| Background The treatment of pancreatic cancer has been a problemin the world, traditional treatment such as surgery, radiation andchemotherapy all have poor efficacy. Radical surgery is one of the possiblecure treatment methods; the5-year survival rate is less than20%even forpatients experienced surgery. Who prone to local and systemic metastasis;for most patients with unresectable pancreatic cancer, the primary treatmentis still radiotherapy or chemotherapy. Because of the lack of oxygen,pancreatic cancer is poor sensitivity to radiotherapy and chemotherapy, sothe clinical effect is not ideal,High intensity focused ultrasound (HIFU) is a noninvasive tumortreatment technology risen in recent years, which can cure all kinds ofbenign and malignant solid tumors, including prostate cancer, uterinefibroids, liver tumor, kidney tumor, breast cancer, and pancreatic cancer.Clinical studies have showed that safety and efficacy of HIFU on pancreaticcancer. HIFU ablation became one of the important treatments of patientswith pancreatic cancer, who lost the opportunity to operation. At present, ultrasonic ablation treatment of pancreatic cancer is stillunder clinical research, but just reports the phenomenon. As for the causesof phenomenon and safe of irradiation scope is rarely reported at present,the basic research still in serological levels, high intensity focusedultrasound ablation of the pancreas is not comprehensive reported. Therefore,this topic is a in-depth study on the basis of clinical studies, to observation ofhigh intensity focused ultrasound ablation after pancreas, observe thehistological pathology outcome of pancreas and serological recoverycharacteristics, discusses the process of the pancreas outcome afterultrasonic ablationObjective To observe the function of Serum amylase and fastingblood glucose changes of pancreas after High Intensity Focused Ultrasound(HIFU) thermal ablation on pancreas of SD rats, and observe the pathologyoutcome of islet and variation of Insulin antibodies and glucagon antibody,to investigate the effects of HIFU ablation on normal pancreas, to providethe basis experimental data for clinical application of HIFU treatment ofpancreatic cancer.Methods Totally135SD rats were random divided into3groups, i.e.half pancreas irradiation group (HI group), quarter pancreas irradiationgroup (QI group) and control group (C group, each n=45). CZFgynecological was applied to ablation partially on pancreas of SD rats, andthen, the four Index were examined in the nine time period (immediately, two hours, three days, one week, two weeks, three weeks, four weeks, threemonths, six months), and to detect serum amylase with Biochemical, todetect fasting blood-glucose with glucose oxidase, to detect fasting seruminsulin with Chemiluminescence and to detect fasting serum glucagons withELISA method. taking the pancreas in the4%paraformaldehyde for thepathological mechanism with H.E and IHC(immunohistochemical) thatdetected INS、IRG, which was observed at the same time.Results1. After HIFU ablation on the pancreas of SD rats with the strength of2500W/cm2is10s. observed all the SD rats has awake within2h,afterultrasound ablation, HI groups was found that it has bloating and pyloricblockage (2.2%). Histological outcomes:①Naked eye observation Inimmediate, the coagulation necrosis was seen clearly. over the time,coagulation necrosis can absorbed gradually in a months, in6month, therewas a thin layer of light yellow tissue augmentation in it.②Histopathology： Results H.E stain showed that, in immediate grouppancreatic, cells swelling and lightly staining, nucleus karyopyknosis anddarkly staining，cellular outline is complete in the region irradiated；cellsswelling still at2hour after ablation；the necrotic tissue is absorbedgradually after3days， New blood vessels is found in the region irradiated3weeks after be ablated，in the1/4groups after3months began to appearsimilar to new pancreatic duct,while after6months in the1/2groups. In all control groups, the morphology in the exocrine portion and endocrineportion (pancreas islet) of pancreas is normal. Immunohistochemistry： itwas a strong positive expression rates between the ablation groups and thecontrol groups in INS and IRG.2.Serological changes①The fasting blood-glucose were statisticaldifference at immediately time of ablation and at2h among in HIFU1/2：11.225mmol/l，9.03mmol/l，HIFU1/4：10.08mmol/l，7.05mmol/l，control:7.62mmol/l，6.05mmol/l(ρ<0.05).And it has a different changeswith control, the ablation groups has a significant differences than control atthe same time(ρ<0.05). The level of fasting blood-glucose was no significantdifferences among the3groups and it has a dynamic equilibrium after3d(ρ>0.05).②Change of insulin secretion：While the fasting serum insulinwas no significant differences among3groups at every time (ρ>0.05), onlyin2h, the ablation groups was significant differences than the control group.But the fasting serum glucagons was no significant different at immediatelytime of ablation (ρ>0.05), but the ablation groups has significant differencethan the control groups, there was a significant difference among3groups(ρ<0.05) between the2h and2weeks after ultrasound ablation, and then, itstarts to stable. There was a significant different between the ablationgroups and the control groups (ρ<0.05).③the level of serum amylase werestatistical difference at immediately time of ablation and at2h afterultrasound ablation among3groups(ρ<0.001), there was significant differences between each other at immediately and at2h among inHIFU1/2:2070U/L,3553U/L,HIFU1/4:1921U/L，3187U/L,control:1323U/L,1586U/L, the ablation groups was high level and has a significantdifferences than control (ρ<0.05). And at3d (ρ<0.01).The level of serum wasno significant differences among the3groups and it start tends to balanceafter1weeks.Conclusion1. We found that irradiation by HIFU with sound intensity is2500W/cm2after six months, the histopathology show that normalpancreas can absorb coagulation necrosis, and the reconstruction of the isletis not perfect, but the outcome is good by observation the expression ofINS and IRG.2. We found that irradiation by HIFU with sound intensity is2500W/cm2after six months, the expression of the fasting blood glucose，blood amylase, INS and IRG in pancreas were increased in early byimmunohistochemical and the serum insulin and serum glucagon, whichshow that after HIFU ablation, the changes had no effect on glucosemetabolism in rats after HIFU ablation of the pancreas. Serum amylaseshowed that the acute pancreatitis has not happened. |
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