不同手术方式对VX2肿瘤侵犯兔下腔静脉预后的影响

目的建立VX2肿瘤侵犯下腔静脉（inferior vena cava,IVC）的动物模型,观察3种不同手术方式对实验动物预后的影响。方法成功建立VX2肿瘤侵犯IVC的动物模型,彩超下证实;将实验动物随机均分为A、B、C三组,分别予以彻底切除IVC和肿瘤、不予重建、彻底切除后人工血管进行重建处理,切下的IVC均送病检。分别于手术后每周彩超观察IVC,出现闭塞的IVC在DSA（digtal subtraction angiography,DSA）下观察侧枝循环建立情况。观察实验动物自然死亡时间,并解剖。结果超声发现3周时所有实验动物均有肿瘤生长（2.75±0.91cm2）,IVC管腔无明显狭窄（2.53±0.23 mm）;DSA显示,人工血管中长期通畅率低,随时间变化实验组可见侧支循环建立和腹壁浅静脉增粗逆流;A、B两实验组生存时间显著高于对照组C组（P1〈0.05;P2=0.036〈0.05）;两实验组中A组生存时间显著高于B组（P3=0.04〈0.05）。两实验组远处转移无差异,均显著低于对照组。结论彻底切除肿瘤可以提高实验动物的术后生存时间和生存率;兔IVC人工血管重建中长期通畅率低,且围手术期死亡率高,生存时间也较不重建组低。

Comparison of the effects of different surgical procedures on the prognosis of VX2 tumor invading inferior vena cava in rabbits

Objective To investigate the effects of different surgical procedures on the prognosis of experimental animals with VX2 tumor invading the inferior vena cava（IVC）.Methods 1.A rabbit model of VX2 tumor invading IVC was established and confirmed by ultrasound examination.2.The rabbits were randomly divided into three groups,12 rabbits in each group： Group A had complete excision of the tumor and IVC,group B had complete excision of the IVC and tumor followed by IVC reconstruction with an artificial vascular graft,and group C had separation and removal of the tumor.All the removed IVC were sent for pathological examination.The rabbits had ultrasound examination of the IVC.The collateral circulation and IVC blood flow was observed by digital subtraction angiography（DSA） after the IVC blockage.The natural death time of the rabbits was observed and autopsy was performed.Results 1.Ultrasound examination showed that all VX2 tumors grew successfully in the animal models（2.75±0.91 cm2）.The lumen of the IVC was not narrowed（diameter 2.53±0.23 mm）.2.DSA showed that the medium and long term patency of the artificial grafts in replacement of infrarenal IVC was low.In the experimental group,communicating branches were gradually enlarged and superficial veins in the abdominal wall were gradually dilated after the surgery.3.The experimental groups had a longer survival time than the control group（P1〈0.001〈0.05,P2=0.036〈0.05）.The group A had a significantly longer survival time than the group B（P3=0.04〈0.05）.There was no significant difference in distant metastasis between the groups A and B,but significantly lower than that in the control group.Conclusions There is a better survival time and survival rate in the rabbits after complete resection of the tumor invading the inferior vena cava.Rabbits with artificial IVC reconstruction have a low medium and long term patency,a higher perioperative mortality,and a shorter survival time than the animals without IVC reconstruction.