超声造影引导下注射明胶基止血剂治疗犬脾脏创伤的疗效  

Percutaneous therapy of hemostatics of injected gelatin matrix under the guidance of contrast-enhanced ultrasound for splenic trauma in canine

作　　者：田江克[1] 谢霞[2] 武荣[2] 吕发勤[2] 罗渝昆[2] 唐杰[2] 

机构地区：[1]解放军第三〇二医院超声科,北京100039 [2]解放军总医院超声诊断科

出　　处：《中华医学超声杂志（电子版）》2013年第9期769-775,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金资助项目(81071279);卫生公益事业基金资助项目(201302017)

摘　　要：目的探讨超声造影引导下注射可注射性明胶基止血剂(HIGM)治疗犬脾脏创伤的效果。方法 24只健康杂种犬常规麻醉,开腹后暴露脾脏,用止血钳在脾脏膈面制作长、宽、深分别为4.0、4.0、2.5cm的脾脏实质锐器伤。实验犬随机均分为治疗组与对照组2组,每组各12只犬。治疗组实验犬超声造影引导下注射4mlHIGM,对照组实验犬超声造影引导下注射4ml蛇毒凝血酶和α-氰基丙烯酸酯对脾脏创伤灶行局部注射治疗。常规超声检查及超声造影观察注射后即刻疗效,并在注射后第1、3、7、14、21天行常规超声检查及超声造影分别观察、记录实验犬腹腔积液深度和脾脏创伤灶面积。治疗组实验犬于注射后第7、14、21天行组织病理学检查。应用t检验分别比较治疗组与对照组实验犬腹腔积液深度、脾脏创伤灶面积。结果所有实验犬均存活。治疗组实验犬在超声造影引导下注射HIGM后即刻,脾脏损伤区域均未见活动性出血;注射后第1、3、7天脾脏创伤灶面积分别为(12.91±0.89)、(4.45±0.75)、(1.38±0.23)cm2,注射后第14、21天均未见创伤灶回声;对照组实验犬注射后第1、3、7、14天脾脏创伤灶面积分别为(16.74±0.91)、(11.26±0.99)、(8.02±0.82)、(1.58±0.36)cm2,注射后第21天均未见创伤灶回声。注射后第7、14天治疗组与对照组实验犬脾脏创伤灶面积差异有统计学意义(t=27.162,P=0.008;t=15.129,P=0.001)。治疗组实验犬注射后第1天腹腔积液深度为(0.91±0.05)cm,注射后第3、7、14、21天均未见腹腔积液;对照组实验犬注射后第1、3、7天腹腔积液深度分别为(1.96±0.17)、(1.30±0.11)、(0.81±0.12)cm,注射后第14、21天均未见腹腔积液。注射后第1、3、7天治疗组与对照组实验犬腹腔积液深度差异有统计学意义(t=20.934,P=0.003;t=41.310,P=0.000;t=22.520,P=0.000)。注射后第21天治疗组实验犬大体标本显示脾脏组织愈合良好,未见粘连。注射后Objective To evaluate the efifcacy and safety of hemostatics of injected gelatin matrix (HIGM) under the guidance of contrast-enhanced ultrasound (CEUS) for treating splenic trauma in canine model. Methods A total of 24 commercial hybrid dogs underwent celiotomy with creation of uniformly blunt splenic trauma lesion of 4.0 cm×4.0 cm×2.5 cm (length, width and depth, respectively) by hemostatic clamp. Subjects were prospectively randomized into two groups. The treatment group was treated with HIGM under the guidance of CEUS and the positive control group received thrombin solution. Conventional ultrasound and CEUS were performed to record the ascites and the splenic lesion areas at 1st, 3rd, 7th, 14th and 21st day. The ifne needle biopsy and splenectomy were performed for histopathologic examination. The weight, free intraperitoneal lfuid and injury site were compared with t test between HIGM and postive group. Results All animals in two groups survived. All dogs stopped hemorrhage after injection of HIGM under CEUS guidance. The area of injury site was (12.91±0.89) cm2, (4.45±0.75) cm2 and (1.38±0.23) cm2 at 1st, 3rd and 7th day and splenic lesions were not found at 14th and 21st day in all dogs (n=12) of HIGM group. The splenic lesion was (16.74±0.91) cm2, (11.26±0.99) cm2, (8.02±0.82) cm2 and (1.58±0.36) cm2 in the postive group at 1st, 3rd, 7th and 14th day and splenic lesions were not found at 21st day in all dogs (n=12). At 7th and 14th day post-injection, lesion areas were statistically significant between two groups (t=27.162, P=0.008;t=15.129, P=0.001). Free intraperitoneal lfuid was (0.91±0.05) cm at 1st day detected by conventional ultrasound and free intraperitoneal fluid was not found at 3rd, 7th, 14th and 21st day in all dogs (n=12) of HIGM group. The free intraperitoneal fluid in thepositive group was (1.96±0.17) cm, (1.30±0.11) cm and (0.81±0.12) cm at 1st, 3rd and 7th day and free intraperitoneal lfuid was not found at 14th and 21st day in all dogs (n=12). At 1st, 3rd and 7th day post-

关 键 词：超声检查 造影剂 创伤和损伤 脾 止血药 治疗结果 

分 类 号：R657.6[医药卫生—外科学] R445.1[医药卫生—临床医学]