脉冲式温热灌注对肿瘤血管渗透性的影响

Effect of 60℃ saline perfusion by pulsed-wave mode on vascular permeability of tumor liver tissue in VX2 tumor-bearing rabbits

目的探讨60℃生理盐水经脉冲式灌注肝组织及肿瘤组织对其血管渗透性的影响。方法建立30只兔VX2移植性肝癌模型,随机分为3组(37℃盐水组、60℃盐水连续灌注组及60℃生理盐水脉冲式灌注组),每组10只。经股动脉插管至肝动脉进行灌注,灌注液为生理盐水(液量60ml),灌注过程中,测量60℃热灌注组肿瘤组织达43～45℃持续时间,灌注结束前5min,各组经导管推注1%伊文思蓝(EB)2ml/kg,灌注EB后置10min,取出肝脏用生理盐水灌注肝动脉冲洗血管中残留的EB。取小块正常肝组织、瘤组织,称重后,放入1ml甲酰胺液中,置于50℃恒温水浴箱60h,提取液用722型光栅分光光度计测出620nm下的A值,从标准曲线上测出相应的EB含量,以反映该组织毛细血管的渗透性。结果灌注EB10min后,60℃脉冲式灌注组肿瘤组织EB含量(15.21±0.94)μg/100mg,与60℃连续灌注组(10.71±0.84)μg/100mg相比差异有统计学意义(P<0.01),与37℃灌注组(3.42±0.87)μg/100mg相比差异有统计学意义(P<0.01)。60℃脉冲式灌注组正常组织EB含量(8.32±0.86)μg/100mg与60℃连续灌注组(7.59±0.65)μg/100mg相比差异无统计学意义(P>0.05),但与37℃灌注组(2.68±0.73)μg/100mg相比差异有统计学意义(P<0.01)。60℃脉冲式灌注组肿瘤组织(43～45℃)持续时间为(12.3±3.3)min,与60℃连续灌注组的(5.7±2.5)min相比有差异(P<0.01)。结论60℃脉冲式灌注热疗可以增加肿瘤组织的血管渗透性,可能是一种更为有效的介入热疗方法。

Objective To evaluate the effects of 60℃ saline perfusion via hepatic artery by pulsedwave mode on vascular permeability of tumor and normal liver tissue. Methods VX2 tumor model was established in 30 Newzland rabbits livers. All 30 rabbits were randomly divided into three groups （n = 10 in each group）： 37℃ 60 ml saline perfusion（group 1 ）; 60℃ 60 ml saline continuous perfusion（group 2）; 60℃ 60 ml saline perfusion by pulsed-wave mode （group 3）. Under DSA guidance the catheter was passed through the hepatic artery, then followed by perfusion in all rabbits. The lasting time periods of 43 - 45℃ for tumor tissues of group 2 and 3 were measured. Then, vascular permeabilities in tumor versus normal liver tissue were assessed with Evan＇s Blue. Results Vascular permeability was measured 10 minutes after perfusion. The content of EB in tumor of group 3 （15.21± 0.94 μg/100 mg）was higher than that in group 2 （10.71 ± 0.84 μg/100 mg） （P 〈 0.01）, and was also higher than that in group 1 （3.42 ± 0.87 μg/100 mg） （P 〈 0.01）. The content of EB in normal liver tissue in group 3 （8.32 ± 0.86 μg/100 mg）was higher than that in group 1 （2.68 ± 0.73 μg/100 mg）（P 〈 0.01 ）, but showed no difference with that in group 2（7.59 ± 0.65 μg/100 mg） （P〉 0.05）. 43 - 45℃ period lasting time in group 3 （12.3 ± 3.3 min）was longer than that in group 2 （5.7 ± 2.5 min）（P 〈 0.01 ）, Conclusions 60℃ saline perfusion via hepatic artery by pulsed-wave mode can increase vascular permeability in tumor, probably be a more effective interventional management among all thermotherapies.