血余炭栓塞狗肾动脉病理改变的初步研究

The preliminary study of histopathologic manifestation of the dog renal atery with crinis carbonisatus particulates as a vascular embolization agent

目的：观察中药血余炭栓塞狗肾动脉的病理改变，为临床提供实验依据。方法：将中药血余炭磨制成200-500μm大小的颗粒，超选栓塞部分末梢动脉血管。栓塞术后第7、14和56天分别处死1、2和3号犬，取出双肾固定，制作病理标本。结果：栓塞术后第7天，肉眼见栓塞部分肾脏缩小，切面末梢血管内有栓塞剂；镜下见血余炭栓塞剂附着于血管壁伴血栓形成。栓塞术后第14天，炎性反应明显，并有少量出血，血管壁炎性坏死，血栓逐渐机化。栓塞术后第56天见栓塞部分肾脏明显缩小，有大面积的缺血性梗死；镜下见血栓完全机化，栓塞组织呈缺血性梗死，栓塞血管有少量再通。结论：血余炭栓塞的病理过程为：血余炭附着血管壁，诱发血栓形成，血栓机化，血管壁炎性坏死，管腔闭塞，栓塞组织缺血性梗死，栓塞血管少量可再通。

Objective： The purpose of this study was to evaluate the histopathologic manifestation of the dog renal atery embolized with crinis carbonisatus particulates（CCP）, and provide the experimental evidence for clinic. Methods： A Chinese medicine product, crinis carbonisatus was made into particulates with a size 200 to 500μm in diameter. These CCPs were delivered into arterioles in left kidneys of three domestic dogs through 4F cobra cathter under fluoroscopy. A super selective renal artery embolization was performed in 3 dogs by using these materials. The both kidneys of the three dogs, which were performed at different intervals within 8 weeks after embolization （Tth, 14th, 56th days）, were removed and prepared for pathological examination and histopathologic study. Results： All 3 dogs well tolerated the anesthetic and endovascular procedures. On the seventh day after embolism, decreased in renal size and thrombosis of the renal arterioles was noted on examination of the gross kidney specimens. Under microscope we could find that CCP attached to intima of target vessels and induce thrombosis. When it came to the forteenth day, obvious inflammatory reaction, little hemorrhage, inflammatory necrosis of vessel wall and organization of the thrombos could be observed. During the 8 weeks after embolization, a progressive, marked decrease in renal size occurred. Histopathologic evaluation confirmed satisfactory embolization of peripheral arteries. Acute or chronic inflammatory cells were observed in several vessels containing CCP microparticles. The occlusion of vessels by CCP lasted at least for 8 weeks when a little recanalization was observed in the target tissue. Conclusion： In the embolization mechanism,CCP attached to intima of target vessels firstly, induced thrombosis and a severe form panarteritis. Organization of the thrombos then take place and a complete occlusion of the vessels occurred, leading to severe ischemia as infarction of embolized area.