平阳霉素碘油乳剂栓塞肺减容术的初步研究

Preliminary study on lung volume reduction by bronchial occlusion with pingyangmycin-lipiodol emulsion

目的探讨平阳霉素碘油乳剂栓塞结合近端支气管骨水泥封堵肺减容术的可行性及安全性。方法①平阳霉素碘油乳剂组12只成年兔经气管选择性插管至段支气管后,经导管向肺段(靶区)内注入平阳霉素碘油乳剂(分3个亚组,每组4只,平阳霉素用量分别为4、8和16mg加入1ml碘油中);②碘油对照组2只兔用同样方法向靶区内注入单纯碘油,碘油用量为1ml。两组于药物栓塞后,均用骨水泥(0.5ml)对近端支气管封堵。术后3d、1、2、4周行影像随访,并按预定时间取全肺作病理检查。结果碘油组与平阳霉素碘油乳剂各亚组表现相似,栓塞肺段明显膨胀不全,胸片及CT示靶区充有碘油并逐渐缩小。病理检查显示早期靶区呈急性渗出性炎症改变;4周后各组靶区均形成轻度纤维化,其周围见平行排列的萎陷肺泡,间质内以嗜酸粒细胞及淋巴细胞浸润为主伴大量肺巨噬细胞聚集,部分靶区出现小灶性坏死或化学性小脓肿(6/14,或43%)。靶区胸膜面光整,胸腔无渗液、脏壁层胸膜间无粘连。非靶区未发生明显的肺炎。结论经导管支气管平阳霉素碘油乳剂栓塞加骨水泥封堵及单纯碘油栓塞加骨水泥封堵皆是安全的,可引起稳定的肺减容。单纯碘油与平阳霉素碘油乳剂两组的肺纤维化程度未见显著差异,可能与样本较小和观察时间较短有关。

Objective To evaluate the feasibility and safety of lung volume reduction by trans-catheter bronchial occlusion with Pingyangmycin-lipiodol emulsion （PLE） followed by occlusion of the selective proximal segmental bronchial lumen with bone cement. Methods After selective segmental bronchial catheterization in 12 adult rabbits, occlusion with PLE was performed. The animals were divided into 3 treatment groups （ n = 4 in each group） and 4 mg,8 mg and 16 mg of Pingyangmycin mixed with 1 ml lipiodol were used respectively. For control, occlusion with pure lipiodol 1 ml was carried out in another 2 rabbits. After all bone cement 0.5 ml was added to occlude the selective proximal segmental bronchial lumen in all animals. Followed up procedures were carried out with imaging examination at 1,2,4 week after the occlusion procedures in all animals, and finally the whole lungs were harvested for histological examination. Results The findings in pure lipiodol group were similar with those in PLE group. Significant atelectasis was observed at occluded segments, with filling of lipiodol and contraction of lung gradually on chest X-films and CT images. Pathologically, the lesions of target areas showed acute alveolitis in the initial stage, mild pulmonary fibrosis surrounded by collapsing pulmonary alveoli with interstitial imfihration of eosinophile granuloeytes and lymphocytes along with a lot of aggregating pulmonary macrophages together with small necrosis or abscess formation in partial target areas（6/14） after 4 weeks of the procedure. Macroscopically, visceral pleura of target areas, remained intact without pleural effusion or adhesion. Pneumonia was not happened in the nontarget areas. Conclusions Transbronchial occlusion with PLE or pure lipiodol followed by occlusion of the selective proximal segmental bronchial lumen with bone cement is safe and effective. No significant difference was shown between the extents of pulmonary fibrosis between the two groups, probably due to the limitation of small sampling numbers and short following periods in this study.