前列腺动脉栓塞治疗犬前列腺增生的初步研究

Transarterial prostatic embolization： initial experience in hormone-induced benign prostatic hyperplasia in dogs

目的评价经导管前列腺动脉栓塞治疗犬前列腺增生的安全性及有效性。方法12只健康雄犬肌内注射丙酸睾酮12周，建立良性前列腺增生模型，然后随机分为栓塞组（6只）及对照组（6只）。栓塞组以直径为100～300肛mEmbosphere微球栓塞犬双侧前列腺供血动脉，记录术后并发症及不良反应。2组分别于肌内注射前、栓塞前（肌内注射12周后）、栓塞后12周行前列腺MR检查，随后对前列腺及周围组织行组织病理学检查。计量资料用面±s表示。组内前列腺体积变化的比较用配对≠检验，2组间前列腺体积变化比较采用￡检验，P〈0．05为差异有统计学意义。结果12只健康雄犬均成功建立良性前列腺增生模型，插管技术成功率100％，无手术相关并发症。MRI示100～300汕mEmbosphere微球栓塞前列腺供血动脉12周后犬的前列腺体积明显缩小。栓塞前栓塞组与对照组前列腺体积分别为（19．5±2．5）、（19．2±3．8）mm3，差异无统计学意义（t=0．14，P〉0．05）；栓塞后12周，两者的前列腺体积分别为（6．1±1．4）、（17．8±3．5）mm。，差异有统计学意义（z=-7．6，P〈0．05）。与栓塞前比较，栓塞组平均体积减少68．7％，差异有统计学意义（z=10．7，P〈0．05）；对照组减少7．3％，差异无统计学意义（t=1．4，P〉0．05）。栓塞后12周组织病理学检查提示，微球已将部分前列腺的供血动脉栓塞，且伴有周边部分正常腺体结构消失，残存的腺体组织萎缩。栓塞组膀胱、输精管、直肠等未见明显异常。对照组可见广泛前列腺腺体增生。结论经导管前列腺动脉栓塞能明显抑制前列腺的增生，并未见明显并发症。

Objective To evaluate the feasibility of transarterial prostate embolization for reducing the volume and its technical safety in hormone-induced dogs prostate hyperplasia. Methods Prostate hyperplasia was induced on 12 adult male dogs by administering testosterone propionate for 12 weeks. Then, the dogs were randomly assigned to transarterial prostatic embolization group （ n = 6） and control group （ n = 6）. Twelve weeks after initiating the hormone treatment, 6 animals in transarterial prostatic embolization group underwent prostatic arterial embolization with Embospheres 100--300 p^m in diameter. Based on MRI, the volume of prostate was measured for both groups on the three time points ： before injection of hormone （BI）, before the procedure of prostatic arterial embolization （BP） and 12 weeks after the procedure of prostatic arterial embolization （AP）. Finally, the prostates and surrounding tissues were harvested for histopathology study. A statistical software package （SPSS version 19. 0） was used for analysis. Measurement data were expressed as x -± s. Samples paired t test was used to compare the prostatic volume between BP and AP. The t test was applied in the intergroup comparison. P 〈 0. 05 was considered to indicate a statistically significant difference. Results The successful rate of BPH mctel establishment and superselectivc catheterization were 100%. No serious procedure-related complication was observed. After 12 weeks of hormone administration ,the mean volume of prostate was 19. 5 ± 2. 5 mm3 in embolization group and 19. 2 ± 3.8 mm3 in control group before prostatic arterial embolization, without statistical difference （ t = 0. 14, P 〉 0. 05 ）. At 12 weeks after prostatic arterial embolization, the mean volume of prostate was 6. 1 ± 1.4 mm3 in embolization group and 17. 8 -± 3.5 mm3 in control group with significant statistical difference （ t = - 7. 6, P 〈 0. 05 ）. Compared with pretreatment measurement, the mean volume of prostate decreased by 68.7% at 12 weeks after prostatic arterial embolization with significant statistical difference （t = 10. 7, P 〈 0. 05 ）. But there was no statistical difference between the two time points in control group with a 7.3% mean decrease （t = 1.4 ,P 〉 0. 05 ）. Histopathology study revealed that embosphere particles had occluded partial arterioles of the prostate in the embolization group of dogs. Near the occluded arterioles, normal gland structure disappeared; while residual gland tissue appeared to be atrophied. In embolization group, there was no gross or microscopic change in the surrounding tissues including bladder, deferent duct and rectum. Extensive prostate glandular hyperplasia was observed in control group. Conclusions Transcatheter arterial embolization is feasible for reducing prostate volume without serious complication in hormone-induced prostate hyperplasia dogs and worthy of further investigation.