小剂量体外放疗预防兔气管金属支架置入术后再狭窄效果观察  

The effect of small-dose external radiotherapy in preventing airway restenosis in experimental rabbits after tracheal metal stent implantation

作　　者：李宗明[1] 张全会[1] 韩新巍[1] 焦德超[1] 任克伟[1] 路慧彬[1] LI Zongming;ZHANG Quanhui;HAN Xinwei;JIAO Dechao;REN Kewei;LU Huibin(Department of Interventional Radiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province 450052,China)

机构地区：[1]郑州大学第一附属医院介入科、郑州大学介入治疗研究所、河南省介入治疗与临床研究中心,450052

出　　处：《介入放射学杂志》2022年第2期162-166,共5页Journal of Interventional Radiology

基　　金：河南省科技攻关计划项目/省部共建青年项目(SB201902005)。

摘　　要：目的探讨体外小剂量放疗预防气管金属支架置入术后再狭窄的有效性。方法选用4月龄新西兰大耳白兔32只,体质量2.5~3.0 kg。采用气管切开联合尼龙毛刷刮擦黏膜方法制备良性气管狭窄动物模型。X线透视下置入镍钛合金裸支架。根据生物等效剂量(BED)随机分为20 Gy组、30 Gy组、40 Gy组和对照组,每组8只;20 Gy组以分割剂量7 Gy/d照射2次,30 Gy组以分割剂量7 Gy/d照射3次,40 Gy组以分割剂量8 Gy/d照射3次,每2次照射间歇5 d,对照组不体外放疗。体外放疗后4、8周每组处死4只实验兔,处死前行胸部CT扫描,记录气管狭窄程度。结果气管狭窄模型制作4周,存活30只,2只分别死于肺部感染、气管黏膜水肿所致呼吸衰竭,补做2只均存活;气管狭窄率为42%~85%。体外放疗4、8周平均气管狭窄率,20 Gy组分别为(46.7±4.8)%、(52.9±3.6)%,30 Gy组分别为(36.2±4.7)%、(39.8±4.5)%,40 Gy组分别为(31.9±5.7)%、(34.8±5.2)%;对照组置入气管支架4、8周后平均气管狭窄率为(65.5±2.6)%、(80.7±3.8)%。实验组各组气管平均狭窄率均小于对照组,差异有统计学意义(均P<0.05);20 Gy组气管平均狭窄率大于30 Gy组、40 Gy组,差异有统计学意义(均P<0.05);30 Gy组气管平均狭窄率大于40 Gy组,差异无统计学意义(P>0.05)。40 Gy组1只实验兔体外放疗后死于气管穿孔所致纵隔感染。结论体外放疗可有效抑制气管支架置入术后黏膜肉芽组织增生。推荐应用30 Gy分次照射方案。Objective To assess the effect of small-does external radiotherapy in preventing airway restenosis in experimental rabbits after tracheal metal stent implantation.Methods Thirty-two 4-months old New Zealand big ear rabbits with body mass of 2.5-3 kg were used for this study.The benign tracheal stenosis animal model was established by using tracheotomy combined with nylon-brush scraping method.Under X-ray guidance,the bare nickel-titanium alloy stent was implanted in the trachea.Based on the bioequivalent dose(BED),the rabbits were randomly and equally divided into 20 Gy group,30 Gy group,40 Gy group and control group with 8 rabbits in each group.Twice radiotherapy with fractionated dose of 7 Gy/d was adopted for the rabbits of the 20 Gy group,3 times of radiotherapy with fractionated dose of 7 Gy/d were adopted for the rabbits of the 30 Gy group,3 times of radiotherapy with fractionated dose of 8 Gy/d were adopted for the rabbits of the40 Gy group;the interval between two radiotherapy procedures was 5 days.No external radiotherapy was conducted for the rabbits of the control group.Every 4 rabbits from each group were sacrificed each time at 4 weeks and 8 weeks after the treatment.Before execution,chest CT scan was performed to evaluate the degree of tracheal stenosis.Results Four weeks after modeling,30 rabbits survived,one rabbit died of pulmonary infection and another rabbit died of respiratory failure caused by tracheal mucosal edema.Two supplementary tracheal stenosis models were established.The tracheal stenosis ratio ranged from 42%to 85%.The post-radiotherapy 4-week and 8-week mean tracheal stenosis ratios in 20 Gy group were(46.7±4.8)%and(52.9±3.6)%respectively,which in 30 Gy group were(36.2±4.7)%and(39.8±4.5)%respectively,in 40 Gy group were(31.9±5.7)%and(34.8±5.2)%respectively,and in control group were(65.5±2.6)%and(80.7±3.8)%respectively.The mean tracheal stenosis ratio in all three experimental groups was obviously smaller than that in the control group,the difference was statistically signifi

关 键 词：体外放疗 动物模型 良性 气管狭窄 支架 肉芽组织增生 

分 类 号：R332[医药卫生—人体生理学] R562[医药卫生—基础医学]