbits were randomly divided into two groups，each having15rabbits：group I: surgical implantation; group II: percutaneousultrasound-guided implantation. After implantation, On7d,14d and21d,respectively,5rabbits in each group were examined by using conventional2-dimensional gray-scale ultrasonography (US), color Doppler (CD) US, powerDoppler (PD) US, and contrast enhanced (CE) US. Pathological examination wasperformed by hematoxylin-eosin (HE).
Results: A new percutaneous US-guided implantation was technically feasible in all rabbits. Evaluation parameters showed that the percutaneousultrasound-guided implantation method is less invasive than the surgicalimplantation. After implantation,13rabbits survived in group I, and13rabbitssurvived in group II. The tumor volume measured by conventional2-dimensionalgray-scale US increased from0.30±0.15cm3,9.23±2.65cm3on7d to on21d ingroup I, and from0.28±0.18cm3to8.90±2.52cm3in group II. No significantdifference existed between two groups (P>0.05). On CD US, PD US and CE US,before14d most tumors were hypervascular and some tumors were observed withvessels and the central hypovascular areas after14d.
Conclusions: Percutaneous ultrasound-guided implantation of VX2carcinoma inrabbit liver is a less invasive alternative to the surgical implantation, achievingequally successful tumor growth in the liver. Conventional2-dimensionalgray-scale US, CD US, PD US and CE US were valuable in assessment of tumorgrowth.
Part Two Experimental Studies of Effects ofUltrasound-guided Percutaneous Laser Ablation on RabbitVX2Liver Tumor
Objective: To evaluate the safety and effects of ultrasound-guided percutaneouslaser ablation (PLA) on rabbit VX2liver tumors by using a neodymium-yttrium-aluminum-garnet (Nd: YAG) laser fiber placed through a skinny needle.
Material and Methods: Fourteen days after implantation of VX2tumors inlivers of60rabbits, animals were randomly separated into three groups, eachhaving20rabbits. Echo Laser tumor ablation equipment was used. It deliveredenergy: group Ⅰ (3W/1800J), group Ⅱ (5W/1800J) and group Ⅱ(7W/1800J). The volume of tumors and ablated regions in three groups are measured byconventional gray-scale US and CE US, the effects on ablated areas wereassessed in terms of CE US and histopathological examination.
Results: Conventional gray-scale US showed ablated areas clear boundary, acentral core of anechoic vaporization, hyperechoic carbonization and surroundinghypoechoic in groupⅠ，Ⅱand Ⅱ, On CE US, coagulated areas depictedperfusion defect. Conventional gray-scale US and CE US showed: the ablatedvolume in group Ⅰ was smaller than that in group Ⅱ and Ⅱ. CD/PD US and CEUS showed residual lesions in periphery ablated areas in three groups. Thevolume of ablated regions in groupⅠand Ⅱ, Ⅰ andⅡ was compared withsignificant difference (P<0.05). The volume of ablated regions in groupⅡand Ⅱwas compared with no significant difference (P>0.05). Hematoxylin-eosinstaining demonstrated necrosis in ablated zones and increasing surrounding fibrabands in three groups.
Conclusions: ultrasound-guided percutaneous laser ablation of liver tissue issafe in this rabbit tumors model. Percutaneous laser ablation can cause fast，precise and effective necrosis of the liver tumors.
Part Three Ultrasound-guided Percutaneous LaserCombined with Ethanol Ablation on Rabbit VX2LiverTumors
Background: Only a small percentage of patients with large hepatocellularcarcinoma (HCC) may benefit out of surgical resection. Thus, most of thesepatients are in need of a form of local control, such as percutaneous ethanolinjection (PEI), percutaneous laser ablation (PLA), or radiofrequency thermal ablation (RFA).
Objective: To investigate the effects of ultrasound-guided PLA combined withPEI on rabbit VX2liver tumors by using conventional gray-scaleultrasonography (US), color/power Doppler (CD/PD)US, contrast-enhanced (CE)US, histopathology examination and liver function.
Material and Methods: Fourteen days after implantation of VX2tumors inlivers of80rabbits, animals were randomly separated into four groups, eachhaving20rabbits:(Ⅰ) PLA;(Ⅱ) PEI;(Ⅱ) combined therapy of PLAimmediately followed by PEI;(Ⅳ) combined therapy of PEI immediatelyfollowed by PLA. The length, width, depth and volume of tumors and ablatedregions in four groups are measured by conventional gray-scale US and CE US,the effects on ablated areas were assessed in terms of histopathologicalexamination and liver function.
Results: Conventional gray-scale US showed ablated areas clear boundary, acentral core of anechoic vaporization, hyperechoic carbonization and surroundinghypoechoic in group Ⅰ, Ⅱ and Ⅳ, and the irregular ablation region withisoechoic in group Ⅱ. On CE US, coagulated areas depicted perfusion defect.Conventional gray-scale US and CE US demonstrated: the ablated volume ingroup Ⅳ was larger than that in group Ⅰ, Ⅱ and Ⅱ. In ablate areas, CD/PD USshowed residual lesions in groupⅠ and Ⅱ, but no residual lesion in group Ⅱ andⅣ. CE US represented no residual lesion in periphery ablated areas in group Ⅳthan that in groupⅠ, Ⅱ and Ⅱ. The length, width, depth and volume of tumorsand ablated regions in group Ⅱ and Ⅳ was compared with significant difference(P<0.05). Hematoxylin-eosin staining demonstrated necrosis in ablated zones andincreasing surrounding fibra bands in four groups, residual viable tissues inablated zones of group Ⅳ were less than those of group Ⅰ, Ⅱ and Ⅱ. In four groups after ablation ALT increased on the first day, and decreased to level ofbefore ablation in fourteen days.
Conclusion: Combined therapies of PEI immediately followed by PLA cansignificantly coagulate larger volumes of tumor and reduce residual lesions.
目的比较兔VX2肝肿瘤模型建立中开腹瘤块包埋法和超声引导下经皮穿刺种植法的应用，探讨超声成像技术在肿瘤种植及种植后观察评估中的价值。
方法30只新西兰大白兔随机分为两组，每组15只。Ⅰ组接受开腹瘤块包埋法。Ⅱ组接受超声引导下经皮穿刺种植法。种植后分别在7d、14d、21d，对每组5只动物进行常规二维灰阶超声成像，彩色多普勒超声（Color Dopplerultrasonography，CD US），能量多普勒超声（Power Doppler ultrasonography，PD US）,超声造影（Contrast enhanced ultrasonography, CE US）检测。然后将动物处死，取出肝脏，进行病理学观察。
结果种植后21d的观察期内，Ⅰ组和Ⅱ组均存活荷瘤动物13只。采用常规二维灰阶超声成像测量肿瘤大小，从7d至21d， Ⅰ组肿瘤体积从0.30±0.15cm3增长至8.90±2.52cm3,Ⅱ组肿瘤体积从0.28±0.18cm3增长至9.23±2.65cm3，两组间未见显著统计学差异(P>0.05)。CD US、PD US及CE US示，14d前肿瘤的内部和周边可以探查到血流分布，14d后由于肿瘤生长过快，肿瘤内部血供不足，出现组织坏死及液化，血流主要分布在肿瘤边缘部分。
结论在兔VX2肝肿瘤模型建立中，与开腹瘤块包埋法相比，超声引导下经皮穿刺种植法操作简便，创伤小，动物存活率高。两种方法种植的成功率和肿瘤生长变化基本相似。常规二维灰阶超声成像，CD US，PD US及CE US等影像技术能够在肿瘤的种植和评价肿瘤生长及血供特征方面发挥重要的作用。
第二部分超声引导经皮激光消融兔VX2肝肿瘤的实验研究
目的超声引导经皮激光消融(Percutaneous laser ablation，PLA)是在超声引导下经皮将激光光导纤维插入肿瘤内，激光光能转变为热能被组织吸收，从而杀灭肿瘤细胞。现已被认为是目前对肿瘤的局部原位灭活有效的微创介入治疗方法之一，是临床非手术治疗领域中一项有广阔应用前景的技术，可应用于原发性和继发性肿瘤的治疗中。本研究的目的是探讨超声引导经皮激光消融兔VX2肝肿瘤的治疗效果。
方法采用超声引导下经皮穿刺种植法建立兔VX2肝肿瘤模型。60只新西兰大白兔种植VX2肝肿瘤14d后，所存活荷瘤动物随机分为三组。采用ECHOLASER集成激光介入超声系统，输出功率和总能量设置为：Ⅰ组3W1800J；Ⅱ组5W1800J；Ⅲ组7W1800J。消融前及消融后3d，进行常规二维灰阶超声成像、CD US、PD US及CE US观察，组织病理学观察。
结果种植后14d，共存活57只动物，每组19只，均接受PLA治疗。PLA治疗后，常规二维灰阶超声成像示整个消融区表现为低回声，最中心为椭圆形的无回声区，周边包绕着一圈强回声。CE US示：激光消融区内未见超声造影剂灌注。传统二维灰阶超声成像示：Ⅰ组消融区体积（0.65±0.31cm3）较Ⅱ组（0.85±0.38）Ⅲ组（0.89±0.38）小（P<0.05）。CE US显示Ⅰ组消融区体积（0.70±0.29）较Ⅱ组（0.92±0.45）Ⅲ组（0.95±0.39）小（P<0.05）。CD US、PD US和CE US示三组消融区边缘部分存在残留血流信号。大体病理结果示消融区边界清晰，呈类椭圆形，中心为椭圆形的空洞形成，空洞周围包绕着一圈黑色的碳化区，外围为粉白色的“熟肉”样环。HE染色示消融区内细胞呈均匀红染，基本结构消失，消融区边缘出现纤维包裹带。随消融后时间延长纤维包裹带逐步增宽。消融后3d至14d，Ⅰ，Ⅱ和Ⅲ组每组17只动物中分别显示有14，11和12只在消融区内存在残留活性肿瘤组织。
结论超声引导经皮激光消融治疗肝肿瘤作为一种微创技术能有效地杀灭肿瘤细胞，形成凝固性坏死区。其疗效确切，特别是对肝脏的小肿瘤治疗更是安全可靠的。
第三部分超声引导经皮激光联合无水乙醇消融兔VX2肝肿瘤的实验研究
目的探讨超声引导下经皮激光联合无水乙醇消融兔VX2肝肿瘤的作用。
方法采用超声引导下经皮穿刺种植法建立兔VX2肝肿瘤模型。80只新西兰大白兔种植VX2肝肿瘤14d后，所存活荷瘤动物随机分为四组。Ⅰ组：单纯PLA治疗。Ⅱ组：单纯经皮瘤内无水乙醇注射（Percutaneous ethanol injection，PEI）治疗。Ⅲ组：在接受PEI前先行PLA治疗。Ⅳ组：在接受PLA前先行PEI治疗。消融前及消融后3d，进行常规二维灰阶超声成像、CD US、PD US及CE US观察。消融后进行病理学观察和肝功能检查。
结果种植后14d，共存活80只动物，每组20只，均接受消融治疗。消融治疗后3d，Ⅰ组，Ⅲ组和Ⅳ组消融区的边界清楚，形态规则。Ⅱ组的消融区边界不清，形态不规则。CE US示：消融区内未见超声造影剂灌注。传统二维灰阶超声成像示：Ⅳ组消融区体积（2.71±1.21cm3）较Ⅰ组（0.83±0.39cm3），Ⅱ组（0.83±0.58cm3）和Ⅲ组（1.82±0.47cm3）明显增大（P<0.05）。CE US也显示Ⅳ组消融区体积（3.59±1.44cm3）较Ⅰ组（0.92±0.45cm3），Ⅱ组（0.93±0.6cm31）和Ⅲ组（2.18±0.63cm3）明显增大（P<0.05）。CD US和PD US示：Ⅰ组和Ⅱ组消融区边缘部分存在残留病灶，但是Ⅲ组和Ⅳ组消融区内未发现残留病灶。CE US示：Ⅰ，Ⅱ和Ⅲ组消融区边缘部分存在残留血流分布，但Ⅳ组消融区内未发现残留血流。HE染色示四组消融区内凝固性坏死，周围可见纤维包裹带，Ⅳ组的残留肿瘤病灶少于Ⅰ组，Ⅱ组和Ⅲ组。治疗前血清丙氨酸氨基转移酶（ALT）四组无显著性差异（P>0.05），治疗后的1d均显著上升，3d后开始下降，14d基本下降至治疗前水平。
结论超声引导下PLA和PEI联合治疗肝肿瘤能扩大消融区体积和减少消融区内残留血流。PLA前先行PEI疗效更好。
Part1Establish of A VX2Rabbit Liver Tumor Model
Objective: To evaluate technical feasibility and experimental usefulness ofpercutaneous ultrasound-guided implantation of VX2carcinoma in rabbitliver.We compared percutaneous ultrasound-guided implantation and surgicalimplantation in establishing VX2rabbit liver tumor model investigated the valueof ultrasonography in the implantation process and the evaluation.
Methods: Thirty New Zealand rabbits were randomly divided into two groups，each having15rabbits：group I: surgical implantation; group II: percutaneousultrasound-guided implantation. After implantation, On7d,14d and21d,respectively,5rabbits in each group were examined by using conventional2-dimensional gray-scale ultrasonography (US), color Doppler (CD) US, powerDoppler (PD) US, and contrast enhanced (CE) US. Pathological examination wasperformed by hematoxylin-eosin (HE).
Results: A new percutaneous US-guided implantation was technically feasible in all rabbits. Evaluation parameters showed that the percutaneousultrasound-guided implantation method is less invasive than the surgicalimplantation. After implantation,13rabbits survived in group I, and13rabbitssurvived in group II. The tumor volume measured by conventional2-dimensionalgray-scale US increased from0.30±0.15cm3,9.23±2.65cm3on7d to on21d ingroup I, and from0.28±0.18cm3to8.90±2.52cm3in group II. No significantdifference existed between two groups (P>0.05). On CD US, PD US and CE US,before14d most tumors were hypervascular and some tumors were observed withvessels and the central hypovascular areas after14d.
Conclusions: Percutaneous ultrasound-guided implantation of VX2carcinoma inrabbit liver is a less invasive alternative to the surgical implantation, achievingequally successful tumor growth in the liver. Conventional2-dimensionalgray-scale US, CD US, PD US and CE US were valuable in assessment of tumorgrowth.
Part Two Experimental Studies of Effects ofUltrasound-guided Percutaneous Laser Ablation on RabbitVX2Liver Tumor
Objective: To evaluate the safety and effects of ultrasound-guided percutaneouslaser ablation (PLA) on rabbit VX2liver tumors by using a neodymium-yttrium-aluminum-garnet (Nd: YAG) laser fiber placed through a skinny needle.
Material and Methods: Fourteen days after implantation of VX2tumors inlivers of60rabbits, animals were randomly separated into three groups, eachhaving20rabbits. Echo Laser tumor ablation equipment was used. It deliveredenergy: group Ⅰ (3W/1800J), group Ⅱ (5W/1800J) and group Ⅱ(7W/1800J). The volume of tumors and ablated regions in three groups are measured byconventional gray-scale US and CE US, the effects on ablated areas wereassessed in terms of CE US and histopathological examination.
Results: Conventional gray-scale US showed ablated areas clear boundary, acentral core of anechoic vaporization, hyperechoic carbonization and surroundinghypoechoic in groupⅠ，Ⅱand Ⅱ, On CE US, coagulated areas depictedperfusion defect. Conventional gray-scale US and CE US showed: the ablatedvolume in group Ⅰ was smaller than that in group Ⅱ and Ⅱ. CD/PD US and CEUS showed residual lesions in periphery ablated areas in three groups. Thevolume of ablated regions in groupⅠand Ⅱ, Ⅰ andⅡ was compared withsignificant difference (P<0.05). The volume of ablated regions in groupⅡand Ⅱwas compared with no significant difference (P>0.05). Hematoxylin-eosinstaining demonstrated necrosis in ablated zones and increasing surrounding fibrabands in three groups.
Conclusions: ultrasound-guided percutaneous laser ablation of liver tissue issafe in this rabbit tumors model. Percutaneous laser ablation can cause fast，precise and effective necrosis of the liver tumors.
Part Three Ultrasound-guided Percutaneous LaserCombined with Ethanol Ablation on Rabbit VX2LiverTumors
Background: Only a small percentage of patients with large hepatocellularcarcinoma (HCC) may benefit out of surgical resection. Thus, most of thesepatients are in need of a form of local control, such as percutaneous ethanolinjection (PEI), percutaneous laser ablation (PLA), or radiofrequency thermal ablation (RFA).
Objective: To investigate the effects of ultrasound-guided PLA combined withPEI on rabbit VX2liver tumors by using conventional gray-scaleultrasonography (US), color/power Doppler (CD/PD)US, contrast-enhanced (CE)US, histopathology examination and liver function.
Material and Methods: Fourteen days after implantation of VX2tumors inlivers of80rabbits, animals were randomly separated into four groups, eachhaving20rabbits:(Ⅰ) PLA;(Ⅱ) PEI;(Ⅱ) combined therapy of PLAimmediately followed by PEI;(Ⅳ) combined therapy of PEI immediatelyfollowed by PLA. The length, width, depth and volume of tumors and ablatedregions in four groups are measured by conventional gray-scale US and CE US,the effects on ablated areas were assessed in terms of histopathologicalexamination and liver function.
Results: Conventional gray-scale US showed ablated areas clear boundary, acentral core of anechoic vaporization, hyperechoic carbonization and surroundinghypoechoic in group Ⅰ, Ⅱ and Ⅳ, and the irregular ablation region withisoechoic in group Ⅱ. On CE US, coagulated areas depicted perfusion defect.Conventional gray-scale US and CE US demonstrated: the ablated volume ingroup Ⅳ was larger than that in group Ⅰ, Ⅱ and Ⅱ. In ablate areas, CD/PD USshowed residual lesions in groupⅠ and Ⅱ, but no residual lesion in group Ⅱ andⅣ. CE US represented no residual lesion in periphery ablated areas in group Ⅳthan that in groupⅠ, Ⅱ and Ⅱ. The length, width, depth and volume of tumorsand ablated regions in group Ⅱ and Ⅳ was compared with significant difference(P<0.05). Hematoxylin-eosin staining demonstrated necrosis in ablated zones andincreasing surrounding fibra bands in four groups, residual viable tissues inablated zones of group Ⅳ were less than those of group Ⅰ, Ⅱ and Ⅱ. In four groups after ablation ALT increased on the first day, and decreased to level ofbefore ablation in fourteen days.
Conclusion: Combined therapies of PEI immediately followed by PLA cansignificantly coagulate larger volumes of tumor and reduce residual lesions.
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