结直肠癌肝脏转移瘤微血管形态的变化

Changes in microvascular architecture in colorectal liver metastases

目的研究结直肠癌肝脏转移瘤微血管形态变化，为结直肠癌肝脏转移的临床治疗提供理论基础。方法本研究以捐献的20例新鲜人尸体的肝脏为研究对象。所有研究对象均为经临床确诊的结直肠癌肝脏转移患者。肝脏用生理盐水灌洗后，分别经肝动脉、门静脉、胆总管灌注不同颜色树脂。灌注成功后进行肝脏腐蚀，定位兴趣区（肿瘤及周围部位），观察其微血管形态及变化。结果20例结直肠癌肝脏转移瘤标本，可测量肿瘤共有64个。其中直径〉3cm肿瘤有23个，≤3cm的41个。肿瘤大体分为：单发结节型、多发结节型、弥漫型。其中〉3cm的肿瘤主要以肝动脉供血为主（21／23），≤3cm的肿瘤主要以门静脉供血为主（36／41；P=0．004）。扫描电镜提示：结直肠癌肝脏转移瘤微血管结构形态复杂，主要分为封闭的环形、分叉状、螺旋状、网格状，并且肿瘤直径不同，其微血管直径差异有统计学意义（均P〈0．05）。结论不同直径结直肠癌肝脏转移瘤血供来源不同、微血管结构不同。这些特点对结直肠癌肝脏转移瘤的临床治疗有重要意义。

Objective To study the changes in microvascular architecture in colorectal liver metastases so as to provide a theoretical basis for clinical treatment for colorectal liver metastases. Methods 20 fresh cadaveric livers were obtained for this research project. These livers were obtained from deceased patients who had a clinical diagnosis of colorectal liver metastases with detailed clinical imaging data. These patients did not receive any surgical resection or intervention treatment for their liver metastases. After perfusion of the liver with physiological saline, the hepatic artery, portal vein and bile duct were infused with different colors of resin. After successful infusion the livers were corroded to remove the liver tissues, leaving behind the resins. The areas of interest （tumor center and periphery） were located and the changes in microvascular architecture were observed. Results There were 20 specimens from 20 patients with colorectal liver metastases with 64 tumors, 23 were more than 3 cm in diameter and 41 less than 3 cm. These tumors were divided into the single nodular, muhinodular, and diffuse types. Cancers of more than 3 cm received mainly their blood supply from the hepatic artery. Cancers of less than 3 cm received their blood supply from the portal vein （P =0. 004）. Scanning electron microscopy showed the microvascular architecture in colorectal liver metastases to be complex and consisted of loops, bifurcated, spiral and networking types. With different tumor diameters, the microvascular diameters showed significant differences （P =0. 038, 0. 012）. Conclusions Different sizes of colorectal liver metastases had different sources of the blood supply with different microvaseular architectures. These features have significant impact on clinical treatment of colorectal liver metastases.