高温盆腔血管隔离灌流治疗直肠癌的分析-analysis of hyperthermic pelvic vascular isolation and perfusion in the treatment of rectal cancer.docxVIP

平中IW.人学l门j济[;学院i山l研究生毕业论立高温盆腔血管隔离灌流治疗直肠癌的研究硕士研究生汪谢丹导师郑启昌教授摘要一目的z应用兔直肠癌模型观察高温盆腔血管隔离灌流对直肠癌的治疗效果并探讨高温灌流治疗肿瘤机制。护法z制作10只日本长耳大白兔VX2细胞株直肠癌移植模型。用血管夹白兔的肾动脉以下腹腔动脉和后腔静脉分叉以上夹闭动静脉，暂时阻断血流。在同一侧下肢近端分离股动、静脉。股动脉逆行插管并与蠕动灌流泵相连，同侧股静脉插管后开放回收灌流液，建立开放式盆腔血管循环。采用高温生理盐水(450C550C)灌流:灌流期C间盆腔组织温度达到430士O.50C，灌流时间持续30分钟。分别于灌流前、灌流后3天观察肿瘤的直径改变和调亡状况。结果z制作成功10只兔VX，瘤株直肠癌移植模型。10只动物模型进行高温盆腔血管隔离灌流。灌流后直肠癌肿瘤表面有纤维样的包裹层，肿瘤的边界清楚，与周围粘连松动。1号模型灌流前直肠癌扁平、圆形直径2向lOmm.侵犯膀脱与膀肮有紧密粘连，灌流后第二天活检，直肠和膀脱的粘连存在，但肿块消失。2号、3号模型手术前有明显的尿道压迫症状，膀肮尿漏留:灌流后一天能自行排尿。5号、7号模型有肠梗阻、肠膨胀:灌流后3夭腹胀有明显减轻。灌流后肿块直径减小和模流前相比有显著性差异(P0.05)。准流后肿瘤组织凋亡指数增高与灌流前有显著性差异，(PO.05)。无灌流后动物死亡:未发现灌流后并发症I结论z兔VX，瘤株能在兔直肠壁上种植成功。高温盆腔血管隔离灌流能明显使直肠癌体积减小，使肿瘤边界洁晰，与周围的粘连减轻。高温诱导凋亡可能是主要的治疗机制。该方法无明显于术后并发症。盆腔血管隔离高温灌流是治疗直肠癌安全有效的措施。关键词=凋亡、J-，/.盆腔直肠肿瘤凋亡\.，./隔离灌流高温43，、HyperthermicPelvicIsolation-PerfusionInTheTreatmentOfRectalCancerPostgraduateWangXiedanTutorProf.ZhengQichangabstractAims:Toevaluatetheroleofhyperthermicisolationperfusion(IP)intreatmentofrabbitsrectalcancerMethods:Tenjapanesslongearrabbitsmodel(Nü1-1O)oftherectalcancerofVX2stainweremaded.ThegoalofpelvicI-Pistoisolatethevascularcomp缸tmentofthepelvis企omthetheuppertorsoandlowerextremities.vascularisolationwereaccomplishedbyoccludingtheaortaandvenacavajustabovethebifurcationwithvascularclampes.cannulatethefemoralvesselwitharterialandvenouscannulae，andperfusethepelvisbymeansofapump.Theperfusateisheatedtoobtaintissuetemperaturesof42.Cto43.Cwhichlastedfor30minutes.theefl1uxwasdrainedthroughafemoralvein.The4句diameterofthetumormasswasrecordedbeforetheperfusionand3dayafterperfusionrespectivelyandapoptosisofthecancerwasobservedsimultaneously.Results:RabbitsVX2staincanbeentransplantedìntojapanesslongearrabbitssuccessfully.Isolationofthepelviswasaccomplishedinalltenmodelsofthepelvìccancerasmanifestedbyselectivepelvicheating.Duringperfusion，pelvictissuetemperat旧esranged丘om42Cto43.5Cwiththelivertemperaturerangingfrom32Cto33C.Thetumor(diameterlOmm)inN01whichextendedintotheurinarybladderwasdisappeared3dayafterperfusion.N02andN03，thetumorpres