兔VX2肝脏转移瘤血供来源分析

The analysis of blood supply of rabbit VX2 liver metastases

目的通过CT灌注扫描、数字减影血管造影(digital subtraction angiography,DSA)及病理组织结构染色分析兔肝脏转移瘤(liver metastases,LM)血供来源,为LM的血管内介入治疗提供理论依据。方法新西兰大白兔35只,将兔间变表皮鳞癌瘤株(VX2)种植于脾脏,通过脾脏形成LM,两周后行CT平扫,确认兔LM形成后行CT灌注扫描,分析兔LM灌注参数;DSA下行直接肝动脉及间接门静脉造影,分析兔LM的血供;分离荷瘤兔LM行HE染色,分析兔LM组织结构构成。结果兔LM的CT灌注扫描表现为环形强化,环形强化区的肝动脉灌注指数(hepatic arterial index,HPI)、肝动脉灌注量(hepatic arterial perfusion,HAP)、肝动脉供血分数(hepatic arterial fraction,HAF)、总血量(blood volume,BV)、组织血流量(blood flow,BF)明显大于癌旁正常肝组织(t=5.189、5.836、6.446、6.587、5.457,P<0.05),门静脉灌注指数(portal venous perfusion index,PPI)、门静脉灌注量(portal vein perfusion,PVP)明显小于癌旁正常肝组织(t=-6.092、-2.268,P<0.05),差异均有统计学意义。兔LM的DSA直接肝动脉造影表现为环形染色,瘤组织中心无或有轻微染色,间接门静脉造影显示肿瘤区域为环形缺损,未见瘤内供血征象。兔LM的HE染色表现为中心区域有大量坏死的肿瘤细胞,周围为正常的肿瘤细胞、纤维结缔组织及炎性细胞。结论兔LM中心由大量坏死的肿瘤细胞,CT灌注或DSA表现为中心区域无强化或染色,LM周围由生长活跃的肿瘤细胞、结缔组织、炎性细胞及新生毛细血管构成,CT灌注或DSA表现为周边的环形强化或环形染色,LM病理表现与CT灌注及DSA表现一致,肝动脉参与LM供血,门静脉不参与供血。

Objective The blood supply of liver metastases （LM）in rabbits was analyzed by CT perfusion scan, digital subtrac- tion angiography（DSA） and histopathological staining, which provided the theoretical basis for the endovascular treatment of LM. Methods 35 New Zealand white rabbits were implanted in the spleen, and LM was formed in the spleen. CT scans were performed two weeks later to confirm the formation of rabbit LM. CT perfusion parameters were analyzed. And direct hepatic artery and indirect portal vein angiography were performed to analyze the blood supply of rabbit LM. The LM of the rabbits were isolated and stained with HE to analyze the structure of rabbit LM. Results CT perfusion scan of rabbit LM showed annular enhance- ment, hepatic arterial perfusion index （ HPI ） , hepatic arterial perfusion （HAP） , hepatic arterial fraction （ HAF ） （ t = 5.189, 5. 836, 6. 446, 6. 587, 5.457, P 〈 0. 05 ）, portal vein perfusion index （ BFI ） and blood flow （BF） were significantly higher than those in the adjacent normal liver tissues Portal venous perfusion（PVP） was significantly lower than that in normal liver tis- sue （ t = - 6. 092, - 2. 268, P 〈 0. 05 ）, the differences were statistically significant. Rabbit LM DSA direct hepatic artery angi- ography showed ring staining, no or a slight staining of the tumor tissue, indirect portal vein angiography showed ring region of the tumor defect, no signs of intra - tumor blood supply. HE staining of rabbit LM showed a large number of necrotic tumor cells in the central area, surrounded by normal tumor cells, fibrous connective tissue and inflammatory cells. Conclusion There were no enhancement or staining in the central area of the rabbit LM center, which was composed of a large number of necrotic tumor ceils, CT perfusion or DSA. LM was composed of active tumor cells, connective tissue, inflammatory cells and nascent capillaries. CT perfusion or DSA showed Peripheral ring enhancement or ring staining, LM patholo^cal manifestations and CT perfusion and DSA showed the same, hepatic artery involved in LM blood supply, portal vein does not participate in blood supply.