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研究生:林君敏
研究生(外文):Chun Ming Lin
論文名稱:冷凝式射頻切除療法在兔腎臟VX2腫瘤模式之應用
論文名稱(外文):Application of Radiofrequency Ablation of Renal VX2 Tumors in a Rabbit Model by Cooled-tip Electrode
指導教授:林永昌林永昌引用關係
學位類別:碩士
校院名稱:國立中興大學
系所名稱:獸醫學系
學門:獸醫學門
學類:獸醫學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
中文關鍵詞:射頻切除療法腎臟VX2腫瘤
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近年來,由於影像診斷技術的廣泛使用,如超音波 (ultrasonography)、電腦斷層掃描(computed tomography)及磁振造影(magnetic resonance imaging)等,因此使得小型腎臟腫瘤(直徑<3.5公分)被意外發現的頻率增加許多[Marshall et al., 1997]。利用影像引導的低侵入性腎臟腫瘤療法中,以射頻切除療法(Radiofrequency ablation, RFA) 最具發展潛力[McGovern et al., 1999; Lorentzen, 1996; Ni et al., 2000]。本實驗的目的在於評估RFA對於兔腎臟VX2腫瘤模式之療效。首先,為建立一穩定兔腎臟VX2腫瘤模式,分別以腫瘤懸浮液法和腫瘤團塊直接法來接種腫瘤。兩者的腫瘤接種成功率皆為100%。之後,利用Cool-tip RF system來治療直徑1-3 cm的腎臟VX2腫瘤。將條件設定於15-30W,依腫瘤大小來決定持續3-6分鐘,可形成平均約1.3×1.8×1.5 cm之病灶。觀察依腫瘤所在位置不同,經RFA治療後所形成的併發症,包括梗塞、腎周圍血腫、水腎、膿瘍、腸道損傷等,其總發生率為38.5%。再以血液學、血清生化學及尿液檢查持續追蹤手術後的生理狀況,在7-14天內可恢復正常狀態。將經RFA治療後的實驗兔,持續以對比電腦斷層(contrast-enhanced computed tomography)觀察並驗證其確實切除範圍。結果顯示:第14天發現腫瘤完全切除率為76.9%和腫瘤局部再生長率為23.1%。組織病理學方面,由內而外可見探針的痕跡、腫瘤細胞凝固性壞死、壞死的實質組織、周圍的出血灶、以及炎症反應層。目前RFA在兔腎臟VX2腫瘤模式中具有高度的治癒率,未來期許能應用於人類腎臟腫瘤的治療。
Small renal masses (<3.5 cm in diameter) are now being diagnosed more frequently as a result of the widespread use of imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging. Radiofrequency Ablation (RFA) has the most potential among these image-guided minimally invasive therapies. Our proposal is to assess the efficacy of RFA to renal VX2 tumors in a rabbit model. First, for building up a stable rabbit model of renal tumors, we use tumor cell suspension and fresh tumor tissue to implant VX2 tumors. Both of the tumor implant successful rate are 100%. Then we apply Cool-tip RF system to treat the renal VX2 tumors which are 1-3 cm in diameter. We set the power at 15-30W and depend on tumor size continuing 3-6 minutes, the average lesion is 1.3×1.8×1.5 cm. Depending on the position of the tumors, the complications that happen after RFA, including infarction, perirenal hematoma, hydronephrosis, abscess, bowel injury. The total incidental rate of complications are 38.5%. Additionally, we use hematology and urinalysis to continue observing postoperative physical state, the experimental rabbits are back to normal in 7-14 days. After RFA, the experimental rabbits are observed by contrast-enhanced CT and ensure the ablative range. According to our result, complete tumor ablation rate is 76.9% and local tumor growth rate is 23.1%. In histopathology, we find central needle track, tumor coagulation, renal tissue coagulation, peripheral hemorrhage, and inflammatory layer. Application of RFA in renal VX2 tumors in rabbit model has high curative rate, we hope to apply it in human renal tumor in the future.
目錄.........................................................Ⅰ
圖次.........................................................Ⅳ
表次.........................................................Ⅵ
中文摘要.....................................................Ⅶ
英文摘要.....................................................Ⅷ
第一章 緒言..................................................1
第二章 文獻探討..............................................2
第一節 腎臟腫瘤之探討....................................2
1-1. 流行病學................................................2
1-2. 病因學..................................................2
1-3. 臨床症狀與診斷..........................................3
1-4. 組織病理學..............................................4
第二節 腎臟腫瘤治療模式之探討............................5
2-1. 外科手術.................................................5
2-2. 低侵入性的治療方式.......................................6
2-3. 預後判定與追蹤...........................................7
第三節 Radiofrequency Ablation對腫瘤療法之應用...............7
3-1. RFA的原理...............................................7
3-1-1. 裝置設計..............................................7
3-1-2. RF切除腫瘤的機制......................................8
3-2. RFA的早期應用...........................................9
3-3. 增加RF治療範圍的必要性.................................10
3-4. RF電極的種類...........................................10
3-4-1. 多探針式電極........................................11
3-4-2. 雙極電極............................................11
3-4-3. 冷凝式電極..........................................12
3-4-4. 成束電極............................................13
3-4-5. 脈衝電流............................................13
3-5. RF的臨床應用...........................................13
第四節 兔腎臟VX2腫瘤模式的建立..........................14
4-1. VX2腫瘤的繼代方式......................................14
4-2. 建立兔腎臟VX2腫瘤模式的方法............................16
4-3. 腎臟VX2腫瘤的轉移及預後................................16
第三章 材料及方法...........................................22
第一節 VX2細胞培養及增殖................................22
第二節 腎臟VX2腫瘤模式的建立............................23
2-1. 實驗動物.......................................23
2-2. 腎臟VX2腫瘤的接種......................................24
2-3. 腫瘤對生理的影響...............................24
2-4. 監測腫瘤的生長.................................25
第三節 RFA之應用........................................26
3-1. Cool-tip RF System..............................26
3-2. RFA的治療過程...................................26
第四節 電腦斷層影像診斷及追蹤...........................27
第五節 術後評估.........................................27
第六節 組織病理學檢查...................................27
第四章 結果.................................................33
第一節 兔腎臟VX2腫瘤模式之建立..........................33
第二節 RFA對於腎臟VX2腫瘤模式之療效.....................34
第三節 血液學、血清生化學和尿液分析.....................35
第四節 組織病理學結果...................................36
第五章 討論.................................................49
參考文獻.....................................................54
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