超声与增强CT评价肝癌射频消融术疗效的相关性及射频消融术对兔肝残余肿瘤生物学行为的影响

发布时间：2018-08-25 14:41

【摘要】：第一部分超声与增强CT评价肝癌射频消融术疗效的相关性分析目的：探讨超声与增强CT评价肝癌射频消融术（radio frequency ablation，RFA）治疗效果的相关性。方法：选取大连医科大学附属第二医院2008年1月-2012年12月124例临床资料完整且临床确诊为肝癌的患者，原发灶108个，转移灶40个，共148个病灶。分别对124例患者于RFA治疗前、RFA治疗后1个月、3个月行超声及增强CT检查，分析治疗前后消融灶声像图改变与CT扫描结果的相关性。结果：与术前对比，根据病灶损毁程度及时间变化，超声与CT评价消融区疗效的影像表现呈正相关性（P＜0.05）。结论：超声与CT虽各具优点，但超声操作简单、经济、耗时少、创伤小、并发症少，可作为RFA疗效评价的首选方法。第二部分兔肝VX_2肿瘤射频消融术后残癌中caspase-8表达变化的意义目的：探讨兔肝脏VX_2肿瘤射频消融术（radio frequency ablation，RFA）后残余瘤组织中天冬氨酸特异性半胱氨酸蛋白酶（caspase-8）表达变化的意义。方法：实验兔28只，VX_2荷瘤兔3只，传代2只，肝内接种23只。从荷瘤兔腿部切取肿瘤周边生长旺盛的鱼肉样组织，剪成大小约1mm3的瘤块，超声引导下将VX_2瘤粒接种于23只已麻醉成功的实验兔肝脏内，2周后制成兔肝脏VX_2肿瘤动物模型。随机抽出3只行超声检查，明确肝内出现阳性病灶，处死动物，行HE染色，观察镜下细胞形态，以确定肿瘤是否接种成功。将成功制成的兔肝脏肿瘤模型随机分为5组，A组3只，为对照组，不行RFA治疗；将剩余20只行RFA治疗，损毁范围约为肿瘤最大半径的2/3，人为造成肿瘤组织残余。按治疗后不同时间点分为术后0h组（B组）5只、术后1周组（C）组5只、术后2周组（D组）5只和术后4周组（E）组5只。经超声检查后分别将荷瘤兔处死，应用免疫组化方法检测4组治疗后兔肝脏VX_2肿瘤残余瘤组织中及未经治疗组中caspase-8的表达情况。结果： 1.造模结果接种后2~4w行超声检查，23只实验兔全部接种成功。超声显示肝脏内见圆形或类圆形的低回声结节，大小1.5±0.5cm，边界清晰，无包膜回声，，血流丰富，并探及动脉血流。随机抽出3只处死后行HE染色，观察癌细胞呈巢状分布，体积大，排列不规则，胞核大且深染，示肝内接种成功。 2.RFA术后超声显示术后0h肿瘤毁损部呈不规则强回声，边界不清晰，形态不规则，彩色多普勒（CDF）及能量多普勒（CDE）未探及血流。术后1w、2w、4w肿瘤大小与术前相似，治疗区呈不规则高回声，中心见少量不规则无回声；术后1w、2w，CDF及CDE无明显血流信号，术后4w，CDE部分残癌周边见血流信号。 3.免疫组化结果 A组caspase-8在肝癌组织中呈低表达，为（9.4±2.3）%；B组caspase-8残癌组织中阳性表达率为（12.6±2.9）%；C组caspase-8残癌组织中阳性表达率为（45.8±12.8）%；D组caspase-8残癌组织中阳性表达率为（76.7±15.5）%；E组caspase-8残癌组织中阳性表达率为（96.6±18.3）%。B~E组caspase-8在消融区呈低表达。结论：射频消融术可以诱导兔肝VX_2肿瘤残余瘤组织中的肿瘤细胞凋亡，从而起到进一步的治疗作用。
[Abstract]:Part one: correlation analysis between ultrasound and enhanced CT in evaluating radiofrequency ablation of liver cancer
Objective: To investigate the correlation between ultrasound and enhanced CT in evaluating the therapeutic effect of radio frequency ablation (RFA) for hepatocellular carcinoma.
Methods: From January 2008 to December 2012, 124 patients with hepatocellular carcinoma were selected from the Second Affiliated Hospital of Dalian Medical University. There were 108 primary lesions, 40 metastatic lesions and 148 lesions. Correlation between sonographic changes and CT scan results.
Results: According to the lesion damage degree and time changes, the imaging manifestations of ultrasound and CT were positively correlated (P < 0.05).
Conclusion: Ultrasound and CT have their own advantages, but they are simple, economical, less time-consuming, less trauma, less complications, and can be used as the first choice for evaluating the efficacy of RFA.
The significance of caspase-8 expression in second cases of residual liver cancer after radiofrequency ablation of rabbit liver VX_2 tumor
Objective: To investigate the expression of caspase-8 in residual VX_2 tumor of rabbit liver after radio frequency ablation (RFA).
Methods: 28 experimental rabbits, 3 VX_2 tumor-bearing rabbits, 2 subcultured rabbits, and 23 intrahepatic inoculated rabbits were used. Fish-like tissues around the tumor were cut from the legs of the tumor-bearing rabbits and cut into tumors about 1 mm 3 in size. The VX_2 tumor particles were inoculated into the liver of 23 anesthetized experimental rabbits under the guidance of ultrasound. Two weeks later, the rabbit liver VX_2 tumor model was made randomly. Three rabbits were randomly divided into 5 groups, 3 in group A without RFA treatment, and the remaining 20 rabbits were treated with RFA, the lesion area was about half of the tumor. Five rabbits were divided into group B, group C, group D, and group E at different time points after treatment. Five rabbits were sacrificed after ultrasonic examination, and the remaining tumor tissues of liver VX_2 were detected by immunohistochemistry. The expression of caspase-8 in the treatment group.
Result:
1. modeling results
Ultrasound examination was performed 2 to 4 weeks after inoculation, and all 23 rabbits were successfully inoculated. Ultrasound showed round or quasi-circular hypoechoic nodules in the liver, with a clear border, no envelope echo, rich blood flow and arterial blood flow. Three rabbits were randomly selected and executed for HE staining. The tumor cells were nested, large in size and irregularly arranged. The nuclei were large and deep stained, indicating that the liver was successfully inoculated.
Ultrasonography after 2.RFA
The lesion showed irregular strong echo at 0 h after operation, unclear boundary, irregular shape, and no blood flow was detected by color Doppler (CDF) and energy Doppler (CDE). The tumor size was similar to that before operation at 1 w, 2 W and 4 W after operation, irregular high echo was found in the treatment area and a few irregular high echo was found in the center. E peripheral blood signals were seen in some residual cancers.
3. immunohistochemistry results
The expression of caspase-8 was low in group A (9.4 +2.3)%; positive in group B (12.6 +2.9)%; positive in group C (45.8 +12.8)%; positive in group D (76.7 +15.5)%; positive in group E (96.6 +2.9)%. 18.3) caspase-8 in%.B~E group was low expressed in ablation area.
CONCLUSION: Radiofrequency ablation can induce apoptosis of VX_2 tumor residual tissues in rabbit liver and play a further therapeutic role.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R445.1;R816.5;R735.7

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