目的 评估微泡造影剂在猪肝创伤性出血模型中,对超声引导下微波消融止血定位准确性及止血效果的增强作用。方法 采用随机对照动物实验设计,将24只实验小型猪(体重30~50 kg)建立标准化创伤性肝出血模型后,随机分为微泡造影剂组(n=12,经静脉注射SonoVue 0.1 ml/kg)和生理盐水对照组(n=12,注射等量生理盐水)。两组均在超声引导下应用KY2000微波治疗仪(功率60 W)对肝破裂创面实施消融止血。术中持续监测心率、平均动脉压(MAP)及肛温等参数。术后行肝脏大体解剖及组织病理学检查。结果 实验显示使用微泡造影剂组止血区域超声影像学回声显著增强,与邻近正常肝组织边界清晰度显著提高,有助于术中精准定位出血灶。超声引导下微波穿刺针可迅速抵达出血灶中心,不同肝脏部位平均耗时(3.00±0.32)min止血;在邻近肝动脉区域,微泡造影剂组的凝血时间显著短于对照组[(5.50±0.52) min vs (9.67±0.85) min, P<0.001];而在邻近膈肌与邻近胆囊区域,两组凝血时间差异无统计学意义。术中生理参数监测显示,两组间心率、MAP及肛温差异均无统计学意义;然而,血压变化趋势分析表明微泡造影剂组的收缩压与舒张压波动幅度较小,血流动力学状态更为稳定。术后24 h实验室检测显示,微泡造影剂组的血红蛋白下降幅度、血小板计数减少程度及总失血量均显著低于对照组(P<0.05)。病理学检查显示,两组微波消融后均形成纺锤形凝固性坏死区[直径(1.52±0.15) cm];光学显微镜下观察,微泡造影剂组肝窦充血及扩张程度更为显著。结论 在猪创伤性肝出血模型中,微泡造影剂可显著增强超声对出血区域的显影效果,提高定位精确性,并在邻近肝动脉等关键解剖区域有效缩短微波消融止血时间,提升整体止血效能。

Objective To evaluate the enhancement effect of microbubble contrast agent on the accuracy of ultrasound-guided microwave ablation for hemostasis and the hemostatic efficacy in a porcine traumatic liver hemorrhage model. Methods A randomized controlled animal trial was conducted utilizing 24 miniature pigs (weight: 30-50 kg). Following establishment of a standardized liver injury model, subjects were randomly allocated to either a microbubble contrast agent group (n=12, receiving intravenous SonoVue at 0.1 ml/kg) or a saline control group (n=12, administered an equivalent volume of saline). Both groups were treated with KY2000 microwave therapy instrument (power 60 W) for ablation hemostasis under ultrasound guidance. Hemodynamic parameters-including heart rate, mean arterial pressure, and rectal temperature-were monitored continuously throughout the procedure. Postoperative liver dissection and histopathological examinations were performed. Results The experimental results showed that in the ultrasonographic examination, the group using microbubble contrast agents exhibited significantly enhanced echo intensity in the hemostatic area, with markedly improved clarity of the boundaries adjacent to normal liver tissue, facilitating precise intraoperative localization of the bleeding site. The microwave needle under ultrasound guidance rapidly reached the center of the bleeding site, with an average hemostasis time of approximately 3±0.32 minutes across different liver regions. In areas adjacent to the hepatic artery, the coagulation time in the microbubble contrast agent group was significantly shorter than that in the control group [(5.50±0.52)min vs. (9.67±0.85)min, P<0.001]. However, in regions near the diaphragm and gallbladder, there was no statistically significant difference in coagulation time between the two groups. Intraoperative physiological parameter monitoring revealed no statistically significant differences in heart rate, mean arterial pressure (MAP), or rectal temperature between the two groups. Nevertheless, analysis of blood pressure trends indicated that the microbubble contrast agent group had smaller fluctuations in systolic and diastolic blood pressure, suggesting a more stable hemodynamic state. Laboratory tests 24 hours postoperatively showed that the decrease in hemoglobin, reduction in platelet count, and total blood loss in the microbubble contrast agent group were significantly lower than those in the control group (P<0.05). Pathological examination revealed that both groups formed spindle-shaped coagulative necrosis zones [diameter (1.52±0.15) cm] after microwave ablation. Under optical microscopy, the degree of hepatic sinus congestion and dilation was more pronounced in the microbubble contrast agent group. Conclusions In a porcine model of traumatic liver hemorrhage, microbubble contrast agent can significantly enhance ultrasonographic visualization of the bleeding site, improve localization accuracy, and effectively abbreviate microwave ablation hemostasis time in critical areas such as the adjacent hepatic artery, thereby enhancing overall hemostatic efficiency.