丁氰酯类医用胶栓塞脑动静脉畸形后的病理学(国产与进口产品对比研究)

The pathology of cyanoacrylates embolized cerebral AVM (compare domestic with imported products)

目的:本文是对国产α-氰基丙烯酸异丁酯(IBCA)、α-氰基丙烯酸正丁酯(NBCA)和进口NBCA栓塞脑动静脉畸形(AVMs)后病理学对比研究.方法:32例脑AVMs用国产IBCA、NBCA和进口NBCA经过1～3次栓塞后,最短10h,最长193d行脑AVMs切除,所有标本经HE及弹力纤维染色,光学显微镜观察病理变化.结果:①管腔内有胶样物质;②血管壁及周围脑组织急性期以多核白细胞浸润为主,伴血管壁变性、坏死,中晚期以淋巴细胞和嗜酸粒细胞浸润为主(中晚期管腔内大量异物巨细胞反应);③血管壁纤维化、钙化;④未发现栓塞剂移至管脏外或脑实质内的现象,被栓塞的血管腔内未见血管重生及再通现象.国产NBCA与进口NBCA病理变化相似.结论:①IBCA和NBCA可做永久性栓塞剂;②国产IBCA、NBCA可代替进口同类产品;③IBCA和NBCA的病理变化相似;④未发现有致畸致癌作用,无AVM复发.

The purpose of this study is to evaluate the pathological changes produced by IBCA and NBCA and compare the differences between these two embolic materials. Materials and Methods: The pathological changes of 32 cases of IBCA or NBCA embolized cerebral AVMs were sutdies. These AVMs had undergone IBCA (domestic) or NBCA( domestic or imported) em-bolization for 1 to 3 times,and were resected 10 hours to 193 days after ernbolization. Specimen were HE stainned and elastic fiber stainned, then observed under light microscope. Results; The main pathological changes were:(1)Calloidal substance filling in the vascular lumen. (2)Leukocyte infiltrating in the vessel wall and surrouding brain tissue. In acute phase, there was mainly multinuclear leukocyte infiltration with vessel degeneration and necrosis, while one month later, there was mainly lymphocyte and eosinophile infiltration and in vascular lumen vast amount of foreign body giant cell reaction. (3)The vessel wall was ftbrosed and calcified. (4) No evidence of embolic agent leakage to the brain and no recanalization of occuluded vessel and newly developed vessel. Similar result can be seen both in domestic NBCA and imported NBCA embolized AVMs. Conclusion: (1) IBCA and NBCA can be used as permanent embolic agent. (2)Domestic NBCA and IBCA can be used as a subsiti-tute to imported product. (3) The pathological changes of IBCA and NBCA embolized AVMswere similar. (4)No malformation and cancer inducing effect could be found. There also no AVMs recurrence be found.