摘要
目的 比较手术、放疗、先放疗后手术、先手术后放疗 4种制作梗阻性慢性肢体淋巴水肿模型的方法。方法 选用新西兰大白兔 32只 ,分为手术、放疗、先放疗后手术、先手术后放疗共 4组。手术采用环切腋区 3cm宽皮肤、皮下组织达肌肉 ,清扫腋区淋巴结 ,镜下分离、切除与肱部血管伴行的深部淋巴管。放疗用 6 0 Coγ射线照射仪 ,照射野为 6 cm× 4 cm,一次性给予 2 0 0 0 c Gry剂量。先放疗后手术组、先手术后放疗组间隔时间为 3d,方法同前。采用体积测量、SPECT动态显像、MRI检查、大体观察及手术探测、病理组织学切片等指标观测。结果 在 18周的观察期内 ,手术与放疗相结合造模组体积测量、SPECT显像、MRI检查、手术探测和病理组织学切片均显示典型的淋巴水肿改变 ;单纯手术组仅见轻度的淋巴水肿形成 ,放疗组未见淋巴水肿形成。结论 手术与放疗相结合造模与单纯手术或放疗相比 ,慢性肢体淋巴水肿出现早 ,稳定持久 ,淋巴水肿发生率高 ,可重复性强 ,且与临床上乳癌、盆腔癌等术后产生的阻塞性肢体淋巴水肿有极大的相似性 ,近似克隆 。
Objective To compare four different methods of making forelimb lymphedema methods in New Zealand rabbits.Methods In 32 New Zealand rabbits,we made forelimb Iymphedema models by either axillary nodal/lymphatic microsurgical ablation(S) (guided by visual blue dye lyphography)or limited fieldaxillary irradiation(R)alone (2000 cGry)or combined R followed by S or S followed by R.Observations were made for 18 weeks.Forelimb volumes were determined serially and the findings compared with similar measurements in the contralateral non-manipulated limb.In rabbits random selected from R+S or S+R group,the lymphatic drainage was assessed by motive lymphography,soft tissue swelling by magnetic resonance imaging(MRI),the pathological changes of lymphedema were measured histochemically.Results R+S or S+R induced moderate to severe sustained limb lymphedema,remarkablely superior to S or R alone,which produced only no or transient limb edema(P<0.01).S+R was superior to R+S.(P<0.01).The Increased limb volume,impared lymphatic drainage(SPECT),subcutaneous fluid accumulation(MRI)and obviously pathological changes of lymphedema could be observed in R+S or S+R in 18 weeks.Conclusion R+S or S+R has the following advantages compared with S or Ralone,early appearing,stable clinical condition,successful reproduction,similar colony of secondary lymphedema after operation and radiotherapy for cancer.It is a good method for making chronic limb lynphedema.
出处
《实用骨科杂志》
2004年第3期216-218,共3页
Journal of Practical Orthopaedics
基金
山西省卫生厅科技基金项目
