超声造影引导止血剂局部注射治疗闭合性脾外伤的实验研究

Guidance of contrast-enhanced ultrasonography of hemostatic agent for blunt splenic trama： an animalexperiment

目的 探讨超声造影引导止血剂局部注射治疗闭合性脾外伤出血的即刻及近期疗效。方法 模型建立后，将损伤程度为Ⅲ～Ⅳ级的动物随机分为治疗后即刻处理组（I组）及近期观察组（II组）。I组治疗30min后剖腹探查止血情况；II组治疗3周后剖腹探查。结果 I组超声造影示止血剂注射处局部呈强回声，造影剂外溢消失，剖腹探查见凝血块和胶膜覆盖病灶，出血基本停止；II组3周后超声造影示强回声减小，剖腹探查见病灶完全愈合，局部可见大网膜贴附。I组HE染色见无结构的坏死组织；II组见脾被膜衬覆致密纤维结缔组织，其中可见新生的薄壁血管。结论 超声造影引导止血剂联合局部注射治疗Ⅲ～Ⅳ级脾外伤出血效果及时可靠，操作简单，可实现外伤诊断后的即刻止血。

Objective To investigate hemostasis effect after hemocoagulase and cyanoacrylate injected into injury sites under the guidance of contrast-enhanced ultrasonography（CEUS） in blunt splenic trauma. Methods Ten blunt splenic injury dogs with grade III ～ IV were randomly assigned into 2 groups. Hemocoagulase and cyanoacrylate were directly injected into the injury sites and transected micro-vessels under the guidance of CEUS. After injecting, the treatment areas were observed and harvested for histopathology 30 minutes later in group I . Animals were exploratory laparotomy 3 weeks later in group II. Results CEUS demonstrated that active bleeding disappeared and there were no rehaemorrhagia after treatment,the local treatment areas appeared hyperechoic and blood clots and glue membrance covered the injury areas in group I. In group II , CEUS showed the hyperechoic areas diminished 3 weeks later, the injury sites completely healed and greater omentum could be seen around the injuries. Histopathologic examination showed that the normal structure of spleen disappeared in group I. Fibrous connective tissues were covered the splenic capsule and thinness neogenetic vessel appeared in the fibrous connective tissue in group II. Conclusions Hemocoagulae and cyanoacrylate can stop bleeding effectively and immediately by directly injected into the injury sites with gradeIII～ IV blunt splenic trauma. This therapy method is easy to manipulate and can implement the instantly hemostasis.