肺动脉栓塞法肺减容可行性研究  

The feasibility study of lung volume reduction with pulmonary embolization

作　　者：谢远财[1] 陈在中[2] 温见翔[3] 乌达[1] 赵洋[4] 幸波[1] 

机构地区：[1]北京大学深圳医院胸外科,广东深圳518036 [2]北京大学深圳医院介入科 [3]北京大学深圳医院检验科 [4]北京大学深圳医院病理科

出　　处：《罕少疾病杂志》2010年第3期15-18,共4页Journal of Rare and Uncommon Diseases

基　　金：广东省深圳市科技计划项目(项目编号:200802012)

摘　　要：目的探讨肺动脉栓塞法肺减容的可行性。方法 26只新西兰大白兔,体重2.0-2.5kg,雌雄不限,分为实验组和对照组,对照组2只,实验组24只,均经股静脉插管至右心室,实验组应用明胶海绵行肺动脉栓塞,对照组仅注入生理盐水5ml。实验组动物分别于栓塞后2h、1周、2周、3周、4周处死,对照组均于第4周末处死,行肺脏解剖,观察栓塞肺组织病理改变。结果 5只兔在实验中猝死,19只成功栓塞的兔中有7只兔的肺组织出现病理性改变,动物栓塞2h见肺组织局部变暗红,肺组织充血、水肿,镜下见肺泡间隔增宽、渗血、炎细胞浸润、小血管扩张,肺泡受压、变形;1周后,栓塞肺组织变黑、变硬、失去弹性,镜下见肺疱间隔增宽、少量炎性细胞浸润,小支气管内见纤维渗出,肺疱塌陷;2周后,栓塞肺组织变黑、变硬,镜下可见肺组织坏死,炎性细胞浸润减轻,纤维组织增生,肺泡结构破坏;3周后,栓塞肺组织缩小、变硬,镜下可见纤维组织增生,肺泡结构破坏、消失,局部少量纤维组织;4周后见梗塞肺呈索条状改变,镜下见肺组织结构消失,代之为纤维结缔组织。对照组2只兔肺组织无明显变化。结论兔行人工肺动脉栓塞是可以耐受的,通过肺动脉栓塞的方法可以使肺缺血、梗死、纤维化而使肺容积缩小。Objective To investigate the feasibility of lung volume reduction with pulmonary embolization. Methods 26 New Zealand white rabbits,weighing 2.0-2.5kg,were divided into experimental and control group. In the experimental group（24）,the gelatin sponge was delivered into the pulmonary artery through a catheter from the femoral vein to the right ventricle. In the control group（2）,the pulmonary artery only injected with 5ml normal saline. The experimental animals were killed 2h,1week,2weeks,3weeks,4weeks postoperative in the control group and the animals of control group were killed in 4weeks postoperative. The anatomy and pathological changes were investigated in all animals. Results Five rabbits during the experiment were sudden death and 19 rabbits were embolized successfully. The pathological changes of lung were observed in 7 rabbits. The lung were changed into dull red,congestion,edema in 2h after embolization. Under microscope,alveolar septum widened,bleeding,inflammatory cell infiltration,small vessels expanded,alveolar was pressured and deformation;1 week later,the embolization lung was black,hard,and loss of elasticity. Under microscope,the alveolar septum widened,the inflammatory cell and cellulose could be seen,the lung alveolar collapsed;2 weeks after embolization the lung tissue was black and hard. Under the microscope,the necrosis and fibrous tissue hyperplasia were observed,the inflammatory cell was decreased,the alveolar structural damage; 3 weeks after embolization reduced lung tissue,hardening,microscope,fibrous tissue hyperplasia,alveolar structure damaged;4 weeks later,the lung structure was disappeared,replaced by the fibrous connective tissue. In the control group,there was no changes in the lung tissue. Conclusion The rabbits with artificial pulmonary embolism could tolerated,by means of pulmonary embolism could make the lung ischemia,infarction,fibrosis and reduced lung volume at last.

关 键 词：肺 肺栓塞 肺减容术 动物 

分 类 号：R543.2[医药卫生—心血管疾病]