血余炭栓塞狗肾动脉病理改变的初步研究

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。     

微创经皮肾镜取石术后严重出血的DSA诊断和介入治疗

目的 探讨肾结石微创经皮肾镜取石术(MPCNL)术后出血的肾动脉造影表现及超选择性肾动脉栓塞止血的价值.方法 回顾性分析48例肾结石MPCNL术后出血患者的临床与动脉造影资料,分析其肾动脉造影表现、栓塞治疗效果及并发症等.结果 肾动脉造影结果显示MPCNL后出血的原因:单纯假性动脉瘤25例(52.1%)、假性动脉瘤伴动静脉瘘6例(12.5%)、假性动脉瘤伴对比剂外渗1例(2.1%)、肾动静脉瘘11例(22.9%)、血管破裂对比剂外渗2例(4.2%)和包膜动脉曲张1例(2.1%),未发现异常2例(4.2%).46例接受了栓塞治疗,并达到了栓塞治疗成功的DSA标准和临床标准,其中采用聚乙烯醇颗粒(PVA)栓塞18例、PVA+钢圈栓塞5例、明胶海绵栓塞10例、明胶海绵+钢圈栓塞11例、PVA+明胶海绵+钢圈栓塞2例.栓塞后均出现不同程度的栓塞后综合征;术后血清肌酐较术前轻度升高12例.结论 超选择性肾动脉栓塞能有效止血和保存肾脏功能,是MPCNL术后严重出血的首选治疗方法.     

三丙烯微球栓塞肾动脉的实验研究

目的探讨三丙烯微球的动脉栓塞效果、不良反应及组织相容性。方法将36只日本大耳白兔随机分成A、B两组,每组18只。A组用三丙烯微球(300～500μm)栓塞右肾动脉;B组用聚乙烯醇(PVA)颗粒(300～500μm)栓塞右肾动脉。两组于术后1、4和8周分别随机抽取6只动物行肾动脉造影复查,并取肾脏行病理检查。结果两组栓塞后组织形态改变相似,在复通率、误栓率方面组间差异无统计学意义(P>0.05)。A组栓塞时间为(11.4±2.1)min,B组为(29.2±4.3)min,A组栓塞时间明显较B组缩短(P<0.05)。A组栓塞后血管周围炎症反应均较B组低(P<0.05),栓塞血管相符率较B组高。结论三丙烯微球与PVA颗粒动脉栓塞效果相似,安全有效,但三丙烯微球比PVA颗粒操作简便,可预见性强,组织相容性好,是值得临床应用和推广的栓塞剂。     

非肿瘤性肾动静脉畸形或瘘节段性肾动脉栓塞治疗

目的　分析非肿瘤性肾动静脉畸形或瘘引起肾出血节段性肾动脉栓塞治疗的方法及疗效 ,探讨栓塞后肾脏再出血的原因及处理措施。方法　 4例肾出血患者 ,其中 2例先天性肾动静脉畸形 (AVM) ,2例肾穿刺后并发肾动静脉瘘 (AVF)。经股动脉插管行肾动脉及其分支造影 ,用明胶海绵、钢丝圈或无水酒精超选择性栓塞病变血管。结果　 4例畸形血管均闭塞 ,出血停止 ,全部病例在栓塞后无严重并发症发生 ;1例先天性AVM病人用钢丝圈及明胶海绵栓塞 8个月后再出血 ,经无水酒精再次栓塞后出血停止 ,随访 9个月无再出血。结论　肾动脉造影是诊断肾脏AVM和AVF的可靠方法 ;节段性肾动脉栓塞术是治疗肾脏AVM和AVF有效、安全的微创性手术 ;少数病例再发出血 ,可能与栓塞剂类型的选择和病变的特点有关 ,需应用永久性栓塞剂或多种栓塞剂联合治疗 ,甚至外科手术处理。     

损伤性肾出血的动脉栓塞治疗

目的:探讨经保守治疗无效的损伤性肾出血的动脉介入治疗的临床疗效。方法:23例经肾动脉造影证实的肾损伤后肾出血患者,采用明胶海绵颗粒和/或弹簧圈超选择性行肾动脉栓塞治疗。结果:23例患者经肾动脉造影均可明确肾出血部位,单支肾动脉出血者15例,2～3支肾动脉出血者7例;共置入弹簧圈45枚,栓塞后造影显示出血动脉中断、闭塞,对比剂外溢、染色现象消失,术后1～3d患者临床症状明显缓解,2～4个月后血液检查示肌酐、尿素氮均在正常范围内,而且均未出现肾性高血压征象。结论:超选择肾动脉栓塞术治疗损伤性肾出血创伤小、疗效好、并发症少、能最大限度的保护肾脏功能,是一种安全、有效的治疗方法。     

创伤性肾出血的DSA诊断与介入栓塞治疗

目的评价创伤性肾出血的DSA诊断与介入栓塞止血治疗的临床应用价值。资料与方法48例创伤性肾出血患者均行肾动脉DSA检查,栓塞材料采用明胶海绵、聚乙烯醇(PVA)微粒或弹簧钢圈。结果48例肾内血管损伤患者经选择性或超选择性肾动脉造影均获得了明确的诊断,36例可见对比剂外溢;7例肾内受损动脉痉挛、移位,末梢血管不规则、毛糙、其中3例合并动-静脉瘘;5例肾内受损动脉分支中断、缺支,其中2例合并假性动脉瘤。6例单纯采用明胶海绵栓塞后,其中2例分别于术后7天、12天再发血尿,其余病例采用PVA微粒或弹簧钢圈栓塞均一次成功。所有患者肉眼血尿术后平均3天消失,平均随访18个月无肾出血复发,血尿素氮、肌酐及血压正常,静脉尿路造影见肾未栓塞部分肾功能正常,栓塞部分肾盏有不同程度变形。结论DSA是诊断创伤性肾出血的可靠方法,选择性肾动脉栓塞治疗创伤性肾出血微创、疗效好且迅速、并发症少,能最大程度保护损肾功能。选择恰当的栓塞材料可以减少复发率及异位栓塞。     

聚丙烯腈多块共聚物肾动脉栓塞的实验研究

聚丙烯腈(PAN)可作为一种新型的治疗用栓塞剂。本研究旨在检测PAN的二种液态制剂和其固态微粒制剂(微粒直径100～400微米)的栓塞效果。将18只白兔平均分成三组,分别用上述的一种制剂进行单侧肾动脉栓塞。PAN对所有被栓塞的肾脏均能造成梗塞。采用血管造影和病理检查观察其梗塞效用,结果表明PAN是一个可靠而有效的肾动脉栓塞剂。     

肾部分切除术后尿漏介入栓塞治疗(2例并文献复习)

目的 探讨介入栓塞治疗在肾部分切除术后尿漏的临床应用及疗效.方法 报道2例肾部分切除术后尿漏患者的治疗,手术采用Seldinger方法穿刺右股动脉,将5 F Cobre导管置于患侧肾动脉内,造影确定残余肾动脉分支后,用PVA颗粒及微弹簧圈栓塞病变血管及分支,术后观察患者症状改善情况及相关并发症的发生.结果 2例患者均取得满意疗效,术后第1日引流液即明显减少.1例栓塞术后3d拔除引流管,1例栓塞术后2周拔除引流管.2例术中及围术期均无明显并发症发生.随访至今,无肾积水及肾功能损害发生.结论 超选择性肾动脉栓塞术以其微创、安全、有效、可以最大限度保留肾功能等优点,成为治疗肾部分切除术后尿漏的首选方法.     

医源性肾血管损伤出血的介入治疗

目的评价应用血管内栓塞技术治疗医源性肾血管损伤出血的安全性和疗效。 方法对34例医源性肾血管损伤出血患者进行了超选择性肾动脉栓塞治疗。损伤原因有肾脏穿刺活检术后14例,肾部分切除术后8例,经皮肾镜碎石术后8例,经皮肾盂造瘘术后3例,经皮氩氦刀术后1例。栓塞材料包括微钢丝圈、氰基丙烯酸正丁酯碘油混合物、聚乙烯醇微球、明胶海绵碎粒。 结果选择性肾动脉造影显示肾实质假性动脉瘤21例,肾动静脉瘘8例,肾实质破裂造影剂外溢10例。栓塞技术成功率为100%,治疗结束时复查造影显示异常血管消失,正常分支保留。30例患者栓塞后失血症状改善,栓塞后30天内出院,4例患者术前伴失血性休克,栓塞后10天内死亡。30例患者随访5～48个月均未再出血,也未出现其他严重并发症,16例死于原发疾病。 结论经导管选择性肾动脉分支栓塞术是治疗医源性肾血管损伤出血安全有效的方法。     

医源性肾血管损伤的急诊血管内栓塞治疗

目的评价用介入技术治疗医源性肾血管损伤的安全性和疗效。方法对9例医源性肾血管损伤患者进行了超选择性肾动脉栓塞治疗。损伤原因有行肾脏穿刺活检术后5例、血管内介入治疗术后2例、经皮穿刺右肾盂造瘘术后1例、肾脏肿瘤局部切除术后1例。临床表现有失血性休克7例、患侧剧烈腰痛7例、血尿8例;CT和超声波检查发现肾脏周围血肿8例。栓塞材料用微型钢丝圈7例、普通钢丝圈2例,同时用聚乙烯醇微球5例、用明胶海绵碎粒2例。结果选择性肾动脉造影显示肾实质内动静脉瘘6例、假性动脉瘤2例、肾实质血管破裂对比剂外溢1例。本组9例均栓塞成功;治疗结束时复查造影显示异常血管消失,正常分支保留。7例失血症状明显者,栓塞后经给予补充血容量、失血症状迅速改善;7例剧烈腰痛者,术后2～4d腰痛消失;血尿8例,术后2～14d消失。术后原有肾功能不全加重3例、新出现肾功能不全2例,其中2例接受血液透析治疗。超声复查显示肾周围血肿于2～4个月逐渐吸收。随访6～78个月(平均38个月),4例死于原发疾病,5例健在、未再针对肾脏损伤进行外科或介入治疗,未再发生出血,血肌酐、尿素测定属正常范围。结论经导管选择性肾动脉分支栓塞术是治疗医源性肾脏血管损伤的安全、有效方法。     

中药白芨作为栓塞剂运用于骨骼肿瘤的治疗

目的：评价中药白芨作为栓塞的对骨骼系统肿瘤治疗的临床疗效。材料与方法：６例患分别患有骨母细胞肉瘤，软骨母细胞肉瘤，纤维肉瘤并骨转移，肺癌耻骨转移，脊索瘤及纤维异常增殖症，行动脉选择性造影后病人知动脉注入白芨颗粒达到完全栓塞，再采用平片，血管造影及手术后病理分析评价疗效。结果：（１）３例恶性骨肿瘤栓塞后使原有剧疼症状明显减轻；（２）２例恶性骨肿瘤栓塞后１个月显示病灶内明显钙化；（３）５例手术后病理     

Degradable gelatin microspheres as an embolic agent: an experimental study in a rabbit renal model.

OBJECTIVE: To investigate the basic characteristics of degradable gelatin microspheres (GMSs), including their embolic behavior and degradation periods when they are used as embolic materials in the renal arteries of rabbit models. MATERIALS AND METHODS: Based on the GMS particle size, 24 kidneys were divided into 3 groups of eight kidneys, and each group was embolized with a different GMS particle size (group 1: 35-100 microm, group 2: 100-200 microm, and group 3: 200-300 microm). From each group, two rabbits were sacrificed immediately after embolization (day 0), and a pair of rabbits from each group underwent an angiogram and were sacrificed on days 3, 7, and 14, respectively, after embolization. The level of arterial occlusion, the pathological changes in the renal parenchyma, and the degradation of the GMSs were evaluated angiographically and histologically. RESULTS: A follow-up angiogram on days 0, 3, 7, and 14 revealed the presence of wedge-shaped poorly-enhanced areas in the parenchymal phase as seen in all groups. The size of these areas tended to increase with the particle diameter, and persisted up to day 14. On days 3, 7, and 14, parenchymal infarctions were observed histologically in all cases, and this observation corresponded with the parenchyma being supplied by the embolized arteries. GMSs of group 1 mainly reached the interlobular arteries, while those of group 3 mainly reached the interlobar arteries. In all but two cases, the GMSs were identified histologically even on day 14, and sequential degradation was histologically identified in all GMS groups. CONCLUSION: GMSs can be used as degradable embolic materials which can control the level of embolization.     

Pathologic evaluation of a spherical polyvinyl alcohol embolic agent in a porcine renal model

PURPOSE: To evaluate the effects of a spherical embolic agent consisting of polyvinyl alcohol (PVA) and to compare this agent with commercially available embolization agents. MATERIALS AND METHODS: Eleven miniature pigs were included in the study population. The upper poles of both kidneys were selected as the target organs for embolization. PVA spheres (700-900 micro m) were used in nine kidneys, PVA particles (500-710 micro m) were used in six kidneys, gelatin spheres (700-900 micro m) were used in five kidneys, and gold-colored gelatin spheres (700-900 micro m) were used in three kidneys. Two animals were killed immediately after embolization. In the remaining animals, angiography was performed before sacrifice 7 days (in five pigs) or 28 days (in four pigs) after embolization. Pathologic and histologic evaluation of the kidneys was performed. RESULTS: All agents resulted in target vessel occlusion and end-organ infarction. All arteries embolized with spherical agents were recanalized at follow-up angiography. In vessels embolized with PVA particles, the occluding plug consisted of thrombus and PVA. In vessels embolized with spherical agents, the occluding plug consisted mostly of the embolic agent. PVA spheres were associated with the mildest inflammatory responses at 7 and 28 days when compared with PVA particles and gelatin-based microspheres. Arterial wall destruction was seen to a greater extent in kidneys embolized with gelatin-based microspheres than in those embolized with PVA-based agents. CONCLUSIONS: The spherical, PVA-based embolization agent resulted in target organ infarction and temporary arterial occlusion. The inflammatory response to PVA spheres was significantly less aggressive than the response to other agents tested. Further study with clinical and long-term pathologic follow-up is suggested to determine if these findings may have favorable clinical implications for patients undergoing embolization procedures.     

支气管动脉畸形致大咯血的血管造影检查和栓塞治疗

目的：探讨支气管动脉造影及栓塞术对支气管动脉畸形致大咯血的诊治价值。材料和方法：对7例不明原因的大咯血患者急诊或择期支气管动脉数字减影血管造影（DSA）检查，对异常血管用聚乙烯泡沫醇（PVA）颗粒或明胶海绵颗粒加钢圈栓塞。结果：共发现9支畸形支气管动脉，表现为一侧或双侧支气管动脉扭曲、分支增多，粗细不均，远端有弥漫造影剂浓染者3例，伴有一处或多处支气管动脉－肺动脉瘘者4例。除1例明胶海绵及钢圈栓塞患者1周内复发外，PVA栓塞者平均随访27．5月未见复发。结论：支气管动脉造影可明确致大咯血的支气管动脉畸形，栓塞治疗可望获得良好的远期疗效。     

Relative rates of blood flow reduction during transcatheter arterial embolization with tris-acryl gelatin microspheres or polyvinyl alcohol: quantitative comparison in a swine model

PURPOSE: To determine whether two commonly used embolic agents have differing rates of blood flow reduction during transcatheter embolization of the renal arteries in an animal model. MATERIALS AND METHODS: The renal arteries of 10 pigs were embolized with either polyvinyl alcohol (300-500 or 500-700- micro m) or tris-acryl gelatin microspheres (300-500 or 700-900- micro m). Equivalent unit doses of each agent were suspended in 40 mL of fluid and injected in 1-mL aliquots for 20 mL and then in 5-mL aliquots for 20 mL. Blood flow was measured after each aliquot with an intraarterial Doppler flow wire placed through the embolization catheter. RESULTS: Renal arterial blood flow was most rapidly and reliably decreased by 300-500- and 700-900- micro m microspheres, both of which had achieved >90% reduction from baseline flow after the injection of 6 mL of suspension. An equivalent reduction in flow required 25 mL of 300-500- micro m PVA suspension and 30 mL of 500-700- micro m PVA suspension. The reduction in blood flow with microspheres was significantly greater (P <.05) than that with PVA between 5 and 19 mL of suspension delivered. Differences between larger and smaller particle sizes of the same agent were not statistically significant. CONCLUSIONS: Tris-acryl gelatin microspheres reduced renal blood flow more quickly and reliably than did PVA. The type of agent used in embolization had a greater impact on the rate of flow reduction than did particle size in the range of sizes tested.     

Chemical ablation of the canine kidney using sodium tetradecyl sulfate (Sotradecol). A histopathologic study

We studied the histopathologic effect of intraarterial Sotradecol (Elkins-Sinn, Inc., Cherry Hill, NJ) on the kidney and examined the mechanism for destruction of renal parenchyma by Sotradecol. Sotradecol was injected into one renal artery distal to an occlusion balloon catheter in six dogs, and the kidneys were removed for histologic examination; four dogs within 20 minutes, and one each at 12 and 24 hours after embolization. The contralateral kidney of each dog underwent the same procedure but was injected with normal saline, and served as control. Histologic examination of the control kidneys was unremarkable. The embolized kidneys revealed extensive endothelial denudation and mural necrosis of the arteries and coagulation necrosis of the renal parenchyma. The changes were evident as early as 20 minutes after embolization, and necrosis became complete by 24 hours. The arteries were filled with red blood cell sludge. Sotradecol produces extensive tissue necrosis and complete renal parenchymal destruction through its direct cytotoxic action on the arterial wall, blood cell elements, and renal parenchyma.     

Looking for the Ideal Particle: An Experimental Embolization Study

This study sought to compare the most frequently used embolic particles in an animal model. In 16 New Zealand white rabbits, right renal arteries were embolized using four different embolic particles (polyvinyl alcohol [PVA] particles, 150–250 μm; PVA microspheres [PVAMs], 150–300 μm; Tris-acryl gelatin microspheres [TGMs], 100–300 μm; expanding microspheres [EXMs], 50–100 μm). Quantity of embolic material used, embolization time, and angiographic patterns were documented. Fourteen days later, a control angiography was done to document angiographic recanalization and all animals were sacrificed. Histopathological specimens were analyzed for microscopic appearance and granulometric size of the particles, extravasation of the particles, perivascular inflammation, and neocapillarization. The volume of the infarct area in each kidney was calculated. Results revealed a significantly lesser amount of embolic material used in the EXM group (p = 0.020). The angiographic recanalization rate in the EXM group (100%), compared with the PVA (0%) and TGM (0%) groups, was found to be statistically significant (p = 0.014). Although 75% of the renal arteries embolized with PVAMs were recanalized, this was not found to be statistically significant (p = 0.071). Occlusion levels in the PVA group were more proximal than with any of the microspheres. While there was no extravasation in the TGM group, extravasation rates in the PVA, PVAM, and EXM groups were 50%, 25%, and 75%, respectively. A mild degree of inflammation was noted in the PVA, PVAM, and TGM groups. EXMs caused a moderate degree of inflammation in two kidneys (50%). There was neocapillarization in the vessel lumen in all kidneys in the PVA and PVAM groups. The difference was significant (p = 0.014) compared with the TGM and EXM groups, which did not have any neocapillarization. Regarding infarct area volumes, the difference among the groups was significant (p = 0.022). EXMs caused significantly (p = 0.021) less infarction than the other embolic agents. We conclude that EXMs are less efficient due to a high recanalization rate and lesser volume of infarct compared with the other embolic agents in the rabbit kidney model. The most efficient embolization was seen in kidneys embolized with TGMs.     

中药白芨胶作为血管栓塞剂的实验研究

目的研究中药白芨胶作为血管栓塞剂的有效性、安全性及相关特性。材料与方法从中药白芨茎块中提取有效成分，制备成白芨胶栓塞剂。对其进行一系列有关特性的鉴定，并应用白芨胶进行４头健康猪的肝动脉栓塞实验。结果（１）白芨胶为一种均质的胶状物，有一定粘滞性，相对粘度２３２４．６ｍｍ２／ｓ，不透Ｘ线，易经４Ｆ导管注射；（２）白芨胶具有良好的血液相容性和组织相容性，无致热原性及毒性作用；（３）白芨胶－丝裂霉素Ｃ（ＭＭＣ）体外混合后，无分层及悬浮现象，释放ＭＭＣ５０％约需１．８小时，１００％需３．４小时；（４）白芨胶主要栓塞末梢小动脉，栓塞牢靠，维持时间可达５周，不易形成侧支循环；（５）白芨胶栓塞对正常肝组织损伤轻微，未出现肝细胞坏死。结论白芨胶具有良好的血管栓塞作用、载体特性和缓释特性，使用方便、安全，是一种较理想的末梢型血管栓塞剂。     

Chitin-based embolic materials in the renal artery of rabbits: pathologic evaluation of an absorbable particulate agent

PURPOSE: To prospectively evaluate the tissue reaction to and the embolic effect and absorption of chitin and chitosan microspheres and polyvinyl alcohol (PVA) in the renal artery of rabbits. MATERIALS AND METHODS: This experiment was performed in accordance with regulations on animal care and experiments. Thirty-six New Zealand white rabbits were divided into four groups according to the materials (PVA, chitin particles, and chitosan particles, and chitosan microspheres; diameter, 150-250 microm) used for embolization of the right renal artery. A rabbit from each group was sacrificed 1 and 3 days and 1, 2, 4, 8, 16, 24, and 32 weeks after embolization. Gross and microscopic pathologic findings were examined with hematoxylin-eosin, Masson trichrome, and Victoria blue staining. RESULTS: Gross pathologic findings were examined, and swelling of embolized kidneys was observed 1 and 3 days after embolization, whereas shrinkage of the embolized kidneys was consistently seen after 2 weeks, with a hard consistency and nodular surfaces being noted. At histologic analysis, chitosan microspheres filled the lumen more compactly than did other particles. With PVA, a large amount of capillary formations occurred within the embolized arteries, whereas chitin particles and chitosan microspheres showed a lower rate of capillary formation. The shape of all embolic materials remained intact until week 8, at which time the materials gradually decreased in size and number. The chitosan particles and the chitosan microspheres were absorbed around weeks 16 and 24, respectively. CONCLUSION: Chitosan microspheres have great potential as a new embolic material since they block blood vessels more compactly with a lower rate of capillary formation. This material is biocompatible, and it is absorbed 24 weeks after embolization.     

应用自体毛发进行动脉性栓塞的实验研究

目的：探讨不同长度体毛的栓塞价值。方法：对6只狗15个脏器随机分为3组。A组：用长体毛栓塞肾脏4个，脾脏1个。B组：用体毛颗粒栓塞脾脏3个，肝脏1个。C组：用混合体毛栓塞肾脏5个。每只狗栓塞后饲养2周处死取标本观察。栓塞前后及处死前分别进行血管造影。结果：13个脏器栓塞后血管造影有供血减少，血流减慢；9个脏器出现造影剂明显分布不均；长体毛栓塞的10支动脉干2周后造影；3支出现充盈缺损，2支出现狭窄，而标本显示9支动脉干内有血栓形成。13个标本出现组织坏死，2个脏器无明显改变。A组栓塞面积约40%，B组栓塞面积约50%，C毛组栓塞面积约70%。结论：不同长度的体毛具有不同的动脉栓塞作用。因此，可以根据需要选择不同长度的体毛栓塞不同的靶血管。