微波凝固及醋酸注射治疗兔肝VX_2肿瘤的实验对照研究

An experimental contrast study between microwave tissue coagulation and percutaneous acetic injection in the treatment of VX_2 rabbit liver tumors

目的 探讨微波凝固及醋酸注射治疗肝肿瘤的效果 ,并将二者进行对照研究。方法 将 18只 2 0个 VX2 兔肝癌结节随机分为两组 :微波治疗组与醋酸治疗组。微波治疗组 :肿瘤直视下将微波针斜形尽量插入肿瘤中心 ,微波辐射每次 6 0 W× 12 0 s。醋酸治疗组 :超声检测瘤灶 ,沿已选择好的路径用抽有 70 %醋酸的注射器针头经皮经肝穿刺肿瘤 ,待荧光屏上观察到针尖位于肿块中心时 ,随即在 2 0～ 30 s内匀速注入适量醋酸。每个瘤灶注射 1次 ,注射剂量为 1～ 1.5 m L ,平均 1.2 5 m L ;每 1.0 cm瘤灶直径注射量平均为 0 .8m L。治疗后 10～ 15 m in后行能量多普勒声学造影 (levovist)评价其疗效。随机抽取各阶段标本行常规病理光镜检查。结果 醋酸瘤内注射 2 4h后 8个结节肿瘤细胞发生完全凝固性坏死 ,2个结节肿瘤原发灶大部分发生变性及凝固性坏死 ,边缘有少量肿瘤残存。微波治疗 2 4h后 ,10个肿瘤结节均呈不完全坏死 ,2周后 9个肿瘤结节显示为完全坏死。结论 醋酸治疗后即刻、2 4h肿瘤坏死程度明显强于微波治疗组。但醋酸弥散性强 ,疼痛剧烈 ,凝固范围不固定 ;微波热场分布均匀 。

Objective To contrast the effectiveness of microwave tissue coagulation (MTC) and percutaneous acetic injection (PAI) in the treatment of VX 2 rabbits liver tumors.Methods Eight New Zealand rabbits bearing 10 VX 2 liver tumor nodes were intratumorally injected with 70% acetic acid (1～1 5 mL per bout,1 25 mL average;0 8 mL per 1 0 cm tumor diameter).Ulitrasound microwave therapy 1 (UMT 1) equipment of 9 mm length was inserted directly into the tumor by laparotomy in 10 VX 2 bearing rabbits.The energy output was 60 W×120 min per bout.Postcoagulation contrast enhanced (levovist,300 g/L,0 2～0 3 mL/kg) imaging was performed 10～15 min after treatment.Pathologic anatomy was applied to contrasts.Results The 8 tumor nodes of the PAI group were necrotic completely in 24 hours,residual tumor tissues were found at the edge of another 2 tumor nodes after injection.The 10 tumor nodes of MTC group were necrotic incompletely in 24 hours while 9 nodes appeared to be necrotic completely 2 weeks later.Conclusion The degrees of immediate necrosis and within 24 h necrosis in PAI group are obviously higher than those in MTC group.But acetic acid is diffusible and induces fierce pain.PAI coagulation lacks clear definition,in the contrary MTC has its microwave well distributed,and the scope clear and definite.