经皮瘤内注射乙酸治疗兔VX2肝种植瘤实验研究  

Percutaneous Acetic Acid Injection for the Treatment of Implanted VX2 Liver Tumor: An Experimental Study in Rabbits

作　　者：刘亚洪[1] 彭志康[1] 贾洪顺[1] 陈运鸿 全显跃[1] 陈建华[1] 王丽芝[1] 

机构地区：[1]第一军医大学珠江医院放射科,广州510280

出　　处：《临床放射学杂志》2003年第5期416-420,共5页Journal of Clinical Radiology

摘　　要：目的　探讨经皮乙酸注射 (PAI)的肿瘤灭活机制、疗效及治疗方法。材料与方法　兔VX2肝多发瘤模型8只 ,超声导引下经皮穿刺病灶 ,每只兔肝内 3个瘤灶内分别一次性注射 5 0 %乙酸、无水酒精和生理盐水 ,注射剂量以超声显像病灶被药液完全浸润为度 ,观察注射后 1小时、1天、3天和 14天大体、光镜、电镜下肿瘤病理改变及 14天后肿瘤生长情况。结果　各组肿瘤均有继续增大 ,PAI组肿瘤增长率最小 (2 5 7.39%± 14 0 .6 4 % ) ,坏死率最大(4 6 .2 7%± 16 .30 % ) ,与生理盐水对照组比较均有显著性差异 (P增长率 =0 .0 36 ,P坏死率 =0 ) ,与经皮无水酒精注射(PEI)组比较无显著性差异 (P >0 .0 5 )。组织病理学改变 :PAI后 1小时肿瘤细胞即溶解坏死 ;1天、3天肿瘤中央区大片凝固性坏死 ,边缘部呈网格状坏死 ,岛样残留瘤灶内可见扩张血管腔 ,边缘部肿瘤细胞以膜性结构破坏为主 ;14天后肿瘤表现继续扩大的凝固性坏死区 ,边缘残留少量肿瘤组织 ,并见大量纤维肉芽组织增生。PEI组各时段、区域肿瘤组织细胞破坏坏死改变相对PAI组较轻 ,纤维、肉芽组织增生较少、较晚 ,但PEI治疗后肿瘤血管内皮细胞损伤表现较明显。结论　PAI具有肿瘤灭活作用 ,其效力高于PEI。PAI肿瘤灭活效应主要是由乙酸的化学特性决定的 ,其作用途?Objective To explore the principle, effect and method of percutaneous acetic acid injection (PAI) for tumor ablation.Materials and Methods Eight rabbit models with multiple lesions of VX2 tumor were used for this study. Normal saline, 50% acetic acid and absolute ethanol (PEI) were respectively injected into three separated lesions in each rabbit. After the procedure, the macroscopic, light microscopic and electronic observation of the lesions at 1 hour, 1 day, 3 days and 14 days, and the measurement of tumor's growth at 14 days were carried out.Results Tumors in all groups kept growing after the procedure. For PAI group, the growing rate was lowest (257.39%±140.64%) and the necrotic rate was the highest (46.27%±16.30%). Significant difference in the growing rate and necrotic rate existed between PAI group and saline group (P 1=0.036, P 2=0.000), while no significant difference was found between PAI group and PEI group (P>0.05). Pathologically, the tumor cells became necrosed one hour after PAI, and large central coagulation necrosis with peripheral network necrosis appeared one or 3 days later. Dilated vessels could be observed within island shaped residual tumors. At 14 days after PAI, the coagulation necrosis became larger with massive granulation and fibrous hyperplasia. In PEI group, the destruction and necrosis of the tumor were milder, and the granulation and fibrous hyperplasia were less, than that in PAI group, but the damage of tumor vessel endotheliocyte was very marked.Conclusion PAI can more effectively ablate tumor tissue than PEI does. Acetic acid can coagulate and corrode the protein, destroy cellular membrane. Nevertheless, it is difficult to use high dose of acetic acid with a single injection to completely ablate a large tumor.

关 键 词：经皮瘤内注射 乙酸 治疗 VX2肝种植瘤 实验研究 动物模型 

分 类 号：R735.7[医药卫生—肿瘤]