高强度聚焦超声与无水乙醇毁损腰交感神经节对犬后肢动脉闭塞病变影响的比较研究

THE COMPARATIVE STUDY ON THE EFFECTS OF LUMBAR SYMPATHECTOMY WITH HIGH INTENSITY FOCUSED ULTRASOUND OR DEHYDRATE ALCOHOL ON THE HIND LIMB ARTERIAL OCCLUSIVE DISEASE MODEL IN DOGS

目的:用无水乙醇和高强度聚焦超声(HIFU)阻滞后肢动脉闭塞犬腰交感神经节,比较两种处理方式对后肢皮肤温度、神经节形态结构及脊髓P物质影响的差异。方法:27只杂种犬制作后肢缺血模型,术后2周随机分为3组(各组n=9):对照组(A组),HIFU治疗组(B组),乙醇治疗组(C组)。A组不予处理,B组和C组分别用HIFU和无水乙醇阻滞腰交感神经节。各组在造模前、治疗前(造模后2周)、治疗后1周分别检测肢体皮肤温度、神经节形态结构及脊髓P物质含量的变化。结果:(1)三组造模后与造模前相比皮肤温度均显著降低(P<0.05),治疗后B、C两组回升。(2)镜下B组所有神经元细胞出现坏死;C组大部分神经元坏死。(3)SP免疫阳性反应物集中分布在脊髓背角I、Ⅱ层,造模后各组脊髓腰段SP的平均光密度(OD)值与造模前相比均显著升高(P<0.01),治疗后B、C两组脊髓腰段SP的OD值较治疗前显著降低(P<0.05),组间无显著差异(P>0.05),结论:高强度聚焦超声和无水乙醇均可有效阻滞腰交感神经节,两种方法在对后肢动脉闭塞犬后肢皮肤温度、脊髓P物质改变方面影响无显著差异,而HIFU对神经节破坏更彻底。

Objective： To compare the change of skin temperature of the hind limb, the microstructure of the nerve ganglion and the substance P （SP） in the spinal cord under the two disposals of lumbar sympathectomy with high intensity focused ultrasound （HIFU） and dehydrate alcohol on the hind limb arterial occlusive disease model in dogs. Methods： Hind limb ischemia models were made on 27 mongrel dogs. They were randomly assigned to 3 groups in 2 weeks after the surgery （ n = 9 each） ： control group （ group A）, HIFU therapy group （group B）, alcohol therapy group （group C ）. In group A, no disposal was given to. In groups B and C, HIFU or the dehydrated alcohol were used to block the lumbar sympathetic ganglion. The change of the limb skin temperature, the microstructure of the nerve ganglion and the SP in the spinal cord were detected before the surgery, before the therapy （2 weeks after the surgery）, 1 week after the therapy. Results： （ 1 ）Hind limb skin temperature in the 3 groups decreased significantly（P 〈0. 05） after the surgery. The temperature returned after therapy in groups B and C. （2） All neurons were necrotized in group B, most of the neurons were necrotized in group C. （3） SP immunization positive reactant localized in the laminae Ⅰ,Ⅱ in the dorsal horn in the 3 groups. After the surgery, the average optical density（OD） of SP in the lumbar segment increased significantly（P 〈0. O1 ）. After the therapy, the OD in groups B and C decreased significantly （P 〈 0.05 ） and there was no significant difference between the two groups （ P 〉 0.05 ）. Conclusion ： Lumbar sympathetic ganglion blocking with HIFU or dehydrated alcohol can block the lumbar sympathetic ganglion effectively. There was no significant difference in hightening the hind limb skin temperature and lowering SP in spinal cord between two groups. The necrosis of neurons was more severe in HIFV group than dehydrated alcohol group.