HEMA共聚物液体栓塞剂经动脉栓塞兔肾的实验研究

Experimental study on trans-arterial embolization of rabbit kidneys with copolymer liquid embolic agent HEMA

目的 探讨HEMA共聚物液体栓塞剂经动脉栓塞实质脏器的可行性、安全性和效果。方法 应用HEMA共聚物液体栓塞剂经动脉栓塞6只新西兰大白兔单侧肾脏, 术后分别于急性期（栓塞后1-3天）和慢性期（栓塞后8周、12周）复查血管造影表现, CT平扫观察栓塞剂沉积和肾脏形态。光镜观察栓塞血管内及周围肾脏组织病理变化。结果 6只兔单侧肾脏均成功栓塞并存活。栓塞术后检查微导管, 见导管完整、内壁光滑、无栓塞剂黏附。复查显示栓塞剂在肾实质内沉积良好, 栓塞血管无再通。栓塞后急性期处死3只动物, 栓塞血管内膜完整, 无坏死, 管腔内大量中性粒细胞和单核细胞浸润, 肾小球、肾小管呈灶状坏死;栓塞后慢性期处死3只动物, 肾小球、肾小管大量萎缩、纤维化、玻璃样变。结论 HEMA共聚物液体栓塞剂在X线下显影良好, 黏度低不粘管, 兼容常用市售微导管并易于注射, 栓塞效果稳定持久, 血管无再通, 适于栓塞实质脏器。

Objective To study the feasibility, safety and effect of trans-arterial embolization for solid organs with copolymer liquid embolic agent HEMA in rabbit kidneys. Methods Each rabbit＇s unilateral kidney of 6 New Zealand white rabbits was embolized trans-arterially with HEMA via 3 types of micro-catheters. Angiography performance, deposition of HEMA and the morphological changes of the embolized kidneys was observed in the acute phase （1—3 day after embolization） and chronic stage （8 weeks or 12 weeks after embolization）. Histopathological changes of intravascular and the surrounding tissues were observed under microscope. Results Unilateral kidneys of all the 6 rabbits were embolized successfully. There was no catheter gluing and the internal surfaces of the micro-catheters were still smooth after embolization. Satisfying deposition of HEMA was observed in the kidneys and there was no angiographic recanalization at follow-up. No vascular intima necrosis was found in acute phase and a large number of neutrophils and monocytes infiltration was observed in the vessels, focal necrosis of glomerular and renal tubular were also found in this period. In chronic stage, the changes of glomerular and renal tubular were atrophy, fibrosis and hyaline degenerations. Conclusion Copolymer liquid embolic agent HEMA has the property of radiopacity, low viscosity, without catheter gluing, compatible with common commercially available micro-catheters, better biocompatibility, and no angiographic recanalization at follow-up. It is suitable for solid organ embolization.