肝纤维化并VX2肝癌介入治疗前后肝功能、免疫生化指标及组织病理学改变

发布时间：2018-08-12 17:46

【摘要】：目的探讨联合栓塞的安全性和疗效,为临床治疗肝硬化并肝癌提供实验依据。方法 45只大白兔随机选取10只作为对照组(A组,n=10),剩余35只大白兔饲养2周后建模,选取建立模型成功并存活的25只新西兰大白兔,依随机表法分为模型组(B组,n=8)、单纯化疗栓塞组(C组,n=9)及联合栓塞组(D组,n=8)。术中及术后2周内死亡的大白兔立即行肝脏病理学检查。各组兔(介入治疗后存活2周以上)于各观察点(术前和术后1、3、7、10、14 d)经耳缘静脉采血测定血清肝功能指标(ALT、AST、Alb、TB);术前及术后7、14 d行CT检查,测定非栓塞肝叶体积、肿瘤体积等指标并计算非栓塞肝叶体积增加率。第16周末处死所有试验兔,剖腹取肝组织,4%多聚甲醛固定,石蜡包埋,行苏木精-伊红(HE)染色;同时B、C、D组行Masson染色;A、B、C、D组非栓塞肝叶行免疫组织化学检查测定PCNA和Ki-67的表达。结果 C组、D组于介入治疗后ALT、AST、TB均呈一过性增高表现(P0.05),血清Alb水平始终保持稳定。术后7、14 d B组肿瘤体积明显增加(P0.05),C组、B组及A组非栓塞肝叶体积术前、术后未见明显变化。C组仅见个别肿瘤细胞胞核呈不规则形态,肿瘤中心仅见局限性坏死区域,周围肝细胞未见明显变化;B组肿瘤细胞生长仍较旺盛,肿瘤细胞向肝实质大量浸润,肿瘤中心见局限性坏死区域。免疫组织化学变化:术前活检已建立模型兔肝组织PCNA及Ki-67表达较A组多(P0.05),术后D组非栓塞肝叶PCNA及Ki-67的表达较术前明显增加(P0.05),较C组增加(P0.05),C组、B组及A组较术前未见明显增加(P0.05)。结论肝动脉化疗栓塞联合选择性门静脉栓塞较单纯化疗栓塞更有效地抑制肿瘤细胞生长和致肿瘤细胞坏死作用;联合栓塞可以诱导非栓塞侧肝细胞增生,增加非栓塞肝组织体积。
[Abstract]:Objective to investigate the safety and efficacy of combined embolization in the treatment of liver cirrhosis and liver cancer. Methods Forty-five rabbits were randomly selected as control group (group A, n = 10), the remaining 35 rabbits were fed for 2 weeks, and 25 New Zealand white rabbits were selected. According to the random table method, they were divided into three groups: model group (group B), chemoembolization group (group C) and combined embolization group (group D). Pathological examination of the liver was performed immediately during operation and 2 weeks after operation. The serum hepatic function index (alt ASTT Albtb) was measured at each observation point (1: 3 / 10 ~ 14 days before and after interventional therapy), and the volume of non-embolized liver lobe was measured by CT at 714 days before and after interventional therapy, and the serum hepatic function index (AlTASTT) was measured by blood collection through auricular vein before and after interventional therapy, and the volume of non-embolized liver lobe was measured by CT scan at 714 days before and after interventional therapy. Tumor volume and other indexes were used to calculate the increase rate of non-embolized liver lobe volume. At the end of the 16th week, all the experimental rabbits were killed, the liver tissues were fixed with 4% paraformaldehyde by laparotomy, paraffin embedded and stained with hematoxylin and eosin (HE), and the expression of PCNA and Ki-67 in the non-embolized liver lobes were detected by immunohistochemistry in the Masson staining group. Results after interventional therapy, all patients in group C showed a transient increase in alt ASTT TB (P0.05), and the level of serum Alb remained stable. 7 days after operation, the tumor volume in group B was significantly increased (P0.05). The volume of liver lobe in group B and group A was significantly increased before operation. There was no significant change after operation in group C. the nuclei of individual tumor cells in group C were irregular, and localized necrotic areas were found in the center of tumor. There was no obvious change in the peripheral hepatocytes in group B, the tumor cells still grew vigorously, the tumor cells infiltrated into the liver parenchyma, and the focal necrotic area was found in the center of the tumor. Immunohistochemical changes: the expression of PCNA and Ki-67 in liver tissue of model rabbits established by preoperative biopsy was more than that in group A (P0.05), the expression of PCNA and Ki-67 in group D was significantly higher than that in group C (P0.05), and the expression of PCNA and Ki-67 in group C was significantly higher than that in group C (P0.05). Conclusion Hepatic arterial chemoembolization combined with selective portal vein embolization is more effective than chemotherapy embolization alone in inhibiting tumor cell growth and inducing necrosis of tumor cells, and combined embolization can induce non-embolized hepatocyte proliferation. Increase the volume of non-embolized liver tissue.
【作者单位】：广东医科大学院附属医院介入病区;广东医科大学院附属医院麻醉科;
【分类号】：R735.7;R575.2

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