灰阶超声造影引导止血剂局部注射治疗闭合性肝外伤的实验研究

Hemostatic agents injected into injury sites under the guidance of contrast-enhanced ultrasound control hepatic trauma hemorrhage: an animal experiment

目的动物实验探讨超声造影（CEUS）引导止血剂局部注射治疗闭合性肝外伤的价值。方法实验动物为18只杂种犬。使用小型生物撞击器制作闭合性肝外伤模型。14只犬肝脏出现Ⅲ-Ⅳ级钝器伤。带伤动物被随机分为治疗组和对照组。CEUS检查确定肝损伤的部位、范围、有无活动性出血及被横断的微血管,并与CT检查比较。治疗组在CEUS引导下于外伤灶内及可疑微血管横断处分别注射蛇毒凝血酶、可吸收性氰基丙烯酸酯粘合胶。对照组于病灶内注射同等数量的生理盐水。注射后即刻、3d、7d、14d及21d分别进行CEUS及CT复查。于第21d处死动物观察局部情况,取病理标本进行检查。结果治疗组注射后均存活,对照组中3只于24h内先后死亡。治疗组局部注射治疗后3d、7d、14d及21d病灶逐渐缩小,于第21d处死动物后,打开腹腔见网膜向肝脏损伤灶处贴附,肝表面见外伤愈合瘢痕。组织HE染色显示肝小叶结构清楚,肝窦轻度淤血,被膜下纤维组织轻度增生,伴少量炎症细胞浸润。结论动物实验显示CEUS引导止血剂局部注射治疗Ⅲ-Ⅳ级肝外伤出血,效果可靠;该方法操作简单、快捷,可在CEUS诊断肝外伤后即刻进行。

Objective To evaluate whether hemostatic agents injected into injury sites under the guidance of contrast-enhanced ultrasound （CEUS） can stop hemorrhage from hepatic truama. Methods Eighteen dogs were impacted by a miniature impactor for hepatic trauma models. Among 18 dogs, 14 underwent blunt hepatic injury of grade Ⅲ～Ⅳ, and were randomly divided into 2 groups： the treatment group （n=7） and the control group （n=7）. CEUS and CT were performed for detecting the extent and size of the injury site, and CEUS was used to detect whether active hemorrhage and transected micro-vessels occurred. In the treatment group, Hemocoagulase and cyanoacrylate were respectively injected into the injury sites and transected micro-vessels under the guidance of CEUS. And in the control group, normal saline was injected into the injury sites under the guidance of CEUS. CEUS and CT were performed on the 3rd day, 7th day, 18th day and 21st day after injection. All survivals were killed on the 21st day for therapic evaluation. Results All animals in the treatment group survived, and 3 dogs died in the first 24 hours. In the treatment group, CEUS and CT demonstrated that hepatic injury became smaller and smaller from the 3rd to the 21st day after injection. Gross examination demonstrated that the hepatic injury sites injected were adhered and covered by great omentum. Scar on the liver surface was visualized. Histopathology showed hepatic lobule texture, hepatic sinusoid with mild congestion, fibrous tissue with mild hyperplasia and a bit of inflammatory cells infiltrated under liver capsule. Conclusion In this animal model, hemostatic agents injected into injury sites under the guidance of CEUS can stop hemorrhage from hepatic truama of grade Ⅲ-Ⅳ. This therapy is simple, rapid and effective. It may be performed immediately after hepatic injury was diagnosed.