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目的通过超选择性插管入犬空肠动脉分支后用聚乙烯醇(polybviny lalcohol particles,PVA)颗粒栓塞,观察肠壁缺血坏死程度和范围,探讨其安全性。方法44只犬随机分为A、B两组。A组(22只):空肠动脉二级分支水平远端栓塞;B组(22只):空肠末级动脉弓前一级分支水平栓塞。分别注入大小为150～250μm(A1组6只,B1组6只)、355～500μm(A2组8只,B2组8只)和710～1000μm(A3组8只,B3组8只)PVA颗粒。少量、缓慢、间断推注PVA,血流停滞时即停止。术后3、7、14d,处死犬取出空肠行大体及病理学观察。结果栓塞技术成功率为95.5%。PVA颗粒量为5～10mg。注入150～250μm、355～500μm、710～1000μmPVA颗粒肠坏死的发生率分别为:81.8%(9/11)、40.0%(6/15)、25.0%(4/16),组间差异具有统计学意义(P<0.05)。A、B两组发生肠坏死的发生率分别为61.9%(13/21)、28.6%(6/21),组间差异有统计学意义(P<0.001)。结论在同一栓塞水平下,PVA颗粒越小则越易发生肠坏死。最佳的栓塞水平在末级动脉弓前一级分支水平,PVA颗粒大小应选择710～1000μm。
Objective To observe the degree and extent of intestinal ischemia-necrosis with polybviny lalcohol particles (PVA) embolization into the canine jejunum after superselective catheterization, and to investigate its safety. Methods Forty dogs were randomly divided into A and B groups. Group A (22 rats): horizontal distal embolization of the secondary branch of jejunum; Group B (22): horizontal embolization of the anterior arch of the jejunum distal aortic arch. Were injected into PVA pellets of 150-250 μm in size (6 in A1, 6 in B1), 355-500 μm (8 in A2, 8 in B2) and 710-1000 μm (8 in A3, 8 in B3) . A small amount, slow, intermittent injection of PVA, stop when the blood flow is stagnant. At 3, 7 and 14 days after operation, dogs were sacrificed and the jejunum was removed for gross and pathological observation. Results The success rate of embolization was 95.5%. The amount of PVA particles is 5 ~ 10mg. The incidence of intestinal necrosis of NPVA with injection of 150 ~ 250μm, 355 ~ 500μm and 710 ~ 1000μm were 81.8% (9/11), 40.0% (6/15) and 25.0% (4/16), respectively Significance (P <0.05). The incidences of intestinal necrosis in groups A and B were 61.9% (13/21) and 28.6% (6/21), respectively. The differences between the two groups were statistically significant (P <0.001). Conclusion Under the same embolization level, the smaller the PVA particles, the more prone to intestinal necrosis. The best level of embolism is at the level of the anterior branch of the distal aortic arch. The PVA particle size should be 710 ~ 1000μm.