载紫杉醇覆膜金属支架对食管鳞癌治疗作用的探讨

Animal experimental study of paclitaxel-eluting metallic stent on the therapeutic effects of esophageal squamous cell carcinoma

目的利用兔食管鳞癌模型评价载紫杉醇覆膜金属支架对食管鳞癌的疗效。方法在超细胃镜直视下将VX2肿瘤组织块种植于食管黏膜下层,成功建立VX2兔食管鳞癌模型。通过内镜检查确认食管狭窄超过2/3管腔为支架置入适应症。在此基础上,将成瘤动物随机分为两组,即普通镍钛记忆合金覆膜支架组(普通金属支架组)和载紫杉醇覆膜金属支架组(紫杉醇药物支架组),各9只。通过支架输送器将支架置入病变部位。支架置入后2周处死兔子,分析紫杉醇药物支架治疗兔食管鳞癌的安全性和有效性。结果支架置入前超声内镜测量两组肿瘤大小,普通金属支架组组为(0. 362±0. 128) cm^2,紫杉醇药物支架组为(0. 317±0. 093) cm^2,两组间无统计学差异(P> 0. 05)。支架置入过程顺利,无出血、穿孔等并发症。支架置入术后2周内,普通金属支架组有2例、紫杉醇药物支架组有1例因肿瘤转移而死亡。支架置入后2周处死实验兔,发现普通金属支架组有1例、紫杉醇药物支架组有2例出现支架移位。最终,普通金属支架组和紫杉醇药物支架组各6只兔的数据被纳入统计分析,紫杉醇药物支架组肿瘤体积为(0. 721±1. 021) cm^3,明显小于普通支架组的(6. 507±3. 695) cm^3(P <0. 05)。两组均有2例出现肝、肺等远处转移。结论紫杉醇药物支架可延缓局部食管鳞癌的生长与食管腔的狭窄,具有较好的安全性和有效性。

Objective To evaluate the therapeutic effect of paclitaxel-eluting stent in a rabbit model of esophageal squamous cell carcinoma.Methods VX2 tumor tissue was implanted into the submucosa of the esophagus under endoscopy,and the model of VX2 esophageal squamous cell carcinoma in rabbits was successfully established.Indications for stent placement were confirmed by endoscopic examination of esophageal stenosis exceeding 2/3 lumen.The tumorigenic animals were randomly divided into two groups:the group of nickel-titanium memory alloy polyurethane-covered stent(SEMS)and the paclitaxel-eluting stent group(PEMS),with 9 rabbits in each group.The stent was introduced into the esophagus with an introducer set.The rabbits were sacrificed 2 weeks after stenting,and the safety and efficacy of paclitaxel-eluting stents in the treatment of esophageal cancer were analyzed.Results Tumor size was measured by endoscopic ultrasonography before stent placement,which was(0.362±0.128)cm2 in the SEMS group and(0.317±0.093)cm2 in the PEMS group(P>0.05).The stent was successfully implanted without complications such as bleeding and perforation.Two rabbits in the SEMS group and 1 rabbit in the PEMS group died of metastasis within 2 weeks.Rabbits were sacrificed 2 weeks after stent placement.One case in the SEMS group and two cases in the PEMS group showed stent displacement.Finally,the data of 6 rabbits in each group were statistically analyzed.The tumor volume in the PEMS group was(0.721±1.021)cm3,which was significantly smaller than that in the SEMS group(6.507±3.695)cm3(P<0.05).There were 2 cases of distant metastasis in each group.Conclusion Paclitaxel-eluting stent can slow the growth of local esophageal squamous cell carcinoma and relieve dysphagia in rabbit esophageal cancer models,which may provide a new research direction for the management of advanced human esophageal squamous carcinoma.