院前明胶海绵栓塞治疗肾血管损伤的动物研究

Animal Study of Pre-hospital Gelatin Sponge Embolization for Renal Vascular Injury

目的:探讨在新型综合手术救治方舱中明胶海绵栓塞治疗肾血管损伤的可行性和疗效。方法:在新型综合手术救治方舱中构建3例动物肾腹(背)干动脉损伤模型、3例肾段动脉损伤模型,先用1 mm×1 mm×1 mm明胶海绵颗粒对损伤血管进行栓塞治疗,若未能止血,改用2 mm×2 mm×2 mm颗粒栓塞,观察栓塞后15分钟、1月后的肾动脉造影,栓塞后1月的组织病理表现。结果:3例肾段动脉和1例肾腹干动脉使用1 mm×1 mm×1 mm明胶海绵颗粒一次栓塞成功;1例肾腹干动脉和1例肾背干动脉用1 mm×1 mm×1 mm颗粒栓塞未能完全止血,改用2 mm×2 mm×2 mm颗粒栓塞成功。6例动物术后生命体征平稳,全部存活,一个月后造影复查见栓塞动脉未再通,但其余分支动脉血供得到保留。大体标本观栓塞侧肾明显缩小,未见脓腔和脓性分泌物,病理切片示栓塞后局部肾组织有不同范围缺血性梗死。结论:野战方舱中明胶海绵栓塞治疗出血效果明确,对于一般肾血管损伤定位准确,止血迅速、彻底,有良好的可行性和疗效。

Objective： To investigate the feasibility and effectiveness of the gelatin sponge embolization for renal vascular damage in the novel comprehensive operation rescue shelter. Methods： Three cases of renal truncus arteriosus injury model and three cases of animal renal segmental artery injury model were made in the comprehensive operation rescue shelter. All the injured renal arteries were em- bolizated with 1 mm × 1 mm × 1 mm gelatin sponge particles first. If the embolization failed, 2 mm × 2 mm× 2 mm particles would be used. Renal artery angiography and histological examination was performed after one month. Results： Three cases of animal renal seg- mental artery injury model and one case oftruncus ventralis injury model were embolizated with 1 mm × 1 mm × 1 mm gelatin sponge particles once successfully. Two cases of renal truncus arteriosus failed to stop bleeding after embolization with 1 mm × 1 mm × 1 mm gelatin sponge particles, then 2 mm× 2 1mm× 2 mm particles succeeded. Postoperative vital signs of six animals were stable and all sur- vived. After 1 month, angiography was no recanalization of the occluded renal arteries but the blood supply of the remaining branches was preserved. The embolized kidneys atrophied significantly without abscess cavity and purulent discharge. Pathological section showed the localized renal tissue had various range ofischemic infarction. Conclusion： Gelatin sponge embolization is a safe and effective treat- ment for renal vascular injury in the comprehensive operation rescue shelter, having good effect ofhemostasis and providing the possibil- ity for subsequent treatment with accurate angiographic positioning.