经胆管^(192)Ir内照射对胆管、肝脏放射损伤的实验研究  

The experimental study of radiation injury on bile duct and liver tissue

作　　者：曹贵文[1] 王滨[1] 孙业全[1] 邵学叶[1] 宁厚法[1] 隋守光[1] 王秀春[1] 白旭明[1] 

机构地区：[1]潍坊医学院附属医院影像中心介入科,261031

出　　处：《介入放射学杂志》2007年第1期53-56,共4页Journal of Interventional Radiology

基　　金：山东省卫生厅计划课题

摘　　要：目的探讨经胆管192Ir内照射的安全性、可行性以及有效治疗范围,为肝门部胆管癌经胆管192Ir内照射提供理论依据。方法取雄性健康杂种犬16只,据照射剂量随机分成4组,每组4只。内照射前从犬肝边缘切取1 cm3大小肝组织作对照研究。术中将近距离治疗施源器经胆囊送入胆囊管与肝总管汇合处并用金属夹固定,根据预先设定的剂量进行胆管内照射。10 d后处死动物,取被照射胆管中央部分长约5 mm胆管,及距离胆管壁由近及远按设计距离分别取1 mm3大小肝组织,制备光镜切片,作HE染色;同时用2．5％戊二醛固定后常规制备电镜切片。光镜下观察胆管及周围肝组织的放射损伤并对损伤程度评分。电镜下观察肝组织超微结构损伤变化并计数凋亡肝细胞。结果经胆管192Ir内照射30 Gy时,胆管损伤达部分肌层;50 Gy时,胆管仅存外膜;60 Gy时,胆管出现全层坏死。胆管周围肝组织放射损伤随剂量增加而加重。在胆管最大安全耐受剂量50 Gy时,距胆管0～15 mm处肝细胞核出现不可逆性改变。结论正常胆管对192Ir内照射有良好的耐受性。在胆管最大安全耐受剂量50 Gy时,经胆管192Ir内照射有效的治疗范围可达15 mm。Objective To investigate the safety, acceptance and the effective extent of ^192Ir-internal irradiation, providing theoretical guidelines for HC. Methods Sixteen male healthy hybrid dogs enrolled in the experiment were divided into 4 groups of 4 each. The brachytherapy applicator was introduced from gall bladder into the convergence of cystic duct with common hepatic duct during the operation and a small chip of 1 cm3 liver tissue was cut off and taken for control later on. The animals in group A-D were irradiated by ^192Ir-internal irradiation with 30 Gy, 40 Gy, 50 Gy and 60 Gy at the correlative dose points respectively. Animals were put to death after 10 days subsequently, with sampling specimens obtained from radiation cystic duct and the in between liver tissue with the distant cystic duct. The radiation injury of the cystic duct and liver tissue near bile ducts were observed and studied by light microscope and transmission electron microscope. Results By the limit of the safest endurance dose（50 Gy） of bile duct, unreversed injury of the nuclei of liver cells occurred at 0 to 15 mm from bile duct revealed by transmission electron microscope and light microscope. The whole biliary duct wall would be undergone necrosis with irradiation dose over 60 Gy. Conclusions Normal bile duct possesses good endurance to ^192Ir-intemal irradiation. Within the safest endurance limit of 50 Gy the effective irradiation field could reach 15 mm from the involved bile duct.

关 键 词：^192Ir内照射 放射损伤 凋亡 肝脏 胆管 

分 类 号：R818.7[医药卫生—放射医学]