结肠微栓塞化疗的效果观察

Experimental Evaluation of Microchemoembolism Therapy on Colon

目的 为探索结肠癌微栓塞化疗提供实验依据。方法 成年健康杂种犬 12只 ,行肠系膜下动脉插管及门静脉插管。在DSA下观察单纯造影剂及混有直径 10～ 2 0 μmCH4 4微粒的造影剂显影情况。测定门静脉中 5 Fu浓度 ,描记衰减曲线。计算单纯动脉灌注化疗和微栓塞化疗后 5 Fu的半衰期 ,作t检验。微栓塞化疗后 5min、3h取栓塞段结肠作光镜及电镜检查。 2周后处死动物 ,作病理检查。结果 推注单纯造影剂 ,血管显影时间 (6 .2 5± 1.5 2 )s,走向舒展自然、分支粗而长。推注加有CH4 4微粒的同等剂量造影剂 ,血管立即痉挛迂曲 ,成蛇行状 ,分支细而少 ,显影时间 (930± 192 )s ,与前者显影时间差异显著。单纯动脉灌注化疗时门静脉中 5 Fu初始浓度高 ,衰减速度快 ,平均半衰期 (t1/ 2 ) =(12 .36±5 .2 5 )min。微栓塞化疗时初始浓度相对较低 ,其后上升 ,再缓慢下降 ,衰减速度慢 ,平均半衰期t1/ 2 =(4 7.33± 14.0 2 )min ,与前者有显著差异 (P <0 .0 1)。微栓塞化疗后结肠黏膜肿胀、细胞变性、偶见出血及坏死灶 ,黏膜及黏膜下层有炎症细胞渗出。单纯动脉灌注化疗时反应较轻。 2周后黏膜形态正常 ,偶见部分黏膜上皮增生 ,黏膜下层见局灶性瘢痕组织。结论 经肠系膜下动脉灌注适当的化学微栓子 ,将直接和间接地提?

Objective To explose the experimental basis of microchemoembolism therapy on colon carcinoma. Methods 12 dogs were randomly divided into two groups. Performing inferior mesenteric arterial and portal vein catheterization. Simple contrast medium and the contrast medium mixed with CH 44 (Φ10～20μm) for the angiograms were analysed under DSA. The concentration of 5 Fu in the protal vein were measured with Liquid Chromatography and in recorded diagramatic curve. The half life times of 5 Fu after simple arterial infusion chemotherapy or after microchemoembolism therapy were calculated and analyzed with t test(in Microsoft Excel 97). 5 minutes and 3 hours after the microchemoembolism therapy, embolized colonic segment were taken and observed under optic and transmission electron microscopy. Two weeks later, autopsy was performed. Results The opacificotion time of simple contrast medium after injection was 6.25±1.50 seconds. The arteries looked smooth. The vessels oppeared to show spasm and tortuous after perfusion of the same amount of contrast medium mixed with CH 44 particles associated with narrowing of te bronches the opacification time was 930±192 seconds, which was conspicuously dramatically different from the simple contrast medium. In the simple contrast medium group, the initial concentration of 5 Fu in the portal vein was rather high, then it attenuated rapidly. The mean half life time was 12.36±5.25 min. In the microchemoembolism therapy group, the initial concentration of 5 Fu was relatively lower. After injection, it increased for a little while and then decreased slowly. The mean half life time was 47.37±14.02 min, which was conspicuously different from that of the simple contrast medium group( P <0.01). The morphologic changes of the embolized segments were as follows; mucosal membrane swelling, inflammatory cell exudation in mucosal and submucoals layers. Two weeks later, the mucosal layer recovered; occasionally mucosal proliferation and focal fibrous cicatricial hyperplasia occurred. Conclusions This microchemoembolism therapy would enhance the chemotherapeutic effect on colonic carcinoma, directly or indirectly.