犬空肠动脉栓塞安全性的实验研究

目的通过超选择性插管人犬空肠动脉分支后用聚乙烯醇（polybvinyl alcohol particles，PVA）颗粒栓塞，观察肠壁缺血坏死程度和范围，探讨其安全性。方法44只犬随机分为A、B两组。A组（22只）：空肠动脉二级分支水平远端栓塞；B组（22只）：空肠末级动脉弓前一级分支水平栓塞。分别注入大小为150-250μm（A1组6只，B1组6只）、355～500μm（A2组8只，B2组8只）和710—1000μm（A3组8只，B3组8只）PVA颗粒。少量、缓慢、间断推注PVA，血流停滞时即停止。术后3、7、14d，处死犬取出空肠行大体及病理学观察。结果栓塞技术成功率为95．5％。PVA颗粒量为5．10mg。注入150～250μm、355～500μm、710～1000μmPVA颗粒肠坏死的发生率分别为：81．8％（9／11）、40．0％（6／15）、25．0％（4／16），组间差异具有统计学意义（P〈0．05）。A、B两组发生肠坏死的发生率分别为61．9％（13／21）、28．6％（6／21），组间差异有统计学意义（P〈0．001）。结论在同一栓塞水平下，PVA颗粒越小则越易发生肠坏死。最佳的栓塞水平在末级动脉弓前一级分支水平，PVA颗粒大小应选择710～1000μm。

Experimental Study of Safety of the Embolization of Jejunal Artery in Dogs

Objective To investigate the extent of intestinal necrosis after embolization of jejunal artery branches with polybvinyl alcohol particles （PVA）. Methods Forty-four dogs were randomly divided into two groups, Group A （n=22） and Group B （n=22）. Jejunal artery branches were embolized at the second level and the level prior to arterial arcade. PVAs with a size of 150-250 μm, 355-500 μm, 710-1 000 μm were injected slowly and intermittently until the stasis of blood. Jejunum was removed and prepared for pathological study at day-3, 7 and 14 after embolization. Results The success rate of embolization was 95.5%. The dosage of PVA was ranged from 5 mg to 10 mg. The necrosis rate of jejunum embolized with 150-250 μm, 355-500 μm, 710-1 000 μm PVA was 81.8%, 40%,25%, respectively, and the the results were significantly different between groups （P〈0.05）. The necrosis rate of Group A （61.9%） was significantly different from Group B（28.6%, P〈0.001）. Conclusion Embolization at the same branch level with a smaller size of PVA resulted in a higher necrosis rate. The preferred embolizing site was located at the branch level prior to arterial arcade and the appropriate diameter of PVA was 710-1 000 μm.