张强,李彬,李晓光,高毅.甲基丙烯酸羟乙酯共聚物液体栓塞剂栓塞治疗兔VX2肝肿瘤[J].中国介入影像与治疗学,2018,15(7):434-438
甲基丙烯酸羟乙酯共聚物液体栓塞剂栓塞治疗兔VX2肝肿瘤
Transarterial embolization therapy with liquid embolic agent poly-2-hydroxymethyl methacrylate-co-methyl methacrylate for rabbit VX2 liver tumors
投稿时间:2018-02-25  修订日期:2018-05-21
DOI:10.13929/j.1672-8475.201802024
中文关键词:  甲基丙烯酸羟乙酯-甲基丙烯酸甲酯聚合物  栓塞,治疗性  肝肿瘤  
英文关键词:Poly-2-hydroxymethyl methacrylate-co-methyl methacrylate  Embolization,therapeutic  Liver neoplasms  Rabbits
基金项目:
作者单位E-mail
张强 河南安阳地区医院介入科, 河南 安阳 455000  
李彬 北京医院肿瘤微创治疗中心, 北京 100730  
李晓光 北京医院肿瘤微创治疗中心, 北京 100730 xglee88@126.com 
高毅 河南安阳地区医院介入科, 河南 安阳 455000  
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中文摘要:
      目的 探讨甲基丙烯酸羟乙酯共聚物液体栓塞剂(HEMA-MMA)栓塞兔VX2肝肿瘤的可行性及有效性。方法 采用CT引导下"体外预装示踪一步植入技术"制作兔肝VX2肿瘤模型,21天后行肿瘤栓塞治疗。将少量羰基铁粉与栓塞剂混合,栓塞1只模型,测量其进入血管的内径,对其余肿瘤模型应用HEMA-MMA进行栓塞。A组栓塞终点为肝亚段栓塞(门静脉分支显影),B组栓塞终点为肿瘤染色消失,保留肝左动脉主干,各5只。术后即刻及第1、3天行CT平扫,术后第7、14、28、42天行增强CT扫描,明确有无残余瘤及转移。发现残余瘤或转移时,再随访1周,处死实验兔取材。若术后观察42天无残余瘤及转移,则视为肿瘤完全栓塞坏死,处死实验兔取材,行病理学检查。于术前1天和术后第1、3、7、10、14天抽取耳缘静脉血,检测转氨酶及胆红素。结果 11只实验兔造模成功。栓塞剂可进入内径30~300 μm的肿瘤动脉内。术后即刻CT显示肿瘤周边高密度,术后第1天肿瘤周边密度减低,中心区密度升高,术后第3天肿瘤肿胀,密度均匀,低于正常肝组织。增强CT示A组肝内病变均完全坏死,无强化,术后观察42天无残余瘤及转移,肿瘤与肝组织分界清,肿瘤完全坏死机化,周边可见纤维组织包裹;B组术后第14天4只存在肝内残余瘤,位于肿瘤周边,坏死区为凝固性坏死,1只肝内病变坏死无强化,但肺及肝内均见多发转移。术后兔转氨酶逐渐升高,第3天达到高峰,7天后逐渐好转。结论 HEMA-MMA可用于栓塞治疗兔VX2肝肿瘤,可进入内径为30~300 μm的肿瘤血管;采用该栓塞剂进行肝亚段栓塞,可使肿瘤完全坏死。
英文摘要:
      Objective To explore the feasibility and efficiency of liquid embolic agent poly-2-hydroxymethyl methacrylate-co-methyl methacrylate (HEMA-MMA) in transarterial embolization therapy for rabbit VX2 liver tumors. Methods Liver VX2 tumor rabbit models were inoculated with the method of percutaneous CT-guided implantation of small fragment of tumor into the left lobe of liver, and were embolized after 21 days inoculation. One model was embolized with the mixture of HEMA-MMA and carbonyl iron powder to evaluate the diameters of embolized vessels. The remaining models were treated with pure HEMA-MMA subsegmental embolization or selective embolization (SSE or SE). Plain CT scans immediate postoperation, on the 1st day and 3rd day after operation were performed, while enhanced CT scans on the 7th, 14th, 28th and 42nd day after operation were performed. Residual tumor was defined as delayed enhancement around the necrotic zone. When detected residual tumor or metastasis, the model was followed up for another 7 days and then was harvested for histopathological examination. If there was no residual tumor nor metastasis 42 days after operation, which meant complete necrosis, the liver was harvested for histopathological examination. Transaminase and bilirubin was performed preoperation and on the 1st, 3rd, 7th, 10th and 14th day after operation. Results Eleven rabbits were successfully inoculated VX2 tumors. Embolization agent entered into tumor vessels with inner diameter of 30-300 μm. Five rabbits underwent SSE, and the other 5 were embolized with SE. The embolic agent demonstrated high density and obviously deposited in surrounding zone of tumor on CT images immediate after operation, while density of the surrounding zone decreased accompanied on 1st day CT images after operation. Density of the tumor decreased and became homogeneous on 3rd day CT images. In group A, no residual tumor nor metastasis were detected during follow-up period, whereas complete coagulative necrosis of the total tumor was observed on histopathologic images. In group B, residual tumors were found in 4 rabbits on the 14th day after operation, located in the periphery of the tumor, and coagulative necrosis was also observed; necrosis and non-enhancing were found in the remaining 1 rabbit, while multiple metastases occurred in the lung and liver. During follow-up, liver enzymes increased and reached maximum 3 days after operation and gradually declined and recovered to normal 7 days after operation. Conclusion HEMA-MMA can be used as embolic agent for embolization of rabbit VX2 liver tumors, which can enter tumor vessels with diameter of 30-300 μm. Subsegmental embolization with HEMA-MMA may induce complete necrosis of VX2 liver tumor in rabbit models.
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