纤维蛋白胶复合平阳霉素栓塞硬化治疗面颈部静脉畸形的实验研究  

Experimental study on embolization and sclerotherapy of cervicofacial venous malformations with fibrin glue combined with pingyangmycin

作　　者：闫志伟 沈艳玲 郭军 刘源 杨霞 李欢 冯瑶[5] 孙沫逸 杨耀武 YAN Zhi-wei;SHEN Yan-ling;GUO Jun;LIU Yuan;YANG Xia;LI Huan;FENG Yao;SUN Mo-yi;YANG Yao-wu(State Key Laboratory of Military Stomatology,National Clinical Research Center for Oral Diseases,Shaanxi Clinical Research Center for Oral Diseases,Department of Oral and Maxillofacial-Head and Neck Tomour Surgery,School of Stomatology,Air Force Medical University,Xi'an 710032,Shaanxi Province;Department of Stomatology,Luoyang Central Hospital,Luoyang 471099,Henan Province;Department of Imaging Medicine,School of Stomatology,Air Force Medical University,Xi'an 710032,Shaanxi Province;Department of Oral Histology and Pathology,School of Stomatology,Air Force Medical University,Xi'an 710032,Shaanxi Province;Department of Dental Pulp Disease,School of Stomatology,Jiamusi University,Jiamusi 154002,Heilongjiang Province,China)

机构地区：[1]军事口腔医学国家重点实验室,口腔疾病国家临床医学研究中心,陕西省口腔疾病临床医学研究中心,空军军医大学口腔医院口腔颌面-头颈肿瘤外科,陕西西安710032 [2]洛阳市中心医院口腔科,河南洛阳410099 [3]空军军医大学口腔医院影像医学科,陕西西安710032 [4]空军军医大学口腔医院组织病理科,陕西西安710032 [5]佳木斯大学附属口腔医院牙髓病科,黑龙江佳木斯154002

出　　处：《中国口腔颌面外科杂志》2023年第4期340-344,共5页China Journal of Oral and Maxillofacial Surgery

基　　金：国家自然科学基金面上项目(81470757);陕西省重点研发计划项目(2022ZDLSF03-13);空军军医大学第三附属医院国家口腔疾病临床医学中心临床研究课题(LCB202002)。

摘　　要：目的:通过面颈部静脉畸形动物模型,评价纤维蛋白胶复合平阳霉素栓塞硬化技术的有效性。方法:选择15只绵羊,制备静脉畸形模型,将模型平均分为3组,分别给予平阳霉素、纤维蛋白胶、纤维蛋白胶复合平阳霉素注射。注射后4周,通过多普勒超声、大体及组织学观察评价纤维蛋白胶/平阳霉素栓塞硬化技术致血管纤维化的效果。结果:单纯平阳霉素注射4周后,静脉管壁略增厚,孔径略缩小,部分管腔通畅,部分管腔有血栓形成。多普勒超声检查显示静脉管腔通畅,有血流。组织学观察显示,大部分静脉内皮细胞形态、血管壁结构基本正常,部分静脉血管内膜连续性不完整,部分血管壁局部血管内膜消失,纤维组织增生。单纯纤维蛋白胶注射后4周,多普勒超声检查显示静脉血流消失或明显减少。大体观察见管壁增厚,管腔变细,管腔内见黄色或暗红色有一定韧性的胶冻样栓子。组织学观察显示管腔内有不定形物,成熟或不成熟纤维组织长入不定形物内,血管壁结构不清晰。纤维蛋白胶复合平阳霉素注射后4周,多普勒超声检查显示静脉腔血流消失。大体观察见管壁明显增厚,部分管腔内见黄色或暗红色栓子,部分管腔基本闭锁。组织学观察显示部分管腔内有不定形物,血管区域见大量成熟或不成熟的纤维组织,血管壁结构消失。结论:纤维蛋白胶复合平阳霉素栓塞硬化在促进血管内皮细胞破坏以及血管纤维化方面显示了良好效果,该技术在面颈部静脉畸形治疗领域具有潜在的优势和应用前景。PURPOSE:To evaluate the efficacy of embolosclerotherapy using fibrin glue(FG)combined with pingyangmycin(PYM)in animal model of cervicofacial venous malformations(VMs).METHODS:A total of 15 sheep were selected to make animal models of VMs.The VMs animal models were divided into PYM group,FG group,and FG/PYM group,which were injected with PYM,FG and FG/PYM respectively.Four weeks after injection,the effect of embolization and sclerotherapy on vascular fibrosis were evaluated through Doppler ultrasound,gross and histological observations.RESULTS:Four weeks after PYM injection,the venous wall was slightly thickened,the pore size was slightly reduced,some vascular lumens were unobstructed,and some had thrombosis.Doppler ultrasound showed clear venous lumen and blood flow.Histological observation showed that the morphology of most venous endothelial cells and the structure of the vascular wall were basically normal.The continuity of some venous intima was incomplete,and the local intima disappeared in some vascular walls and the fibrous tissue hyperplasia could be seen.Four weeks after FG injection,Doppler ultrasound showed that venous blood flow disappeared or decreased significantly.Gross observation showed thickening of the venous wall and narrowing of the lumen,and yellow or dark red jelly-like emboli with certain toughness were observed in the lumen.Histological observation showed that the lumen had an amorphous substance,mature or immature fibrous tissue grew into the amorphous mass,and the structure of the vessel wall was unclear.Four weeks after FG/PYM injection,Doppler ultrasonography showed loss of venous blood flow.Gross observation showed obvious thickening of the venous wall,yellow or dark red emboli were seen in some venous lumens,and some lumens were basically blocked.Histological observation showed that some lumens contained an amorphous substance,a large number of mature or immature fibrous tissues were seen in the vascular region,and the vessel wall structure was disappeared.Histological examination

关 键 词：静脉畸形 实验研究 栓塞 硬化治疗 面颈部 绵羊 

分 类 号：R782[医药卫生—口腔医学]