摘要
目的 观察明胶海绵栓塞肠系膜上动脉 (SMA)分支后肠壁缺血改变程度 ,探讨最佳可栓塞动脉级别、最大可耐受栓塞范围以及栓塞剂颗粒的大小。方法 2 0只犬随机分为 4组 ,采用 3F微导管以明胶海绵 (GEF)作为栓塞材料超选择栓塞肠系膜上动脉分支。A、B两组分别采用直径 5 0 0～ 1 0 0 0μm ,1mm× 2mm的GEF颗粒在SMA二级分支末梢段水平栓塞。C、D两组分别采用 1mm× 2mm的GEF颗粒在 2、3支毗邻的SMA二级分支末梢段水平栓塞。术后 2d处死动物 ,取栓塞动脉供血相应肠段及系膜 ,测量其长度 ,并行大体观察和病理学检查。结果 栓塞技术成功率 1 0 0 %。A组肠壁呈重度缺血坏死性改变。B组肠壁各层未见缺血性改变。C组肠壁各层呈现轻度缺血性改变。D组肠壁缺血呈移行改变。A、B两组栓塞范围的差异无显著性 (P >0 .0 5 ) ,B组与C组、C组与D组间栓塞范围差异均有显著性。结论 GEF作为栓塞剂 ,其大小应控制在 1mm× 2mm左右 ,栓塞部位最好选择在末级动脉弓前一级分支末梢 ,最大栓塞范围为相互毗邻的
Objective To investigate the most plausible location, range of vessel occlusion and the most appropriate size of embolic material particle by observing the degree of ischemic changes of the intestine after embolization of superior mesenteric artery(SMA) branches with gelfoam(GEF). Methods Twenty dogs were divided randomly into four groups. Superselective arterial embolization was performed using the modified 3F microcatheter with GEF. The distal segments of secondary order branches of SMA were occluded with GEF particles 500-1000 μm and 1 mm×2 mm in group A and B, respectively. Two and three adjacent distal segments of secondary order branches of SMA were occluded individually with GEF particles 1 mm×2 mm in group C and D. All the animals were sacrified 2 days after the procedure. The examinations of the gross and microscopic pathologic changes were carried out on the removed arterial embolized intestinal segments. Results The embolization were successful in all dogs. In group A, severe ischemia in the intestinal wall occurred in all five dogs. In group B, all layers of the intestinal wall were kept intact without ischemic change. In group C, mild ischemic changes were found. In group D transitional ischemic changes were found. There is no significant difference between group A and B( P >0.05), but there are significant differences between gorup B and C; and group C and D ( P <0.05) according to the embolization extent. Conclusions Using GEF as the embolic material, the most appropriate particle size is approximately 1 mm×2 mm, and the plausible priority location of vessel occlusion is the distal segment of first branch of the pre terminal arterial arcade outcoming with the most promising effect on the occlusion extent with the 2 adjacent involved branches.
出处
《介入放射学杂志》
CSCD
2003年第6期445-448,共4页
Journal of Interventional Radiology
