Effect Of Tumor Blood Supply And Nevascularization After Chemoembolization Of Hepatic Artery Combined With Portal Vein In VX2 Liver Tumor

Objective To investigate the changes of blood supply and neovascularization in rabbit VX2 tumor after transcather arterial chemoembolization(TACE)combined with selective portal vein embolization(SPVE)so that provide guidance for the intervention treatment of primary liver carcinoma(PLC)and making a more reasonable clinical treatment plan.Methods 46 New Zealand White rabbits,body weight 1.9~2.6 kg,regardless of their sexualities,was implanted 2-3 pieces of tumor tissues around 1mm~3size in their left lope of liver with abdominal operation.On the 14th day after tumor implantation,it was confirmed by CT scan and enhanced scan that 42 of 46 rabbits had only one tumor in the left lobe of the liver,which met the experimental requirements.The forty-two rabbits were randomly divided into experimental group(A group)and control group(B group)with 21 animals in each group using"random number table method".Group A and B received left hepatic artery chemoembolization on the 15th day after implantation of the tumor mass,and about 0.4 mL mixed emulsion of Epirubicin and iodized oil was injected in.On the 18th day after implantation of tumor mass,group A underwent selective angiography(DSA)of the left hepatic lobe branch of the portal vein and then was injected 1 ml of ultra-liquid lipiodol.Group B of the left hepatic lobe branch of the portal vein also underwent selective portal vein selective angiography(DSA)and was injected the same amount of salinein with the group A of ultra-liquid lipiodol.A rabbit was dead in each group in above steps.On the 14th and21st day after the implantation of the tumor mass,the CT scan and enhanced scan of the A and B group were performed.On the 22nd day,the directly punctured DSA of the hepatic artery and portal vein were performed and then all the rabbits were sacrificed.Peripheral tumor tissues were excised and the vascular endothelial growth factor(VEGF)and microvessel density(MVD)expression were detected to determine the formation of blood vessels.Results The modeling method of directedly punctured of left hepetic lobe and implanted tumor mass was used.14 days after tumor implantation,42 rabbits in 46were proved to form a single tumor in the left lobe of liver by plain and contrast-enhanced CT scan with tumor diameter of about 1.3-2.2cm.The 14th day CT scan shows low density nodules in the left lobe of liver,a few nodules were lobulated.In the arterial phase of enhanced scanning,tumors showed marked enhancement and clear boundary between tumor and surrounding liver parenchyma.The enhancement was reduced and the boundary of the tumor and liver parenchyma that is obviously strengthened is also obvious in the stage of portal vein and balance.On the 15th day after implantation,DSA of the hepatic artery showed that the blood supply of tumor was donated by the left hepatic artery.The tumors showed nodular staining directly.The distal branches of the left artery of the liver are increased and disordered.On the 18th day,portal vein DSA showed that some of the portal vein branches in the experimental rabbits were squashed by the tumor,and no apparent development was observed.After the portal vein was injected with lipiodol in Group A,there was no obvious lipiodol deposition in the tumor.On the 21st day,low-density necrotic area was seen in the center of the tumor,and the arc-shaped and irregular small platelet-like dense of lipiodol deposits were showed.On the 22nd days,direct puncture hepatic artery angiography showed that most of the lesion stained lighter and some tumor lesions had no obvious staining.Direct puncture portal vein DSA showed no abnormalities in the portal vein and branches and no obvious abnormal signs.The measured values of VEGF in group A and group B were(120.70±10.99)and(136.50±15.45)respectively,with significant difference(t=3.73,P=0.001<0.05).The MVD of group A and group B were(58.90±9.05)and(71.80±12.06)respectively,with significant difference(t=3.83,P=0.001<0.05).There was a positive correlation between VEGF and MVD(r=0.34,P=0.033<0.05).Conclusions The modeling method of directedly punctured of left hepetic lobe and implanted tumor mass is simple and easy with high successful rate.And has fewer postoperative complications.The blood vessel of rabbit is thicker.The femoral artery puncture,hepatic artery and portal vein super-selective intubation are simple and easy;The hepatic artery of VX2 liver cancer is embolized after TACE and the blood supply from the portal vein to the tumor gradually increases.After the TACE combined with SPVE,the portal vein supply to the tumor is also interrupted and it makes the tumor cell necrosis more obvious.The expression of VEGF and MVD in the experimental group decreases compared with the control group.VEGF secretion is positively correlated with MVD.After blocking the hepatic artery,the tumor cells secrete VEGF due to tumor ischemia and hypoxia,and then promote the formation of tumor microvessels.TACE combined with SPVE can enhance the VEGF Secretion,thereby reducing the formation of new blood vessels.