白芨微球与无水乙醇行兔门静脉栓塞的实验研究

Experimental Portal Vein Embolization in Rabbits: A Comparison of Bletilla Microsphere with Absolute Ethanol

目的 探讨门静脉栓塞的安全范围及白芨微球作为门静脉栓塞剂的可行性与有效性。材料与方法 新西兰大白兔 30只 ,随机分为两组 ,分别以白芨微球和无水乙醇行兔门静脉不同分支栓塞治疗 ;栓塞后行连续随访2 8d ,定期复查肝功能、CT、门静脉造影及动物处死后组织病理检查等 ,并将所获的数据行统计学处理。结果 术后丙氨酸转氨酶 (ALT)、天冬氨酸转氨酶 (AST)变化较明显 ,术后第 1d开始增高 ,术后 5d达到最高峰 ,白芨微球组显著高于无水乙醇组 (P <0 .0 5 ) ,但两组均于栓塞后 14d逐步恢复正常。栓塞部位比较 :两组均以右上支加左内支栓塞小组增高最为明显 ,且均有 1只兔于术后 14d死亡。 2种栓塞剂均可导致门静脉段及段以下分支完全性、急性闭塞 ,邻近的门静脉分支未见异位栓塞 ;无水乙醇栓塞后 2 8d ,肝实质呈不规则散在液化坏死 ,部分栓塞的门静脉出现再通现象 ;而白芨微球栓塞后 ,肝实质呈大片状气化坏死 ,未见栓塞区门静脉再通 ;两组术后再通率与不全坏死率有显著性差异 (P <0 .0 5 )。结论 门静脉栓塞的安全性与栓塞范围密切相关 ,其安全范围应小于或等于 3个段 ;白芨微球可作为一种末梢性门静脉栓塞剂 ,其安全性与无水乙醇相似 ,但栓塞效果佳 ,值得进一步临床应用与推广。

Objective To discuss the safety limit of portal vein embolization, to evaluate the feasibility and efficacy of Bletilla microsphere used as an embolic agent for portal vein.Materials and Methods Thirty New Zealand white rabbits were randomly divided into Group A (n=15, Bletilla microsphere) and Group B (n=15, absolute ethanol). Embolization of portal branches were carried out with Bletilla microsphere (Group A) or absolute ethanol (Group B). The rabbits were followed up for 4 weeks. Regular examination of hepatic function, CT and portal angiography were made. After the rabbits were sacrificed, the specimens were pathologically examined. All the data thus obtained were statistically analyzed. Results After the procedure, a transient elevation of ALT and AST was seen in all rabbits, which appeared at the first day and reached its peak at the fifth day. The elevation of ALT and AST in Group A was significantly higher than that in Group B (P<0.05). In both groups, the ALT and AST returned to initial level in two weeks. The elevation of ALT and AST was most obvious in the rabbits with their right-upper and left-medial branches being occluded. Among them, one rabbit died in two weeks after the surgery. Both embolic agents could produce acute, complete occlusion of the segmental and more distal branches. In Group B, irregular necrosis and recanalization of some of the embolized portal branches could be seen in 4 weeks. In contrast, 4 weeks after the procedure massive parenchymal gaseous necrosis occurred in Group A, and the embolized vessels remained occluded. Significant difference in recanalization and incomplete necrosis existed between two groups (P<0.05).Conclusion The safety of portal vein embolization is closely related to the embolized extent, the safety limit is only to embolize three or less segmental branches. Bletilla microsphere can be used as a peripheral embolic agent, its safety is quite the same as absolute ethanol, but its effectiveness is better.