CAJ | 학술논문

目的：通过比较不同容积比例的碘化油-无水乙醇混合剂（Lipiodol-ethanol mixture，LEM）治疗兔VX2肝癌模型的效果，确定LEM的最佳容积比例。方法将18只新西兰白兔按碘化油∶无水乙醇容积比例3∶1（A）、2∶1（B）、1∶1（C）、1∶2（D）、1∶3（E）、1∶4（F）分为6组，每组3只。1周后取肿瘤组织行病理学检查，观察肿瘤生长率，肿瘤微血管密度，肿瘤细胞凋亡指数（apoptosis index，AI）及肿瘤边缘肝组织损伤情况。结果 A、E、F 3组肿瘤体积增大，A组肿瘤生长率明显高于其他5组，差异有统计学意义（P<0．05），B、C、D 3组肿瘤体积缩小，但与肿瘤体积增大的E、F组比较，差异无统计学意义（P>0．05）。不同容积比例LEM中，无水乙醇比例与肿瘤微血管密度呈负相关（R2=0．840，F=89．432，P<0．001）。 A组肿瘤AI明显低于C、D、E、F组（P<0．05）， A、B组间差异无统计学意义（P>0．05）。 B组与C、F组间差异有统计学意义（P<0．05），其他各组间差异无统计学意义（P>0．05）。 A、B组肿瘤周围肝组织损伤明显低于其他各组（P<0．05）。结论从安全性方面考虑，LEM的最佳容积比例为2∶1。若能做到超选择插管至肿瘤供血动脉，严密透视监视下注射，适当提高无水乙醇比例，疗效更佳。
목적：통과비교불동용적비례적전화유-무수을순혼합제（Lipiodol-ethanol mixture，LEM）치료토VX2간암모형적효과，학정LEM적최가용적비례。방법장18지신서란백토안전화유∶무수을순용적비례3∶1（A）、2∶1（B）、1∶1（C）、1∶2（D）、1∶3（E）、1∶4（F）분위6조，매조3지。1주후취종류조직행병이학검사，관찰종류생장솔，종류미혈관밀도，종류세포조망지수（apoptosis index，AI）급종류변연간조직손상정황。결과 A、E、F 3조종류체적증대，A조종류생장솔명현고우기타5조，차이유통계학의의（P<0．05），B、C、D 3조종류체적축소，단여종류체적증대적E、F조비교，차이무통계학의의（P>0．05）。불동용적비례LEM중，무수을순비례여종류미혈관밀도정부상관（R2=0．840，F=89．432，P<0．001）。 A조종류AI명현저우C、D、E、F조（P<0．05）， A、B조간차이무통계학의의（P>0．05）。 B조여C、F조간차이유통계학의의（P<0．05），기타각조간차이무통계학의의（P>0．05）。 A、B조종류주위간조직손상명현저우기타각조（P<0．05）。결론종안전성방면고필，LEM적최가용적비례위2∶1。약능주도초선택삽관지종류공혈동맥，엄밀투시감시하주사，괄당제고무수을순비례，료효경가。
Objective To determine the optimal volume proportion of iodize d oil (Lipiodol)-ethanol mixture by comparing the clinical efficacy of transhepatic arterial embolization-ablation therapy using different volume proportion of Lipiodol-ethanol mixture in treating experimental rabbit models with VX 2 liver cancer. Methods VX2 tumor was implanted in eighteen adult male New Zealand white rabbits. The 18 VX 2 rabbit models were randomly and equally divided into the following six groups according to the Lipiodol-ethanol volume ratio ∶ group A (3 ∶ 1), group B (2 ∶ 1), group C (1 ∶ 1), group D (1 ∶ 2), group E (1 ∶ 3) and group F (1 ∶ 4). One week after the treatment, all the rabbits were sacrificed and their livers were removed and sent for pathologic examination. The tumor growth rate, the microvascular density, the apoptosis index (AI) of tumor tissues and the injury of the hepatic tissue adjacent to the tumor were evaluated. Results After the treatment, the tumor’s size was increased in group A, E and F. The tumor growth rate of group A was significantly higher than that of the other five groups , and the difference was statistically significant (P<0.05). The tumor’s size of groups B, C and D was decreased, although the difference was not significant when compared with the tumor’s size of groups E and F (P > 0.05). The proportion of ethanol in Lipiodol ∶ethanol mixture bore a negative relationship to the microvascular density counts (R2= 0.840, F = 89.432, P < 0.001). AI of group A was strikingly lower than that of groups C, D, E and F (P < 0.05). The difference in AI between group A and group B was not significant (P > 0.05), while the difference in AI between group B and group C or between group B and group F was statistically significant (P<0.05), and no significant difference in AI existed between each other among other groups (P > 0.05). The injury extent of the hepatic tissue adjacent to the tumor in group A and B was remarkably milder than that of other groups (P < 0.05). Conclusion When considered in terms of safety, the optimal volume proportion of Lipiodol-ethanol mixture should be 2 ∶ 1. Successful super-selective catheterization of the tumor feeding artery, strict and close fluoroscopic monitoring of the injection and proper increase in the proportion of ethanol can definitely improve the therapeutic efficacy.