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目的 :研究碘油/无水乙醇肝节段性栓塞术后肝脏的病理变化过程 ,及此过程中肝、肾功能的改变 ,为临床推广应用提供依据。材料和方法 :以健康杂种犬为实验对象(n=12) ,碘油/无水乙醇(Lp/E ,比例4∶1)作为栓塞剂 ,行肝节段性栓塞 ,术前、术后监测血常规、淀粉酶、肝肾功能 ,术后定期复查肝动脉造影、CT并分批处死实验犬进行肝肺组织学检查。结果 :术后定期复查肝动脉造影示靶肝动脉均明确闭塞。病理检查发现肝栓塞区小动脉血栓形成 ,1周后血栓机化 ,术后4周栓塞肝组织完全坏死 ,坏死肝细胞完全崩解 ,代之以纤维组织增生。术后1天白细胞出现一过性升高 ,术后1周即恢复术前水平。肝功能呈一过性损害 ,术后1～3周恢复术前水平 ,主要表现为ALT、AST、γ -GT、ALP和TBA的升高。结论 :Lp/E具有确实的栓塞效果 ,能达到“内科性肝段切除”的目的。
Objective: To study the pathological changes of liver after hepatic segmental embolization with lipiodol/alcohol, and the changes of liver and kidney function during this process, so as to provide basis for clinical application. Materials and Methods: Liver segmental embolization was performed in healthy mongrel dogs (n=12), lipiodol/alcohol (Lp/E, ratio 4:1) as an embolizing agent. Preoperative and postoperative monitoring Blood routine, amylase, liver and kidney function, postoperative hepatic artery angiography, CT and batch sacrifice of experimental dogs for hepatic and pulmonary histology. Results: The hepatic arteriography showed that the target hepatic arteries were clearly occluded after regular reoperation. Pathological examination revealed arterial thrombosis in the hepatic embolism region. One week later, thrombosis was established. Four weeks after embolization, hepatic tissue was completely necrotic. Necrotic hepatocytes completely disintegrated and replaced with fibrous tissue. A transient increase in white blood cells occurred one day after surgery, and the level of preoperative recovery was restored one week after surgery. Liver function was transiently damaged. The preoperative level was restored 1 to 3 weeks after operation. The main manifestations were elevated ALT, AST, γ-GT, ALP, and TBA. Conclusion : Lp/E has a definite embolization effect and can achieve the purpose of “internal hepatectomy”.