明胶海绵-血凝酶封堵剂用于猪肺穿刺活检的作用机制

Mechanism of gelatin sponge-hemagglutinin blocking agent used in pig lung puncture biopsy

目的观察经皮肺穿刺后给予明胶海绵-血凝酶封堵剂所致病理学变化,探讨其预防术后并发症的作用机制。方法对12头巴马小型猪行CT引导下经皮肺穿刺,于肺内活检针切割区注入明胶海绵-血凝酶封堵剂泥浆,并封堵穿刺针道。分别于术后1、4、8和12天各对3头猪行胸部CT扫描,观察明胶海绵泥浆球变化;CT扫描后1天处死动物,获取包含明胶海绵的肺组织,行常规HE染色后,于光镜下观察明胶海绵和周围肺组织病理学改变。结果经皮肺穿刺术后1、4、8天,活检针切割区明胶海绵泥浆球最大径分别为(14.45±1.43)mm、(9.79±1.80)mm和(3.09±1.04)mm(P<0.01),术后12天明胶海绵基本被吸收。术后1天肺组织中的明胶海绵泥浆球呈圆形或椭圆形,间隙内可见红细胞浸润和血栓形成,周围肺组织受明胶海绵泥浆压迫,针道完全被封堵剂泥浆条封堵;术后4天明胶海绵泥浆均以血液和明胶海绵混合物形式存在,明胶海绵颗粒大部分融合,其内部空间减小;术后8天明胶海绵结构松散,间隙增大;术后12天仅见残留明胶海绵泥浆区域,无混合物,泥浆周围肺组织少量纤维化。结论CT引导下经皮猪肺活检后给予明胶海绵封堵可通过吸收血液、压迫肺组织而达到止血和预防气胸的效果;且封堵剂在体内可完全吸收,安全性好。

Objective To observe the pathological changes of gelatin sponge-hemagglutinin blocking agent after percutaneous lung puncture,and to explore its mechanism of preventing postoperative complications.Methods Totally 12 Bama miniature pigs underwent CT-guided percutaneous lung biopsy.Gelfoam-hemocoagulase mixture were injected into the cutting area of smapling,and the puncture needle passage was blocked at the same time.Chest CT scan was performed for 3 pigs 1,4,8 and 12 days after operation,respectively.The sizes of gelfoam-hemocoagulase mixture were observed and recorded.The animals were sacrificed 1 day after CT scan.The lung tissue containing gelfoam-hemocoagulase mixture were obtained,and routine HE staining was performed to observe the pathological changes of gelfoam-hemocoagulase mixture and surrounding lung histopathology under the microscopy.Results CT showed that the maximum diameters of gelfoam-hemocoagulase mixture was(14.45±1.43)mm,(9.79±1.80)mm and(3.09±1.04)mm 1,4 and 8 days after operation(P<0.01),respectively.Gelfoam-hemocoagulase mixture were almost absorbed 12 days after operation.Gelfoam-hemocoagulase mixture in lung tissue were round or oval 1 day after operation,red blood cell infiltration and thrombosis could be seen in the space,the surrounding lung tissues were compressed,and the mud strips completely blocked the needle path.Four days after operation,gelfoams were observed in all samples in form of blood and gelatin sponge mixture,gelatin sponge particles were mostly fused,and the internal space was reduced.The structure of gelfoam-hemocoagulase mixture was loose and the space enlarged 8 days after operation.Twelve days after operation,only residual gelfoam area was observed,no mixture was found,and the lung tissue around the mud was slightly fibrotic.Conclusion Gelfoam-hemocoagulase mixture given after CT-guided percutaneous lung biopsy of pigs could exert the effect of hemostasis and prevention of pneumothorax by absorbing blood and pressing lung tissue,which could be completely absorbed within body and therefore being rather safety.