肾母细胞瘤术前介入治疗的临床病理学研究

The study of clinical pathology of preoperative interventional treatment on nephroblastoma

目的 探讨介入治疗 (动脉化疗栓塞 )对肾母细胞瘤病理组织结构的影响 ,为临床制订合理的治疗方案提供理论依据。方法 对比观察 39例肾母细胞瘤患儿术后病理切片HE染色的组织结构变化 ,同时采用末端脱氧核苷酸转移酶介导末端口标记法 (TUNEL)进行肿瘤细胞凋亡的检测。结果 介入组与单纯手术组的肿瘤坏死区域平均面积分别为 6 0 %、15 % (Uc=2 84 ) ;肿瘤组织呈X3 、X4退变者分别为 10例 (10 / 17)和 1例 (1/ 2 2 ) (χ2c=11 4 )、间质纤维组织增生程度中、重度变化者分别为 11(11/ 17)例和 4 (4/ 2 2 )例 (Uc=2 72 )、淋巴细胞浸润者分别为 12 (12 / 17)例和 4 (4/ 2 2 )例 (χ2c=10 89) ,前者明显高于后者 (P <0 0 1) ;介入组肿瘤细胞分裂指数的中位数为 0 2 ,明显低于单纯手术组的 1 4 (Uc=5 4 5 0 ,P <0 0 1) ;介入组肿瘤细胞凋亡指数的中位数为 2 5 9,明显高于单纯手术组的12 8(Uc=117 0 0 ,P <0 0 5 )。结论 促进肿瘤细胞坏死退变、间质纤维组织增生、淋巴细胞浸润、抑制肿瘤细胞增殖、诱导肿瘤细胞凋亡是肾母细胞瘤手术前介入治疗产生疗效的重要机制。

Objective To discuss the changes of tumor histology induced by preoperative interventional treatment (chemoembolization) in nephroblastoma for deeply illustrating its pathological mechanism Methods A comparative analysis of the pathological findings was made in 39 children with Wilms′ tumor, and the apoptosis of two groups was studied by adopting terminal deoxynucleotigyl transferase medical dUTP X nick end labeling (TUNEL) Results The average area of necrotic field (ANF) of tumor in interventional group and simple excision group was 60% and 15%, respectively( U c =2 84);X 3 and X 4 degeneration of tumor tissue occurred in 10 cases (10/17) in interventional group and 1 case in simple excision group (1/22), respectively(χ 2 c=11 4); and moderate and severe interstitial fibrous hyperplasia in 11 cases (11/17) and 4 cases (4/22), respectively ( U c = 2 72); and lymphocyte infiltration in 12 (12/17) and 4 cases (4/22), respectively(χ 2 c=10 89) The percentage of those parameters in the former group were significantly higher than that in the latter ( P <0 01); The median of mitotic index of tumor cells was 0 2 in interventional group and 1 4 in simple operation group ( U c =54 50, P <0 01); The median of apoptotic index (AI) of the tumor cells was 25 9 in interventional group and 12 8 in operation group The comparison between the means obtained in the two groups revealed significant statistical difference ( U c =117 00, P <0 05) Conclusion The preoperative interventional treatment realizes its therapeutic effects in the following aspects: inducing the tumor cell necrosis and degeneration, boosting interstitial fibrous tissue hyperplasia in tumor and lymphocyte infiltration, inhibiting tumor cell growth, and inducing apoptosis of tumor cells