| ObjectiveTo analyze and explore the effect of blood flow and the diameter of liver arteryon Cryoablation. Explore the more effective cure methods, provide the theoreticalbasis for improving the curative effect of hepatocellular carcinoma.Materials and MethodsAdult experimental dogs were randomly divided into two groups, with each ofeight. The experimental group were underwent liver artery obstruction andcryoablation whereas the control group with only cryoablation. Record thetemperature at the cryoprobe tips,, 1cm and 1.5cm nearby during the operation. Recordthe thawing time. Animals were sacrificed immediately, 3 days, 7 days and 14 days afterthe treatment. With elective hepatic artery visualization and hematoxylin and eosinstain, observe and measure the area of necrosis, the pathologic and image changes ofhepatic artery and the the pathologic change of hepatic cells near the hepatic artery.Results1. In the experimental group, all of the arteries less than 3mm occluded. Norecanalization before being sacrificed., but there are lots of indiscriminate petty arteriesproduced. The vessels ranging in size from greater than 3mm to less than 5mm occluded or damaged partly. The image taken before the sacrificing showed that thepartial injury was repaired partly. There is no change in arteries greater than 5mm. Inthe control group, the diameter of occluded vessels is less than 2ram, and norecanalization, too. In vessels ranging in size from greater than 2mm to less than4mm, the extent of injury decreased and partial repair was shown before beensacrificed. There is no change in arteries greater than 4mm.2. The lowest temperature of different point during the operation is -156±4.2℃atthe cryoprobe tips, -95±5.6℃in 1cm nearby, -42±6.2℃in 1.5cm nearby in theexperimental group. Of the control group, these indexes are -138±4.7℃, -844±3.5℃and -35±5.9℃. There are statistical differentiations between the two groups (P=0.000, 0.000, 0.036).3. The time reach the lowest temperature of different point during the operation is68±5.7s at the cryoprobe tips, 74±4.2s in 1 cm nearby, 81±4.5s in 1.5 cm nearby ofthe experimental group. Of the control group, these indexes are 92±6.1s, 97±5.8s and94±5.7s. There are statistical differentiations between the two groups (P=0.000,0.000, 0.000).4. The thawing time of experimental group was 383±6.3s,longer than the controlgroup greatly, which was 324±5.6s (P=0.000).5. The total area of necrosis and apomorphosis in pathological section ofexperimental group is 5.7±2.1cm~2 of immediately batch, 6.24±2.9cm~2 of 3d batch,5.9±1.5cm~2 of 7d batch, 6.0±2.6cm~2 of 14d batch (P=0.032, 0.039, 0.004, 0.012).The necrosis area is 4.2±2.0 cm~2,4.5±2.6cm~2, 4.1±2.5 cm~2, 4.3±2.1cm~2 of these fourbatches (P=0.010, 0.007, 0.000, 0.001). The percentage of necrosis is 73.8±3.6%, 73.2±2.4%, 71.3±2.1%, 72.4±4.1% (P=0.005, 0.000, 0.002, 0.007).Thereare significant differences between the two groups.6. The diameter is relative with the damage of artery after cryoablation and the incidence of normal hepatic cells rarnain. There is negative correlation between thediameter and the degree of artery damage. But there is positive correlation between the artery andthe incidence of normal hepatic cells ramain. The relationship between the damage of arteryafter cryoablation and the incidence of normal hepatic cells ramain is negative. The moreserious damage was, the lower incidence of heat protect exit.7. The incidence of occlusion of lever arteries less than 3mm is the highest inboth groups. In the experimental group, all of the arteries less than 3mm occluded, theincidence of occlusion of vessels ranging in size from greater than 3mm to less than5mm is 68.2%. In the contral group, the incidence of vessels less than 3ram is 73.0%,there is no occlusion in vessels greater than 3mm. The incidence of partial damage ofliver arteries greater than 5mm is the highest in the experimental group,but in thecontral group it is in the vessels ranging from 3mm to 5mm. The highest incidence ofnormal hepatic cell remain is in the vessels greater than 5mm in both groups. And theincidence of the contral group is greater than the experimental group.Conclusion1. There is synergism between the effect of the blood flow and the diameter ofliver artery on Cryoablation of hepatocellular carcinoma.2. The blood flow occlution affect the curative effect of cryoablation through thesemechanisms:a. It is helpful to promote the decrease of the temperature at the cryoprobe tipsand nearby, to lower the lowest temperature and prolong the thawing time to practicecryoablation after liver artery obstruction.b. It is helpful to increase the volume of necrosis to practice cryoablation afterliver artery obstruction.c. It is helpful to promote the artery damage during the cryoablation and decreasethe incidence of normal hepatic cell remain. 3. The diameter of liver artery have great effect on the therapeutic efficacy ofcryoablation. The aterty greater than 5ram protect the hepatic tissue and affect thetherapeutic efficacy of cryoablation.
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