| Part one Experimental research of CT-guided percutaneous acetic acid injection for the healthy porcine pancreasObjective: To assess the safety, feasibility and efficacy of CT-guided percutaneous acetic acid injection treatment for pancreatic carcinoma by the effect and complications on the healthy porcine pancreas, such as necrotic foci, severe acute pancreatitis, pancreatic fistula, ankylenteron and intestinal obstruction, renal dysfunction and death.Methods: 12 healthy pigs were treated by CT-guided percutaneous acetic acid injection. The treated pigs were scanned by CT and MRI and the biochemical changes in serum were observed before and 12h, 3rd day, 7th day and 14th day after PAI. The 12 pigs were treated with pancreectomy on the 3rd day,7th day and 14th day respectively. The necrotic foci was sampled make with paraffin section ( HE staining ) and observe the necrosis with microscope. Statistical analysis was conducted for the data of the lesion size, the HE staining, the biochemical changes in serum and the complications.Results: The biggest necrotic foci was founded on the 3rd day after PAI, then the lesion decreased on the 7th day and 14th day gradually , which was confirmed by the pathology samples. The change of AMY value was accordant with the necrosis size. Only one pig was diagnosed as SAP, no renal dysfunction occoured. There were no serious complications in other pigs.Conclusion CT-guided percutaneous acetic acid injection for the healthy pancreas can acquired obvious necrotic foci with minimal damage. For advanced pancreatic carcinoma, CT-guided PAI should be considered as a therapeutic approach because of the safety, feasibility and efficacy. But the relationship among the tumor size, the suitable concentration and dose, and how to controll the pancreatitis and renal dysfunction should be done more and further research. Part two The comparative study of experimental research between CT-guided percutaneous acetic acid and thermochemotherapy for the healthy porcine pancreasObjective: To compare the safety, feasibility, efficacy and the injury mechanism of CT-guided percutaneous acetic acid injection and thermochemotherapy for pancreatic carcinoma by the effect and complications on the healthy porcine pancreas.Method: 24 healthy pigs were randomly divided into two groups, each group has 12 pigs, one group were treated with CT-guided percutaneous acetic acid injection(PAI), the other group were treated with CT-guided 5-FU thermochemotherapy on the tail of pancreas . The treated pigs were scanned by CT and MRI and the biochemical changes in serum were observed before and 12h, 3rd day, 7th day and 14th day after PAI or 5-FU thermochemotherapy. And the 12 pigs were treated with pancreectomy on the 3rd day,7th day and 14th day respectively. The necrotic foci was sampled make with paraffin section( HE staining ) and observe the necrosis with microscope. Statistical analysis of the two groups was conducted for the data of the lesion size, the HE staining, the biochemical changes in serum and the complications.Result:①Statistical analysis of AMY level between corresponding period: using SAS statistical analysis software, there were no significance statistical difference between baseline, 12h after being treated and 7th day after being treated of each group, P>0.05; But there was significance statistical difference between 3rd day after being treated of each group, P<0.05.②Statistical analysis of necrosis size between corresponding period: there were significance statistical difference between 1h , 3rd day , 7th day and 14th day after being treated of each group, P<0.05.③Statistical analysis of complication rate: there was no significance statistical difference between two groups.④Comparative study between the necrotic foci under microscope: Clear necrosis was found in all pathology specimen HE staining under microscope. Hemorrhage and necrosis was found in pancreatic tissue and fat tissue 3rd day after being treated by two ways, plenty of WBC was found, too. As the time passing by, the number of WBC was decline, and fibrous tissue hyperplasia.Conclusion: The new Computed Tomography-guided correlative interventional techniques: percutaneous acetic acid injection and thermochemotherapy, have the safety, feasibility and efficacy and are worthy of being studied and applied in clinical. As the size of necrotic foci increases, the pancreatitis occurred more possibly in PAI than that in thermochemotherapy. But the relationship among the tumor size, the suitable concentration and dose, and how to controll the pancreatitis and renal dysfunction should be done more and further research. Part three Therapeutic analysis of interstitial implantation with 125I seeds in treatment of pancreatic cancerObjective: To assess the therapeutic effect of interstitial with 125I seeds in treating pancreatic cancer.Methods: During the period of July 2005—June 2008, interstitial implantation with 125I seeds was 33 patients( 22 males and 11 females , mean age 64 ) with pancreatic cancer. The maximum diameter o the tumor was 1.5~6.5 cm( mean 3.7cm ). The clinical data were retrospectively analyzed.Results: The pain relief rate was 60.6%. Four patients died within 3 months.CT re-exam 3 months after the treatment showed that partial response was observed in 8, stabilization in 13 and deterioration in 8 patients. The overall effective rate was 27.6%. No serious complications, such as pancreatic leakage, gastrointertestinal hemorrhage, etc, occurred. The median survival time was 5.1 months. In 18 patients, 51 seeds were missing. In 5 patients, 11 seeds were migrated, of which 9 moved to intestine, one to liver and one to spleen. Neither radiation enteritis nor hepatic dysfunction developed.Conclusions: In the treatment of pancreatic cancer, interstitial implantation with 125I seeds is very effective in reliving pain, however, a part of patients in stagingⅣenrolled in this study respond poorly to the treatment. Therefore, a prospective cohort study with a large sample is required to further verify the efficacy of the treatment.
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