肝创伤局部注射治疗后超声与病理对照的实验研究

A comparison of ultrasonography and pathology local injection treatment for hepatic trauma

目的观察肝创伤灶局部注射治疗后不同时期常规超声与超声造影表现,并与病理对照,明确局部注射止血法创伤灶的组织修复形式和相对应的超声声像图特点。方法选用NIH小鼠18只,随机分为3组,每组各6只。18只小鼠建立创伤级别相同的肝脏创伤灶,采用局部注射蛇毒凝血酶和α-氰基丙烯酸酯的方法行创伤灶局部注射止血,分别于治疗后1周、1个月、3个月行常规超声检查、超声造影检查,同时处死动物进行病理检查。结果治疗后随着时间延长,治疗区常规超声示回声强度逐渐增高,治疗后1周局部表现为不均匀低回声;治疗后1个月局部表现为不均匀中高回声,内见点状强回声;治疗后3个月可见斑片状强回声,后方伴声影。超声造影显示治疗区为低/无增强,随着时间延长,低/无增强区范围逐渐缩小。创伤区病理表现:治疗后1周表现为肝汇管区血管扩张、淤血,血管及胆管周围可见较多白细胞及淋巴细胞浸润,随时间延长,可见汇管区纤维组织增生,胆管增生并纤维化,治疗后3个月局部可见慢性淋巴细胞、浆细胞及嗜酸粒细胞,并见明显钙化形成。结论局部注射蛇毒凝血酶和α-氰基丙烯酸酯治疗肝创伤,局部表现为炎性瘢痕修复,超声回声强度与局部纤维化和钙化程度呈正相关,超声检查可作为病理改变的初步评价方法。

ObjectiveTo obtain the tissue repair form of hepatic trauma after local injection treatment and corresponding ultrasonography and contrast-enhanced ultrasonographic(CEUS)features,by comparative study between ultrasonography,CEUS and pathology different stages.MethodsEighteen NIH mice were randomly divided into three groups after local injection of thrombin and α-cyanoacrylate to treat hepatic trauma.Three groups were underwent conventional ultrasonography,CEUS and were sacrificed to get tissue pathology at 1 week,1 month,3 months after treatment,respectively.ResultsAfter treatment,the echo intensity of routine ultrasound gradually increased at the treatment area,it was heterogeneous hypoechoic after one week;local uneven hyperechoic with punctate hyperechoic after one month,patchy hyperechoic with acoustic shadow after three months.CEUS showed injury region as low or non-enhanced area,and gradually became smaller over time.Histopathology showed vasodilatation,congestion in hepatic portal area,white blood cells and lymphocytes around blood vessels and bile ducts after one week,fibroplasia,bile duct hyperplasia and fibrosis could be seen in hepatic portal area over time,after three months,lymphocytes, paddle cells,eosinophils,and calcification could be seen in injury region.ConclusionAfter local injection of thrombin and α-cyanoacrylate for hepatic trauma,inflammatory scar repair in trauma area,echo strength in ultrasonography is positively correlated with local fibrosis and calcification,ultrasonography can be used as preliminary evaluation.