经导管栓塞联合射频消融对兔VX2肝肿瘤的干预效果

Effect of transcatheter embolization combined with radiofrequency ablation in treatment of VX2 liver tumors of rabbits

目的探讨经导管动脉栓塞术(TAE)联合射频消融(RFA)对兔VX2肝肿瘤的干预效果。方法将兔VX2肝肿瘤模型分为4组,每组15只。对TACE+RFA组于TACE治疗15 min后行RFA,TAE+RFA组TAE治疗15 min后行RFA,RFA组仅给予RFA,TACE组仅给予TACE。分别于术前1天及术后3、7天检测血清天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT),术后7天检测肿瘤生长率、肿瘤坏死率及Suzuki评分;术后1、3、7天采用免疫组织化学法检测坏死区或凝固区周围肝组织热休克蛋白70(HSP70)表达,计算肝细胞凋亡指数及增殖指数。结果 TACE+RFA组术后3、7天血清ALT、AST水平均高于其他3组(P均<0.05)。术后7天,TACE+RFA组Suzuki评分高于其他3组,TACE+RFA组、TAE+RFA组肿瘤生长率低于RFA组和TACE组、肿瘤坏死率高于RFA组和TACE组(P均<0.05)。4组术后1、3、7天坏死区或凝固区周围肝组织HSP70表达均逐渐升高,TACE+RFA组术后1、3、7天均高于其他3组,术后1、3天TAE+RFA组均高于TACE组和RFA组(P均<0.05)。4组术后1、3、7天坏死区或凝固区周围肝细胞凋亡指数均逐渐降低,TACE+RFA组术后1、3、7天均高于其他3组,TACE组术后1、3天均高于TAE+RFA组、RFA组(P均<0.05)。4组术后3天肝细胞增殖指数均高于术后1、7天,TAE+RFA组术后1、3、7天均高于其他3组,RFA组术后1、3天均高于TACE+RFA组和TACE组(P均<0.05)。结论 TACE+RFA、TAE+RFA抑制兔VX2肝肿瘤生长效果优于单独应用TACE、RFA;TAE+RFA对肝损伤更小,促进肝细胞增殖、抑制其凋亡的效果更好。

Objective To explore the effect of transcatheter embolization combined with radiofrequency ablation(RFA) in treatment of VX2 liver tumors of rabbits. Methods Sixty rabbit VX2 liver tumor models were randomly divided into 4 groups(each n=15). Fifteen minutes after TACE or transcatheter arterial embolization(TAE), RFA was performed in both TACE+RFA group and TAE+RFA group, respectively.And RFA group was only treated with RFA, TACE group underwent only TACE. Serum aspartate aminotransferase(AST) and alanine aminotransferase(ALT) were measured 1 day before and 3 and 7 days after operation. Tumor growth rate, tumor necrosis rate and Suzuki score were measured 7 days after operation. The expression of heat shock protein 70(HSP70) in liver lesions surrounding ablation zone or embolized zone was detected with immunohistochemistry 1, 3 and 7 days after operation, and hepatocyte apoptosis index and proliferation index were calculated. Results The levels of ALT and AST in TACE+RFA group were higher than those in other groups 3 and 7 days after operation(all P<0.05). Seven days after operation, the Suzuki score in TACE+RFA group was higher than that in other groups, and tumor growth rates in TACE+RFA and TAE+RFA groups significantly decreased, while the necrosis rates in TACE+RFA and TAE+RFA groups increased compared with RFA and TACE groups(all P<0.05). The expression of HSP70 in hepatic lesions surrounding the ablation zone or embolized zone increased gradually 1, 3 and 7 days after operation, and in TACE+RFA group were higher than in other groups, in TAE+RFA group were higher than in TACE group and RFA group 3 days after operation(all P<0.05). The hepatocyte apoptosis index in hepatic lesions surrounding the ablation zone or embolized zone decreased gradually in all 4 groups 1, 3 and 7 days after operation, while in TACE+RFA group were higher than the other 3 groups, in TACE group 1 and 3 days after operation were higher than in TAE+RFA group and RFA group(all P<0.05). The hepatocyte proliferation index in 4 groups were higher 3 days after operation than that 1 and 7 days after operation, and compared with other groups, in TAE+RFA group were higher 1, 3 and 7 days after operation, in RFA group was higher 1 and 3 days after operation than in TACE+RFA group and TACE group(all P<0.05). Conclusion The effects of TACE+RFA and TAE+RFA on inhibiting tumor growth are better than TACE and RFA alone for treatment of VX2 liver tumors of rabbits. Compared with TACE+RFA, TAE+RFA can promote hepatocyte proliferation and inhibit hepatocyte apoptosis more effectively with less liver damage.