CAJ | 학술논문

目的探讨血管腔内技术制备犬肝静脉阻塞布加综合征(BCS)模型的可行性、安全性和有效性.方法将24只犬随机分为实验组(n=18)和对照组(n=6).在数字减影血管造影(DSA)引导下,经右颈外静脉送入球囊导管至靶肝静脉(肝左、中静脉共干支),充盈球囊完全阻断血管.实验组经球囊导管端孔注入α-氰基丙烯酸正丁酯(NBCA)-超液化碘油混合液3～5 ml;对照组注入等量生理盐水.动态观察靶肝静脉阻塞后不同时间段肝功能、门静脉压力、靶肝静脉及其引流区肝组织结构的变化.结果建模成功率100％,两组均无肺栓塞、死亡等严重并发症.实验组术后第4、6、8周丙氨酸转氨酶分别为(52.5±12.5)U/L、(61.3±5.7)U/L、(38.6±9.4)U/L,均显著高于对照组(P＜0.05)；前白蛋白分别为(0.18±0.04) g/L、(0.22±0.02)g/L、(0.19±0.06)g/L,均低于对照组(P＜0.05).对照组术后第4周肝静脉均通畅.实验组术后第4、6、8周肝左、中静脉共干支完全闭塞.其引流区肝组织肿胀,分别呈淡红色、暗红色、暗黑色.实验组术后第4周光镜下肝细胞淤血、水肿,肝静脉壁炎性细胞浸润.术后第6周肝细胞水肿严重,肝静脉内膜、中膜增厚.术后第8周肝细胞萎缩、坏死,肝静脉壁内膜明显增厚、中膜弹性纤维大量增生.结论血管腔内技术是制备肝静脉阻塞BCS动物模型安全、有效的方法.
목적 탐토혈관강내기술제비견간정맥조새포가종합정(BCS)모형적가행성、안전성화유효성.방법 장24지견수궤분위실험조(n=18)화대조조(n=6).재수자감영혈관조영(DSA)인도하,경우경외정맥송입구낭도관지파간정맥(간좌、중정맥공간지),충영구낭완전조단혈관.실험조경구낭도관단공주입α-청기병희산정정지(NBCA)-초액화전유혼합액3～5 ml;대조조주입등량생리염수.동태관찰파간정맥조새후불동시간단간공능、문정맥압력、파간정맥급기인류구간조직결구적변화.결과 건모성공솔100％,량조균무폐전새、사망등엄중병발증.실험조술후제4、6、8주병안산전안매분별위(52.5±12.5)U/L、(61.3±5.7)U/L、(38.6±9.4)U/L,균현저고우대조조(P＜0.05)；전백단백분별위(0.18±0.04) g/L、(0.22±0.02)g/L、(0.19±0.06)g/L,균저우대조조(P＜0.05).대조조술후제4주간정맥균통창.실험조술후제4、6、8주간좌、중정맥공간지완전폐새.기인류구간조직종창,분별정담홍색、암홍색、암흑색.실험조술후제4주광경하간세포어혈、수종,간정맥벽염성세포침윤.술후제6주간세포수종엄중,간정맥내막、중막증후.술후제8주간세포위축、배사,간정맥벽내막명현증후、중막탄성섬유대량증생.결론 혈관강내기술시제비간정맥조새BCS동물모형안전、유효적방법.
Objective To investigate the feasibility,safety and efficiency of the establishment of model for Budd-Chiari syndrome with hepatic vein obstruction through endovascular technology in canine.Methods Twenty four dogs were randomly divided into experimental group (n=18) and control group (n=6).Under the surveillance of digital subtraction angiography,the balloon catheter was sent to the target hepatic vein via right external jugular vein,and then the balloon was filled by contrast agent until the target hepatic vein was blocked completely.In the experimental group,3～5 ml the mixture of N butyl-cyanoacrylate and lipiodol was infused into the target hepatic vein through the end hole of the balloon catheter until the hepatic vein flow stasis was achieved.In the control group,equal volume of normal saline was injected.The changes of liver function,portal vein pressure were measured and pathological varieties of target hepatic vein as well as the liver parenchyma were observed in the different periods in the two groups.Results The successful rate of the technique was 100 percent.There were no serious complications such as pulmonary embolism and death in the two groups.In the experimental group,the serum levels of alanine transpeptidase were (52.5 ± 12.5)U/L,(61.3±5.7)U/L,(38.6±9.4)U/L,which were higher than those in control group(P＜0.05) and prealbuminwere (0.18±0.04)g/L,(0.22±0.02)g/L,(0.19±0.06)g/L,which were lower than those in control group(P＜0.05) in the fourth,sixth and eighth weeks after the procedure,respectively.A common trunk formed by the middle and left hepatic veins which was looked as the targetic hepatic vein were completely occluded.the color of the liver appeared light red,dark red and dull black in the fourth,sixth and eighth weeks after the procedure,respectively.However,the hepatic veins were patented in the control group.In experimental group,histopathological observation revealed hepatic cells congestion and edema while a lot of inflammatory cells were seen in the wall of hepatic vein in the fourth week,the hepatic cells changed with severe edema,adipose kind,inner and middle membranes became thicker in the sixth week,and part of the hepatic cells showed hydropic degeneration,besides,inner and middle membrane became more thicker,there was substantially proliferation in elastic fiber hyperplasia in the eighth week.Conclusion Endovascular technology was a safely and effectively way to establish the canine model of Budd-Chiari syndrome with hepatic vein obstruction.