中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2013年
9期
65-70
,共6页
田江克%谢霞%武荣%吕发勤%罗渝昆%唐杰
田江剋%謝霞%武榮%呂髮勤%囉渝昆%唐傑
전강극%사하%무영%려발근%라투곤%당걸
超声检查%造影剂%创伤和损伤%脾%止血药%治疗结果
超聲檢查%造影劑%創傷和損傷%脾%止血藥%治療結果
초성검사%조영제%창상화손상%비%지혈약%치료결과
Ultrasonography%Contrast media%Wounds and injuries%Spleen%Hemostatics%Treatment outcome
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、2.5 cm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4 ml HIGM，对照组实验犬超声造影引导下注射4 ml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。注射后第7、14、21天治疗组实验犬组织病理学检查未见明显异物及异物肉芽肿，可见红髓结构逐渐修复。结论超声造影引导下新型止血药物HIGM用于脾脏外伤止血治疗有应用价值，为临床治疗提供了初步的实验依据。
目的探討超聲造影引導下註射可註射性明膠基止血劑（HIGM）治療犬脾髒創傷的效果。方法24隻健康雜種犬常規痳醉，開腹後暴露脾髒，用止血鉗在脾髒膈麵製作長、寬、深分彆為4.0、4.0、2.5 cm的脾髒實質銳器傷。實驗犬隨機均分為治療組與對照組2組，每組各12隻犬。治療組實驗犬超聲造影引導下註射4 ml HIGM，對照組實驗犬超聲造影引導下註射4 ml蛇毒凝血酶和α-氰基丙烯痠酯對脾髒創傷竈行跼部註射治療。常規超聲檢查及超聲造影觀察註射後即刻療效，併在註射後第1、3、7、14、21天行常規超聲檢查及超聲造影分彆觀察、記錄實驗犬腹腔積液深度和脾髒創傷竈麵積。治療組實驗犬于註射後第7、14、21天行組織病理學檢查。應用t檢驗分彆比較治療組與對照組實驗犬腹腔積液深度、脾髒創傷竈麵積。結果所有實驗犬均存活。治療組實驗犬在超聲造影引導下註射HIGM後即刻，脾髒損傷區域均未見活動性齣血；註射後第1、3、7天脾髒創傷竈麵積分彆為（12.91±0.89）、（4.45±0.75）、（1.38±0.23）cm2，註射後第14、21天均未見創傷竈迴聲；對照組實驗犬註射後第1、3、7、14天脾髒創傷竈麵積分彆為（16.74±0.91）、（11.26±0.99）、（8.02±0.82）、（1.58±0.36）cm2，註射後第21天均未見創傷竈迴聲。註射後第7、14天治療組與對照組實驗犬脾髒創傷竈麵積差異有統計學意義（t=27.162，P=0.008；t=15.129，P=0.001）。治療組實驗犬註射後第1天腹腔積液深度為（0.91±0.05）cm，註射後第3、7、14、21天均未見腹腔積液；對照組實驗犬註射後第1、3、7天腹腔積液深度分彆為（1.96±0.17）、（1.30±0.11）、（0.81±0.12）cm，註射後第14、21天均未見腹腔積液。註射後第1、3、7天治療組與對照組實驗犬腹腔積液深度差異有統計學意義（t=20.934，P=0.003；t=41.310，P=0.000；t=22.520，P=0.000）。註射後第21天治療組實驗犬大體標本顯示脾髒組織愈閤良好，未見粘連。註射後第7、14、21天治療組實驗犬組織病理學檢查未見明顯異物及異物肉芽腫，可見紅髓結構逐漸脩複。結論超聲造影引導下新型止血藥物HIGM用于脾髒外傷止血治療有應用價值，為臨床治療提供瞭初步的實驗依據。
목적탐토초성조영인도하주사가주사성명효기지혈제（HIGM）치료견비장창상적효과。방법24지건강잡충견상규마취，개복후폭로비장，용지혈겸재비장격면제작장、관、심분별위4.0、4.0、2.5 cm적비장실질예기상。실험견수궤균분위치료조여대조조2조，매조각12지견。치료조실험견초성조영인도하주사4 ml HIGM，대조조실험견초성조영인도하주사4 ml사독응혈매화α-청기병희산지대비장창상조행국부주사치료。상규초성검사급초성조영관찰주사후즉각료효，병재주사후제1、3、7、14、21천행상규초성검사급초성조영분별관찰、기록실험견복강적액심도화비장창상조면적。치료조실험견우주사후제7、14、21천행조직병이학검사。응용t검험분별비교치료조여대조조실험견복강적액심도、비장창상조면적。결과소유실험견균존활。치료조실험견재초성조영인도하주사HIGM후즉각，비장손상구역균미견활동성출혈；주사후제1、3、7천비장창상조면적분별위（12.91±0.89）、（4.45±0.75）、（1.38±0.23）cm2，주사후제14、21천균미견창상조회성；대조조실험견주사후제1、3、7、14천비장창상조면적분별위（16.74±0.91）、（11.26±0.99）、（8.02±0.82）、（1.58±0.36）cm2，주사후제21천균미견창상조회성。주사후제7、14천치료조여대조조실험견비장창상조면적차이유통계학의의（t=27.162，P=0.008；t=15.129，P=0.001）。치료조실험견주사후제1천복강적액심도위（0.91±0.05）cm，주사후제3、7、14、21천균미견복강적액；대조조실험견주사후제1、3、7천복강적액심도분별위（1.96±0.17）、（1.30±0.11）、（0.81±0.12）cm，주사후제14、21천균미견복강적액。주사후제1、3、7천치료조여대조조실험견복강적액심도차이유통계학의의（t=20.934，P=0.003；t=41.310，P=0.000；t=22.520，P=0.000）。주사후제21천치료조실험견대체표본현시비장조직유합량호，미견점련。주사후제7、14、21천치료조실험견조직병이학검사미견명현이물급이물육아종，가견홍수결구축점수복。결론초성조영인도하신형지혈약물HIGM용우비장외상지혈치료유응용개치，위림상치료제공료초보적실험의거。
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-injection, free intraperatitoneal lfuid was statistically significant between two groups (t=20.934, P=0.003; t=41.310, P=0.000; t=22.520, P=0.000). Histopathological examination showed that there was no foreign body and foreign body granuloma and the structure of red pulp was recovered at 7th, 14th and 21st day. Gross anatomy showed that the splenic injury site was recovered completely without complications. Conclusion This study explored the value of HIGM for splenic trauma and provided a preliminary experimental evidence for clinical treatment.
