目的 观察骨棘球蚴病在放射治疗后棘球蚴囊的病理改变,探讨放射治疗骨棘球蚴病的临床效果.方法 从自然感染细粒棘球蚴的羊肝脏中无菌取出子囊,剪碎、去除囊皮,用0.9％无菌生理盐水冲洗、沉淀,反复3次,HE染色计数,制成含头节为12×106个/L的混悬液20ml.健康子午沙鼠(简称沙鼠)140只,雌雄各半,鼠龄2～3个月,体质量(38±6)g.将含棘球蚴头节悬液按每只0.2 ml注入沙鼠后腿胫骨骨膜下,12个月后拍摄X光片.根据接种部位骨骼破坏情况,以沙鼠后腿胫骨有明确锯齿状骨质破坏为纳入标准,选取沙鼠骨细粒棘球蚴病动物模型72只,雌雄各半.将72只沙鼠按体质量随机分成4组:对照组、40贝可勒尔放射(Gy)组、50 Gy组、60Gy组,每组18只,雌雄各半.采用分次放疗法,分5次进行,每次放疗间隔2d,照射剂量率为300 cGy/min.放疗后处死各组沙鼠,无菌条件下取出放疗区骨内细粒棘球蚴囊,用于光镜和电镜下观察.抽取囊内囊液,将囊液用0.9％的无菌生理盐水反复冲洗、沉淀,取最后沉渣,HE染色,光镜下观察头节形态及活动情况.结果 对照组囊液中细粒棘球蚴头节形态、活动正常；40 Gy组细粒棘球蚴头节形态尚正常,活动较对照组差,但未被红染；50 Gy组细粒棘球蚴头节形态异常、变形萎缩、红染；60 Gy组细粒棘球蚴头节红染、变形,且有碎裂迹象,周围有不明颗粒包绕.光镜下,对照组照射区细粒棘球蚴囊角质层、生发层育囊及原头节组织学结构基本正常；40Gy组以细粒棘球蚴囊变性为主,结构失常,角质层广泛水肿,生发层变薄,育囊少见；50 Gy组角质层广泛断裂,且生发层部分出现水肿,屈曲皱褶明显,细胞减少,少见育囊及头节；60Gy组以细粒棘球蚴囊坏死为主,角质层广泛断裂,角质层与生发层分离,生发层萎缩、紊乱,未见育囊及头节.电镜下,对照组细粒棘球蚴囊角质层结构清晰,微绒毛排列整齐,生发层细胞及细胞器结构、形态正常；40 Gy组细粒棘球蚴囊生发层内可见大量炎性细胞浸润,微绒毛内微丝及内容物减少；50 Gy组细粒棘球蚴囊微绒毛基本消失,核膜模糊不清,内质网、线粒体扩张,淋巴细胞核染色质结块边集,呈环状排列；60Gy组微绒毛基本消失,核膜界限不清破裂,部分核仁碎裂、边集,内质网广泛扩张,线粒体固缩及明显空泡变,淋巴细胞核染色质结块边集,溶酶体及巨噬细胞出现.结论 放射治疗可破坏骨棘球蚴囊的形态与结构,放射活度在50 Gy时对棘球蚴具有致死作用,放射方法治疗骨棘球蚴病具有良好的临床效果.
目的 觀察骨棘毬蚴病在放射治療後棘毬蚴囊的病理改變,探討放射治療骨棘毬蚴病的臨床效果.方法 從自然感染細粒棘毬蚴的羊肝髒中無菌取齣子囊,剪碎、去除囊皮,用0.9％無菌生理鹽水遲洗、沉澱,反複3次,HE染色計數,製成含頭節為12×106箇/L的混懸液20ml.健康子午沙鼠(簡稱沙鼠)140隻,雌雄各半,鼠齡2～3箇月,體質量(38±6)g.將含棘毬蚴頭節懸液按每隻0.2 ml註入沙鼠後腿脛骨骨膜下,12箇月後拍攝X光片.根據接種部位骨骼破壞情況,以沙鼠後腿脛骨有明確鋸齒狀骨質破壞為納入標準,選取沙鼠骨細粒棘毬蚴病動物模型72隻,雌雄各半.將72隻沙鼠按體質量隨機分成4組:對照組、40貝可勒爾放射(Gy)組、50 Gy組、60Gy組,每組18隻,雌雄各半.採用分次放療法,分5次進行,每次放療間隔2d,照射劑量率為300 cGy/min.放療後處死各組沙鼠,無菌條件下取齣放療區骨內細粒棘毬蚴囊,用于光鏡和電鏡下觀察.抽取囊內囊液,將囊液用0.9％的無菌生理鹽水反複遲洗、沉澱,取最後沉渣,HE染色,光鏡下觀察頭節形態及活動情況.結果 對照組囊液中細粒棘毬蚴頭節形態、活動正常；40 Gy組細粒棘毬蚴頭節形態尚正常,活動較對照組差,但未被紅染；50 Gy組細粒棘毬蚴頭節形態異常、變形萎縮、紅染；60 Gy組細粒棘毬蚴頭節紅染、變形,且有碎裂跡象,週圍有不明顆粒包繞.光鏡下,對照組照射區細粒棘毬蚴囊角質層、生髮層育囊及原頭節組織學結構基本正常；40Gy組以細粒棘毬蚴囊變性為主,結構失常,角質層廣汎水腫,生髮層變薄,育囊少見；50 Gy組角質層廣汎斷裂,且生髮層部分齣現水腫,屈麯皺褶明顯,細胞減少,少見育囊及頭節；60Gy組以細粒棘毬蚴囊壞死為主,角質層廣汎斷裂,角質層與生髮層分離,生髮層萎縮、紊亂,未見育囊及頭節.電鏡下,對照組細粒棘毬蚴囊角質層結構清晰,微絨毛排列整齊,生髮層細胞及細胞器結構、形態正常；40 Gy組細粒棘毬蚴囊生髮層內可見大量炎性細胞浸潤,微絨毛內微絲及內容物減少；50 Gy組細粒棘毬蚴囊微絨毛基本消失,覈膜模糊不清,內質網、線粒體擴張,淋巴細胞覈染色質結塊邊集,呈環狀排列；60Gy組微絨毛基本消失,覈膜界限不清破裂,部分覈仁碎裂、邊集,內質網廣汎擴張,線粒體固縮及明顯空泡變,淋巴細胞覈染色質結塊邊集,溶酶體及巨噬細胞齣現.結論 放射治療可破壞骨棘毬蚴囊的形態與結構,放射活度在50 Gy時對棘毬蚴具有緻死作用,放射方法治療骨棘毬蚴病具有良好的臨床效果.
목적 관찰골극구유병재방사치료후극구유낭적병리개변,탐토방사치료골극구유병적림상효과.방법 종자연감염세립극구유적양간장중무균취출자낭,전쇄、거제낭피,용0.9％무균생리염수충세、침정,반복3차,HE염색계수,제성함두절위12×106개/L적혼현액20ml.건강자오사서(간칭사서)140지,자웅각반,서령2～3개월,체질량(38±6)g.장함극구유두절현액안매지0.2 ml주입사서후퇴경골골막하,12개월후박섭X광편.근거접충부위골격파배정황,이사서후퇴경골유명학거치상골질파배위납입표준,선취사서골세립극구유병동물모형72지,자웅각반.장72지사서안체질량수궤분성4조:대조조、40패가륵이방사(Gy)조、50 Gy조、60Gy조,매조18지,자웅각반.채용분차방요법,분5차진행,매차방료간격2d,조사제량솔위300 cGy/min.방료후처사각조사서,무균조건하취출방료구골내세립극구유낭,용우광경화전경하관찰.추취낭내낭액,장낭액용0.9％적무균생리염수반복충세、침정,취최후침사,HE염색,광경하관찰두절형태급활동정황.결과 대조조낭액중세립극구유두절형태、활동정상；40 Gy조세립극구유두절형태상정상,활동교대조조차,단미피홍염；50 Gy조세립극구유두절형태이상、변형위축、홍염；60 Gy조세립극구유두절홍염、변형,차유쇄렬적상,주위유불명과립포요.광경하,대조조조사구세립극구유낭각질층、생발층육낭급원두절조직학결구기본정상；40Gy조이세립극구유낭변성위주,결구실상,각질층엄범수종,생발층변박,육낭소견；50 Gy조각질층엄범단렬,차생발층부분출현수종,굴곡추습명현,세포감소,소견육낭급두절；60Gy조이세립극구유낭배사위주,각질층엄범단렬,각질층여생발층분리,생발층위축、문란,미견육낭급두절.전경하,대조조세립극구유낭각질층결구청석,미융모배렬정제,생발층세포급세포기결구、형태정상；40 Gy조세립극구유낭생발층내가견대량염성세포침윤,미융모내미사급내용물감소；50 Gy조세립극구유낭미융모기본소실,핵막모호불청,내질망、선립체확장,림파세포핵염색질결괴변집,정배상배렬；60Gy조미융모기본소실,핵막계한불청파렬,부분핵인쇄렬、변집,내질망엄범확장,선립체고축급명현공포변,림파세포핵염색질결괴변집,용매체급거서세포출현.결론 방사치료가파배골극구유낭적형태여결구,방사활도재50 Gy시대극구유구유치사작용,방사방법치료골극구유병구유량호적림상효과.
Objective To observe the pathological changes of bone hydatid cyst of meriones meridianus after radiation therapy,and to investigate the clinical effect of radiotherapy on bone hydatid disease.Methods Ascus was dissected sterilely from sheep liver that naturally infected with Echinococcus granulomas,sheared and sac skin removed.Then it was washed and precipitated with 0.9％ sterile saline for 3 times,and scolex was HE stained and counted,from which a 20 ml suspension was made containing 12 × 106/L of scolex.Health meriones meridianus (referred to as gerbil) 140,male and female were in each half,aged 2 to 3 months,body weight(38 ± 6)g,were involved in the study.Gerbil was injected a 0.2 ml suspension containing Echinococcus granulomas scolex into hind tibial periosteum,and X-ray was taken 12 months after the injection.According to the bone destruction in the vaccination site,gerbil hindleg tibia with clear jagged bone destruction was treated as inclusion criteria,and 72 animal were selected as gerbil bone hydatid disease animal models,male and female were in each half.A tatal of 72 gerbils were randomly divided into 4 groups:control group,40 beequerel(Gy) group,50 Gy group and 60 Gy group,18 rats in each group,male and female in each half.The model animals were treated with radiotherapy for 5 times,with 2 d interval,and radiation dose was 300 cGy/min.Each group of gerbils was sacrificed after radiotherapy,bone Echinococcus granulomas cysts was taken out sterilely,and observed by light and electron microscope.Intracapsular cyst fluid was extracted,washed and precipitated with 0.9％ sterile saline repeatedly,and and the pellet was HE stained for observation of scolex morphology and activity by light microscope.Results The morphology and activity ofEchinococcus granulomas in cystic fluid in control group were normal; the morphology and activity of Echinococcus granulomas were still normal in the 40 Gy group,and Echinococcus granulomas was not stained red; but those were abnormal,deformation and atrophy and stained red in the 50 Gy group; and were stained red,deformed,fractured and were wrapped by unknown in the 60 Gy group.By light microscope,the germinal layer,cuticle layer,brood capsule and histological structure of protoscolex were basically normal in irradiated region in the control group.The pathological changes of hydatid cyst in the 40 Gy group were mainly degeneration,structure of hydatid cyst was abnormal,stratum corneum was extensive edema,germinal layer became thinner and the fertile cyst was rare.The main pathological change of hydatid cyst in the 50 Gy group was that corneous layer was widely fractured,and the germinal layer was edema,buckling folds,cells decreased,rare seen brood capsule and scolex; the main pathological changes of hydatid cyst were mainly necrosis in the 60 Gy group,cuticle was extensive fault,stratum corneum and germinal layer was separated,germinal layer was atrophy and disorder,no brood capsule and scolex.By electron microscope,cuticle structure of Echinococcus granulomas cyst was clear,microvillus arranged neatly,morphology and structure of the cell and organelle in cytoplasm were normal in the control group.There were many inflammatory cells infiltrating germinal layer of Echinococcus granulomas cyst,microfilament and contents in microfilament were reduced in the 40 Gy group.Microvillus of Echinococcus granulomas disappeared,nuclear membrane was unclear,endoplasmic and mitochon eclasis,lymphocyte nuclear chromatin was clumping and edge set and in circular permutation in the 50 Gy group.Microvillus disappeared,perinuclear membrane indistinct and ruptured,parts of nucleoli were fragmented and marinated,endoplasmic reticulum was extensive expansion,mitochondria was pyknosis and obvious vacuolization,lymphocyte nuclear chromatin clumping and edge set,lysosomes and macrophage emerge in the 60 Gy group.Conclusions Radiotherapy can destroy the morphology and structure of bone hydatid cyst,radioactivity at 50 Gy has a lethal effect on hydatid cyst.Radiation treatment of bone hydatid disease has a good clinical effect.
