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背景:临床研究发现肝癌门静脉阻断有利于抑制肝癌的生长,促进未阻断肝组织的代偿性增生,并降低经门静脉途径的转移,目前尚需动物实验进一步验证。目的:探讨兔肝VX2移植瘤门静脉阻断模型的建立方法,及其多层螺旋CT评价价值。)设计:随机分组设计、动物实验。单位:解放军第三军医大学新桥医院放射科。材料:实验于2002-07/2005-01在第三军医大学新桥医院影像学实验室完成。选择新西兰大白兔40只,随机数字表法分为4组,每组10只,门静脉阻断即刻移植瘤体组、瘤体移植3周后门静脉阻断组、阴性对照组、阳性对照组。方法:采用开腹包埋接种法移植兔肝VX2肿瘤,分别进行门静脉阻断后即刻移植瘤体和移植瘤体生长3周后行门静脉阻断,同时设立阴性对照组(门静脉左外支行假手术阻断,兔肝左外叶假性包埋接种)、阳性对照组(移植瘤体未行门静脉阻断)。所有实验兔均行兔多层螺旋CT检查。主要观察指标:门静脉阻断后肝大体变化、瘤体变化、肿瘤转移情况,肝动脉、门静脉各级分支的多层螺旋CT血管成像显示率,肝血流量、血容量、平均通过时间、血管表面通透性和肝动脉灌注分数。结果:纳入动物40只,均进入结果分析。①门静脉阻断即刻移植瘤体组于门静脉分支结扎术3周后均未见瘤体生长。瘤体移植3周后门静脉阻断组动物左内叶明显萎缩,肿瘤的生长明显受抑制,其瘤体最大径明显小于阳性对照组[分别为(2.55±0.46),(3.59±0.37)cm,t=5.57,P<0.001]。瘤体移植3周后门静脉阻断组肝内转移及肺转移发生率也明显少于阳性对照组(分别为10%,40%和100%,90%);但两者的邻近转移率差异却无显著性意义。②多层螺旋CT血管成像检查对Ⅲ级以上肝动脉分支的显示率明显低于Ⅰ、Ⅱ级肝动脉分支的显示率(分别为40%,100%,70%,P<0.05)。门静脉各级分支的显示率差异无显著性意义(P>0.05)。③门静脉阻断即刻移植瘤体组、瘤体移植3周后门静脉阻断组肝血流量、血容量、平均通过时间和血管表面通透性值均较相应对照组降低,但肝动脉灌注分数值均明显增高。结论:门静脉左外支结扎是兔肝VX2移植瘤门静脉阻断的理想模型。多层螺旋CT在兔肝门静脉阻断效果的评价中起着重要作用。
BACKGROUND: Clinical studies have found that portal vein occlusion of liver cancer is conducive to inhibiting the growth of liver cancer, promoting compensatory hyperplasia of non-blocking liver tissue and reducing the metastasis via portal vein. At present, further animal experiments are still needed to verify this. Objective: To explore a method for establishing a portal vein occlusion model of rabbit liver VX2 xenograft and evaluate the value of multislice spiral CT. Design: randomized block design, animal experiments. SETTING: Department of Radiology, Xinqiao Hospital, Third Military Medical University. Materials: The experiment was performed at Imaging Laboratory, Xinqiao Hospital, Third Military Medical University between July 2002 and January 2005. Forty New Zealand white rabbits were randomly divided into four groups (10 in each group). The portal vein was immediately transplanted into the tumor group, and the portal vein occlusion group, the negative control group and the positive control group were implanted 3 weeks after transplantation. Methods: Rabbit VX2 tumors were transplanted with laparotomy. The portal vein was excised immediately after the portal vein was occluded and the portal vein was occured 3 weeks after transplantation. At the same time, a negative control group (the left external branch of the portal vein was blocked with sham operation , Rabbit liver left external lobe pseudo-embedded inoculation), positive control group (transplantation of tumor was not blocked the portal vein). All rabbits underwent multi-slice spiral CT examination. MAIN OUTCOME MEASURES: Gross changes of liver, tumor changes, tumor metastasis after portal vein occlusion, multi-slice spiral CT angiography showed rate of hepatic artery and portal vein branches, hepatic blood flow, blood volume, mean transit time, blood vessel surface Permeability and hepatic arterial perfusion score. Results: Forty animals were included in the analysis of the results. ① portal vein occlusion immediately transplantation tumor group in the portal vein ligation after 3 weeks were no tumor growth. After 3 weeks of tumor transplantation, the left inner lobe of the portal vein was significantly atrophied and the growth of the tumor was obviously inhibited. The maximum diameter of the tumor was significantly smaller than that of the positive control group (2.55 ± 0.46 vs 3.59 ± 0.37 cm, t = 5.57, P <0.001]. The rates of intrahepatic metastasis and pulmonary metastasis in portal vein occlusion group after 3 weeks of tumor transplantation were also significantly less than those in positive control group (10%, 40% and 100%, 90%, respectively); however, No significant significance. ② The multi-slice spiral CT angiography showed that the display rate of branch of hepatic artery above grade Ⅲ was significantly lower than that of grade Ⅰ and Ⅱ branches (40%, 100%, 70%, P <0.05 respectively). There was no significant difference in the rate of portal vein branches at all levels (P> 0.05). (3) The portal vein immediately transplanted the tumor group, the portal vein occlusion group after 3 weeks of tumor transplantation liver blood flow, blood volume, mean passage time and vascular surface permeability values were lower than the corresponding control group, but the fractional hepatic artery perfusion Significantly increased. Conclusion: The left portal vein ligation is an ideal model of portal vein occlusion in rabbit VX2 xenografts. Multi-slice spiral CT plays an important role in the evaluation of rabbit hepatic portal vein occlusion.