门静脉栓塞术对结直肠癌肝转移患者肿瘤生长的影响

Effect of portal vein embolization on the growth rate of colorectal liver metastases

目的观察门静脉栓塞术对结直肠癌肝转移肿瘤生长的影响。方法22例结肠癌肝转移患者术前经门静脉栓塞术治疗，同时对照组为20例未行门静脉栓塞术治疗的结肠癌肝转移患者。通过观察从确诊到手术切除期间内肿瘤的体积（CT／MRI体积）变化来评估肿瘤的生长速度。手术切除后标本分别由2位组织病理学家对肿瘤细胞的分化、坏死百分比及有丝分裂率进行评估。采用细胞周期相关核抗原（Ki．67）的抗体（MIB一1）单克隆抗体进行免疫组织化学检测Ki-67的表达，Glasgow细胞计数法进行定量分析。以患者临床资料、原发疾病的分期、肝转移的体积及化疗情况进行分组比较。结果影像学分析表明门静脉栓塞术治疗组中肿瘤生长速率明显高于对照组[对照组：（0．05±0．25）ml／d，门静脉栓塞术治疗组：（0．36±0．68）mlfd，P〉0．05]。组织学分析表明两组问肿瘤细胞的分化、坏死及凋亡程度差异无统计学意义（P〉0．05）。然而，从Ki-67的增殖指数可表明门静脉栓塞术治疗组的有丝分裂率明显较高（P〈0．05）。结论门静脉栓塞术治疗组中的肿瘤生长速度较快；门静脉栓塞术治疗与肿瘤细胞的分化相关。

Objective 3%0 investigate the effect of portal vein embolization （PVE） on the growth rate of colorectal liver metastases. Methods There were 22 patients who had undergone preoperative PVE and 20 matched controls. Tumour growth rate was calculated by the change in tumour volume （ CT/MRI volumetric assessment） from diagnosis to resection. Resected histological specimens were examined by two histopathologists independently for cell differentiation, percentage of tumour cell necrosis and mitotic rate. Immunochemical staining with proliferation cell nuclear antigen （Ki-67） was carried out using the Ki-67 antibody （ MIB-1 ） monoclonal antibody and quantified using a Glasgow cell-counting gratieule. The groups were comparable in demographics, stage of primary disease, volume of liver metastases at presentation and chemotherapy given. Results The tumour growth rate calculated from imaging was more rapid in the PVE group than in controls [ control ： （0. 05 ＋ 0. 25 ） ml/day, PVE ： （0. 36 ＋ 0. 68） m]/day,P 〉 0. 05 ]. Histo= logically, no difference in the degree of differentiation, extent of necrosis or apoptosis between the two groups. However, mitotic rate was higher in PVE group than in control group （P 〈 0.05 ）. Conclusion This study has confirmed that tumour growth rate was increased following PVE, and PVE is related to＂ the differentiation of tumour cells.