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目的探讨放射性125I粒子组织间植入对正常胃壁的组织学早期放射性损伤。方法将60只家兔随机分为对照组和实验组,近距离放射治疗三维计划系统于胃前壁上部(U区)制定平面计划,并按计划于浆膜下肌层植入呈三角形排列的3颗粒子,其中对照组植入冷源,实验组植入粒子活度为2.96×107Bq。术后将实验组和对照组分别随机分为第7、14、30、60、120、180天组共计12个亚组,观察每个亚组白细胞计数、病理学变化。结果所有实验动物均可进行客观效果评价,无溃疡、穿孔、出血、死亡等严重并发症。对照组粒子脱落率5.6%(5/90),实验组为8.9%(8/90)。病理学结果显示,对照组粒源周围组织轻微炎性改变,以炎细胞浸润为主;实验组呈现较重炎性改变,距粒源2mm以变性、坏死为主,2～5mm范围轻微炎性改变。随时间延长(7～180d),照射剂量增加(10～120Gy),病理损伤深度、范围无增大。实验组与对照组外周血白细胞差异无显著性(F=3.274,P=0.076)。结论125I植入正常胃组织受120Gy周边剂量照射,可发生病理炎性改变,未发生穿孔、出血等早期不可逆放射性损伤。
Objective To investigate the histological early radioactive injury of normal gastric wall implanted with radioactive 125I seeds. Methods Sixty rabbits were randomly divided into control group and experimental group. The brachytherapy three-dimensional planning system developed a planar plan in the upper part of the anterior stomach wall (U zone), and planted subserosal muscle layer in a triangular arrangement 3 particles, which control group implanted cold source, experimental group implanted particle activity of 2.96 × 107Bq. After operation, the experimental group and the control group were randomly divided into 12 subgroups on the 7th, 14th, 30th, 60th, 120th, and 180th days respectively. The white blood cell count and pathological changes of each subgroup were observed. Results All experimental animals could be evaluated objectively without any serious complications such as ulcer, perforation, bleeding and death. Control group, the rate of particle shedding 5.6% (5/90), the experimental group was 8.9% (8/90). The pathological results showed that the surrounding tissues of the control group were slightly inflamed with infiltration of inflammatory cells. The experimental group showed severe inflammatory changes, with 2mm from the granular source to degeneration and necrosis, and slight inflammatory range from 2mm to 5mm change. With time prolonged (7 ~ 180d), radiation dose increased (10 ~ 120Gy), the depth of pathological injury, no increase in the scope. There was no significant difference in peripheral blood leukocytes between experimental group and control group (F = 3.274, P = 0.076). Conclusion 125I implanted normal gastric tissue irradiated by peripheral dose of 120Gy can occur pathological inflammatory changes without perforation, bleeding and other early irreversible radioactive injury.