CAJ | 학술논문

目的观察激光间质加热(laser interstitial thermotherapy,LITT)后兔脑毁损组织与周边脑组织的超微病理改变,评估LITT后急性期的血脑屏障(blood brain barrier,BBB)开放性.方法浙江大学动物实验中心提供新西兰大白兔共70只.经随机筛选设LITT A组(2 W,600 s,20只)及B组(15W,100 s,20只),应用立体定向技术插入半导体激光光纤,分别对兔右侧前脑实行立体定向问质加热,另随机设甘露醇灌注组和假手术对照组各15只.透射电镜下观察LITT后3 h,6 h,12 h,24 h的中心热毁损灶及靶周边脑组织BBB的超微形态学的改变;酶联免疫吸附法测定相廊不同时间的S100B蛋白变化;另检测脑脊液白蛋门与血清白蛋白比值(BBB系数).实验数据作单因素方差分析,组间均数比较用q检验.结果接触激光光纤前端成为加热毁损灶,以细胞坏死为主,细胞膜结构损伤,线粒体、内质网等细胞器膨胀,线粒体嵴消失,胞浆稀疏等.形态学改变明显于对照组.热能传导至周边,可见部分细胞发牛不同时期的凋亡改变.急性期内可见内皮细胞肿胀、血管基膜模糊断裂、周围间隙增宽、缝隙结构破坏,且S100B蛋白及BBB系数在LITT组明显升高,BBB开放的时程较甘露醇灌注组长.但24 h后LITT A组开始恢复,S100B与BBB系数较LITT B组的差异具有统计学意义(P=0.0087).结论利用立体定向技术半导体激光加热兔脑组织的毁损灶,急性期内可导致明确的细胞组织损伤,BBB结构破坏,小功率加热组血脑屏障开放时程较大功率组缩短.提示利用小功率半导体激光可形成精确安全的脑毁损灶,为功能神经外科发展提供了新思路.
목적 관찰격광간질가열(laser interstitial thermotherapy,LITT)후토뇌훼손조직여주변뇌조직적초미병리개변,평고LITT후급성기적혈뇌병장(blood brain barrier,BBB)개방성.방법 절강대학동물실험중심제공신서란대백토공70지.경수궤사선설LITT A조(2 W,600 s,20지)급B조(15W,100 s,20지),응용입체정향기술삽입반도체격광광섬,분별대토우측전뇌실행입체정향문질가열,령수궤설감로순관주조화가수술대조조각15지.투사전경하관찰LITT후3 h,6 h,12 h,24 h적중심열훼손조급파주변뇌조직BBB적초미형태학적개변;매련면역흡부법측정상랑불동시간적S100B단백변화;령검측뇌척액백단문여혈청백단백비치(BBB계수).실험수거작단인소방차분석,조간균수비교용q검험.결과 접촉격광광섬전단성위가열훼손조,이세포배사위주,세포막결구손상,선립체、내질망등세포기팽창,선립체척소실,포장희소등.형태학개변명현우대조조.열능전도지주변,가견부분세포발우불동시기적조망개변.급성기내가견내피세포종창、혈관기막모호단렬、주위간극증관、봉극결구파배,차S100B단백급BBB계수재LITT조명현승고,BBB개방적시정교감로순관주조장.단24 h후LITT A조개시회복,S100B여BBB계수교LITT B조적차이구유통계학의의(P=0.0087).결론 이용입체정향기술반도체격광가열토뇌조직적훼손조,급성기내가도치명학적세포조직손상,BBB결구파배,소공솔가열조혈뇌병장개방시정교대공솔조축단.제시이용소공솔반도체격광가형성정학안전적뇌훼손조,위공능신경외과발전제공료신사로.
Objective To observe ultramicro pathologic change of rabbit brain central damaged tissue and peripheral tissue after LOT, to evaluate the changed structure of blood brain barrier (BBB) of peripheral tissue in acute stage. Method Seventy Newzealand rabbits were randomly screened from Zhejiang University Animal Experiment Center. By stereotaxic technique, semiconductor surgica laser fibers were inserted into right frontal lobes and heat treated to randomly build LITT Group A (2 W, 600 s, n = 20) and LITT Group B (15 W, 100 s, n = 20) brain damaged models successfully. Other 15 nomal rabbits were randomly distributed as mannitol perfusion group and fake operation group. The ultramicro structures in central thermodamaged tissue were observed with transmission electro microscope after LITT 3 h,6 h,12 h,24 h. In peripheral tissue, ultramicro morphologic changes of brain vessels and BBB were evaluated. S100B protein in serum and BBB indexe were measured at different stages post LITT. Experimental data were treated as one-factor analysis of variance and q test. Results The brain damage center connected the tip of laser fiber and turn into thermodamage tissue. The main structure changes were cytoclasis, damnification of cell membrum, swelling of cell organelle such as mitochondrion, endoplasmic reticulurn,disappearance of mitochondrion and sparseness of cytoplasm in local tissure. Heat energy conducted to damage peripheral tissue, some cells occured apoptosis in different stage. In acute stage after LITT, contracted capillary vessel, oncreted red cell, swell endothelium cell, broken base membrum, wide around clearance and destroyed aperture structure were identified. The levels of serum S100B and BBB indexe dramatically rised. The opening time of BBB in peripheral tissue was longer than mannital perfusion group. However at 24 h post LITT, they began to recover in Group A. The difference of serum S100B and BBB indexe between Group A and Group B has statistical significance ( P =0.0087). Conclusions With semiconductor laser heat treatment and stereotaxic techniqe, definite cells cytoclasis, cell membrance structures and chondriosome damage could be performed obviously in rabbit brain thermotherapy point. Apoptosis could be found in peripheral tissue, BBB could be opened in an acute stage. The opening time course of BBB was shortened in those LITT cases with small power. It shew us a new method to perform a safe and exact damage zone of brain for functional neurosurgery.