摘要
目的研究比较不同混合封堵剂对降低肺穿刺活检术后气胸并发症的影响及明胶海绵的有效性和安全性。方法将72只实验兔随机分成生理盐水组(A组)和50%葡萄糖溶液组(B组),各组再随机分为三个亚组:a_(1)组(生理盐水)、a_(2)组(生理盐水+明胶海绵颗粒350~560μm)、a_(3)组(生理盐水+自制明胶海绵碎末);b_(1)组(50%葡萄糖)、b_(2)组(50%葡萄糖+明胶海绵颗粒350~560μm)、b_(3)组(50%葡萄糖+自制明胶海绵碎末),肺穿后按既定分组材料行穿刺针道封堵,术后统计各组气胸发生率并进行统计学分析,分别于术后即刻、术后4天、术后8天及术后12天行CT扫描后处死实验兔,取包含混合封堵剂在内的针道周围肺组织,行常规HE染色,光镜下观察针道内混合封堵剂吸收情况及周围肺组织病理学改变。结果a_(1)组气胸发生率(72.7%)高于a_(2)组(33.3%)和a_(3)组(37.5%);b_(1)组气胸发生率(50.0%)高于b_(2)组(13.6%)和b_(3)组(12.5%);a_(3)组气胸发生率(37.5%)高于b_(3)组气胸发生率(12.5%),以上结果差异均有统计学意义(P<0.05);而a_(2)组气胸发生率(33.3%)低于a_(3)组(37.5%),b_(2)组气胸发生率(13.6%)高于b_(3)组(12.5%),差异均无统计学意义(P>0.05)。病理学结果表明:术后即刻所取病理可见混合封堵剂致密的填充于针道内,针道周围肺组织有受压表现;术后4天所取病理光镜下可见针道内为血液与明胶海绵混合物,明胶海绵密度较前有所减小,针道周围可见炎细胞及红细胞浸润;术后8天病理可见针道内混合封堵剂密度明显减小,针道边缘可见再生肺泡细胞;术后12天病理未见明显封堵剂材料。结论CT引导下肺穿刺活检术后使用自制明胶海绵碎末混合50%葡萄糖溶液所制成的封堵剂进行穿刺针道封堵可显著降低术后气胸发生率,该方法所制封堵剂安全有效、可吸收且价格低廉,值得临床推广应用。
Objective To compare the effect of different combination of mixed sealers on reducing pneumo-thorax complications after lung puncture biopsy and analyze the effectiveness and safety of gelatin sponge.Methods 72 experimental rabbits were randomly divided into the normal saline group(the group A)and the 50%glucose solution group(the group B),and each group was randomly divided into three subgroups:the group a_(1)(normal saline),the group a_(2)(normal saline+gelatin sponge particles 350-560μm),the group a_(3)(normal saline+homemade gelatin sponge crumbs),the group b_(1)(50%glucose),the group b_(2)(50%glucose+gelatin sponge particles 350-560μm),and the group b_(3)(50%glucose+homemade gelatin sponge crumbs),After lung perforation,puncture needle channel occlusion was performed according to the set group materials,and the incidence of pneumothorax in each group was statistically analyzed after surgery.The experimental rabbits were killed after CT scan immediately and 4,8 and 12 days after surgery,respectively,and lung tissues around the needle channel including mixed plugging agents were taken and routine HE staining was performed.The absorption of mixed plugging agent in the needle tract and the pathological changes of surrounding lung were observed under light microscope.Results The incidence of pneumothorax in the a_(1) group(72.7%)was higher than that in the a_(2) group(33.3%)and the a_(3) group(37.5%).The incidence of pneumothorax in the b_(1) group(50.0%)was higher than that in the b_(2) group(13.6%)and the b_(3) group(12.5%).The incidence of pneumothorax in the a_(3) group(37.5%)was higher than that in the b_(3) group(12.5%),and the differences were statistically significant(P<0.05).The incidence of pneumothorax in the a_(2) group(33.3%)was lower than that in the a_(3) group(37.5%),and the incidence of pneumothorax in the b_(2) group(13.6%)was higher than that in the b_(3) group(12.5%),without statistical significance(P>0.05).Pathological results showed that the mixed plugging agent was densely filled in the needle tract immediately after surgery,and the lung tissue around the needle tract was compressed.Pathologically,4 days after surgery,the mixture of blood and gelatin sponge could be seen in the needle passage,the density of gelatin sponge was reduced,and inflammatory cells and red blood cell infiltration could be seen around the needle passage.8 days after surgery,the density of mixed plugging agent in the needle channel decreased significantly,and regenerated alveolar cells could be seen at the edge of the needle channel.No obvious plugging agent material was found in pathology 12 days after operation.Conclusion After CT-guided lung puncture biopsy,the use of self-made gelatine sponge powder mixed with 50%glucose solution for puncture needle channel plugging can significantly reduce the incidence of postoperative pneumothorax.The plugging agent prepared by this method is safe,effective,absorbable and inexpensive,which is worthy of clinical promotion and application.
作者
郑文军
何俊峰
刘扬
石包圣
刘海龙
ZHENG Wenjun;HE Junfeng;LIU Yang;SHI Baosheng;LIU Hailong(Department of Ultrasound,the First Affiliated Hospital of Baotou Medical College,Baotou,Inner Mongolia 014010,China;Department of Radiotherapy,the First Affiliated Hospital of Baotou Medical College,Baotou,Inner Mongolia 014010,China)
出处
《临床肺科杂志》
2025年第12期1827-1832,共6页
Journal of Clinical Pulmonary Medicine
