摘要
目的 :探讨经皮气管穿刺选择性支气管栓塞肺减容术的可行性和安全性。 方法 :成年新西兰兔 5只 ,全麻下行气管穿刺建立通道 ,选择性插管至叶或段支气管后 ,灌注无水乙醇和碘油的混合液 (2 .5～ 4 m l) ,其中 3只同时加用骨水泥封堵支气管腔。术后 1、3、6周行胸片和 CT检查 ,达 6周后处死动物 ,取气管和全肺作组织学检查。结果 :所有动物气管穿刺和插管均获成功 ,气管穿刺点无出血和气肿发生。单纯无水乙醇碘油栓塞的 2只分别于 1、2周并发非栓塞区的炎症而提前终止实验。加用骨水泥栓塞的 3只中 ,1只因骨水泥返流到气管水平而影响呼吸 ,于 12 h死亡 ;另 2只术后随访 6周未发生异常体征 ,未见非栓塞区炎症。胸片和 CT显示栓塞肺叶或肺段完全不张 ,病理显示栓塞区的支气管上皮和肺泡上皮坏死、脱落 ,肺组织体积明显萎缩、纤维化并伴有小脓肿形成。结论 :选择性支气管栓塞可以产生明显的肺减容效果 ,但可能需要同时封堵支气管腔以防止继发感染 ;经皮气管穿刺插管途径安全可行。
Objective:To evaluate the feasibility and safety of lung volume reduction by percutaneous trans-tracheal bronchial embolization with ethanol and lipidol. Methods: Percutaneous tracheal puncture using Seldinger technique was performed on 5 adult New Zealand white rabbits under general anaesthesia to obtain an access through which selective lobar or segmental bronchi catheterization and embolization with ethanol and lipidol emulsion was carried out. Bone cement was added to occlude the bronchial lumen in the other 3 animals. The animals were followed up for 6 weeks by chest X-ray and CT, and the whole lungs and trachea were harvested for histological examination. Results: Tracheal puncture and bronchi catheterization were successful in all animals, with no hemorrhage or emphysema at the puncture site. The two animals embolized with ethanol and lipidol emulsion alone developed inflammation in non-embolized lung field 1 or 2 weeks later, resulting in earlier termination. Of the 3 animals embolized with additional bone cement, one died 12 h later due to reflux of bone cement, while the other 2 were followed up for 6 weeks with no abnormal signs or inflammation in non-embolized lung field. Significant atelectasis was observed at embolized segments or lobes with chest X-ray and CT. Histological examination revealed damage and disruption of the bronchial and alveolar epithelium, severe atrophy and fibrosis of the lung tissue with formation of small abscesses. Conclusion: Selective bronchial embolization with ethanol and lipidol can produce significant lung volume reduction, but it may be necessary to occlude the bronchial lumen simultaneously in order to avoid secondary infection. Percutaneous trans-tracheal puncture and catheterization is safe and convenient for lung volume reduction.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2004年第9期985-988,共4页
Academic Journal of Second Military Medical University
关键词
支气管栓塞
乙醇
肺减容术
bronchial embolization
ethanol
lung volume reduction
