研究低强度超声及微泡超声空化单独或联合应用对无水乙醇消融实验兔肝脏的增强效果，并观察此方法对实验兔肝脏血流灌注、肝功能的影响。

健康新西兰大白兔62只，随机分为5组：低强度超声组（LUS组，6只），无水乙醇组（EA组，14只），低强度超声联合无水乙醇组（LUS＋EA组，14只），微泡超声空化联合无水乙醇组（MEUS＋EA组，14只），微泡超声空化联合低强度超声增强无水乙醇组（MEUS＋LUS＋EA组，14只）。按分组对经腹暴露的兔肝左叶分别给予处理，LUS组、MEUS＋EA组及MEUS＋LUS＋EA组实验兔肝脏分别于超声辐照处理后，对处理叶及对照叶即刻进行超声造影并定量分析。EA组、LUS＋EA组、MEUS＋EA组、MEUS＋LUS＋EA组各取3只实验兔于实验前、实验结束后即刻、48 h、5 d及7 d抽取动脉血检测谷丙转氨酶（ALT）、谷草转氨酶（AST）浓度。余动物于实验结束后48 h分别获取肝脏组织，排液法测量肝脏消融体积，HE染色观察肝脏处理区域组织学改变。采用配对t检验比较各组实验兔肝脏处理叶与对照叶PI、AUC差异。采用Kruskal-Walis H秩和检验比较各组实验兔肝脏消融体积，进一步组间两两比较采用Nemenyi秩和检验。采用重复测量数据的方差分析比较各组实验兔肝脏AST浓度、ALT浓度随时间变化的趋势差异。

LUS组实验兔处理叶PI、AUC较对照叶稍高，但其差异均无统计学意义；MEUS＋EA组、MEUS＋LUS＋EA组实验兔处理叶峰值强度（PI）、曲线下面积（AUC）均较对照叶降低（PI：51.65±16.90 vs 101.09±14.41，44.08±8.46 vs 113.40±9.35；AUC：2183.06±501.13 vs 4258.54±841.21，1900.39±352.59 vs 4385.55±1198.16），且差异均有统计学意义（t=9.059、16.835、9.630、7.932，P均<0.001）。LUS组实验兔未见肝脏坏死灶，肝脏消融体积为0，EA组、LUS＋EA组、MEUS＋EA组、MEUS＋LUS＋EA组实验兔肝脏消融体积分别为（0.84±0.27）、（2.42±1.11）、（3.52±1.34）、（4.01±1.45）ml，EA组实验兔肝脏消融体积均低于其余3组，且差异均有统计学意义（U=-13.800、-20.400、-23.400，P均<0.05），而其余3组间任意2组实验兔间肝脏消融体积差异均无统计学意义。LUS组实验兔肝叶超声辐照区未见明显病理改变，其余4组均出现广泛凝固性坏死。与实验前相比，实验结束后即刻各组实验兔均出现肝脏ALT及AST浓度轻微升高，实验结束后48 h达最高，随后逐渐回落，实验结束后7 d，各组实验兔肝脏ALT、AST浓度基本恢复至实验前正常水平。4组实验兔肝脏AST浓度、ALT浓度随时间变化的趋势基本一致，差异无统计学意义（F=0.256，P=0.855；F=0.517，P=0.686）。

低强度超声及微泡超声空化单独或联合作用均可显著增加无水乙醇消融兔肝脏体积，且不会导致肝功能损伤加重。

To explore the effect of low intensity ultrasound (LUS) and microbubble enhanced ultrasound cavitation (MEUS), alone or in combination, on ethanol ablation (EA) of rabbit liver and observe the changes of liver perfusion and liver function.

Sixty-two healthy New Zealand rabbits were randomized to five groups: LUS group (n=6), EA group (n=14), LUS+ EA group (n=14), MEUS+ EA group (n=14), MEUS+ LUS+ EA group (n=14). For LUS, pulsed low intensity focused ultrasound emission was adopted (focal distance, 15 cm; duty cycle, 0.036%-0.22%; therapy duration, 5-6 min). According to the experiment design, surgically exposed left lobe of the liver was treated. In the LUS, MEUS+ EA, and MEUS+ LUS+ EA groups, quantitative parameters were calculated and compared between the experimental and control liver lobes after different treatments. Three rabbits in each of the EA, LUS+ EA, MEUS+ EA, and MEUS+ LUS+ EA groups were used to detect the contents of alanine aminotransferase (ALT) and aspartate transaminase (AST) in arterial blood at five different time points (before treatment, 1 h, 48 h, 5 d, and 7 d after treatment). The livers of the remaining rabbits were harvested for measurement of ethanol ablation volume by drainage method or examination of the histological changes by HE staining 48 h after treatment.

In the LUS group, the peak intensity (PI) and the area under the curve (AUC) were higher in the experiment lobe than in the control lobe, but there was no significant difference. In the MEUS+ EA and MEUS+ LUS+ EA groups, the PI and AUC values were significantly lower in the experiment lobe than in the control lobe (PI: 51.65±16.90 vs 101.09±14.41, 44.08±8.46 vs 113.40±9.35; AUC: 2183.06±501.13 vs 4258.54±841.21, 1900.39±352.59 vs 4385.55±1198.16; t=9.059, 16.835, 9.630, 7.932, P<0.001 for all). In the LUS group, no necrosis was observed, and the necrosis volume was 0 ml. The necrosis volumes caused by ethanol ablation in the EA, LUS+ EA, MEUS+ EA, and MEUS+ LUS+ EA groups were (0.84±0.27) ml, (2.42±1.11) ml, (3.52±1.34) ml, and (4.01±1.45) ml. The ethanol ablation volume was significantly lower in the EA group than in the other three groups (u=-13.800, -20.400, -23.400, P<0.05 for all), although there were no significant difference between any two of the latter three groups. No pathological changes were observed in the ultrasound exposed liver of the LUS group. In contrast, a wide range of coagulation necrosis area was noted in the other four groups. Compared with pre-treatment values, ALT and AST levels in all groups showed a slight rise after treatment, peaked at 48 h, and gradually returned to the pretreatment levels after seven days. The tendency of changes in ALT and AST levels with time was similar among the four groups (F=0.256, P=0.855; F=0.517, P=0.686).

LUS and MEUS, alone or in combination, could significantly increase the ethanol ablated volume of rabbit liver without aggravating liver function.