【作者】 李正民； 郝克强； 金华； 张锐； 石庆宇；

【Author】 Li - Zheng Min Hao Ke-Qiang (Department of orthopedics, The Third Clinical CoUege, Harbin Medical University, Harbin 150001,China)

【机构】 哈尔滨医科大学附属第三医院骨科；

【摘要】 目的:观察不同剂量一次性照射受侵坐骨神经节段回植后复发情况,探索出一次性照射彻底杀灭肿瘤细胞的理想放射剂量,对受肿瘤侵犯神经的处理方法进行探讨。方法: 取腹水型S180肉瘤昆明鼠腹水种植于健康昆明鼠的前肢与躯干之间皮下,六天后长出实体瘤。选60只昆明鼠,随机分成 A、B、C三组,在一侧坐骨神经附近种植S180肉瘤实体瘤, 1周后待肿瘤长出,切除肿瘤及受侵坐骨神经,A、B组标本分别以不同剂量(4000cGy、2500cGy)高能X线照射,C组不照射,将坐骨神经从瘤体中剥出,并带少量瘤组织一同回植到对侧坐骨神经附近,A、B组2周后,C组1周后大体观察后取标本做病理,在光镜下现察其复发情况及形态。结果:4000cGy 组20只回植侧均无肿块触及,肢体活动正常。2500 cGy组 20只中11只回植侧无肿块触及,肢体活动正常,9只回植侧可触及肿块,但其直径不超过10mm,且与周围组织粘连轻, 易分开。对照组20只回植侧均出现肿块,肿块直径大于 20mm,与周围组织粘连重,界不清。病理观察4000cGy组能见到正常神经纤维旁回植的神经纤维出现髓鞘崩解、正常结构消失,可见大片坏死组织,并未见到肿瘤细胞,2500 cGy组在正常的神经纤维周边可见到回植的神经纤维出现髓鞘崩解、正常结构消失,其中有11只发现有肿瘤细胞,肿瘤位于神经纤维旁,生长较局限,向周围肌肉侵袭,但程度较轻,肿瘤未突入神经外膜。另9只未见到肿瘤细胞。对照组均可见到肿瘤细胞,而且肿瘤生长活跃,向肌间隙广泛侵袭并包绕着神经生长,但也未见到肿瘤侵袭神经外膜。4000cGy组与对照组之间(p<0．005)2500 cGy组与对照组之间(p<0．005)4000cGy 组与2500 cGy组之间(p<0．005)均有显著性差异。结论: 离体一次性照射4000CGy高能X线可以彻底杀灭受侵神经残留的肿瘤细胞,而离体一次性照射2500cGy,虽然不能彻底杀灭肿瘤细胞,但是仍然可以部分杀灭肿瘤细胞,降低复发。更多还原

【Abstract】 Objective: This experiment was designed to measure the optimum radiation dosage which could exhaustive inactivate the extracorporeal tumor cells once time but save effectively the regenerative ability of mouse’ s sciatic nerve. Methods: The tumor and sciatic nerve infested of the mouse with tumor were resected enlarged, then replanted them after irradiating exsomatized with different irradiation dosage (4000cGy, 2500cGy). We observed the recurrent situation of the tumor. Results: The group mice were not recurrent after replanting the tumor irradiated with 4000cGy doses of radiation. Some of the group mice with 2000cGy dosage were recurrent All group mice without irradiation dosage were recurrent Conclusion: The residual tumor cells of infested sciatic nerve were all killed by the extracorporeal irradiation dosage(4000cGy) once time, and the doses can preserve the ability of sciatic nerve regeneration.更多还原