论文部分内容阅读
目的:评估全生物可降解型房间隔缺损(atrial septal defect,ASD)封堵器封堵猪ASD的疗效、组织覆盖情况、降解情况及生物相容性等。方法:15只小型猪经外科开胸术后在心脏超声指引下行房间隔穿刺术,并置入全生物可降解ASD封堵器。术后行心脏超声检查观察封堵效果并测量封堵器大小,于1个月、3个月、6个月及9个月各处死3只,大体肉眼观察组织覆盖情况并测量覆盖面积与封堵器双盘面积;苏木素-伊红染色法(hematoxylin-eosin staining,HE)观察周围组织的炎症反应,酶联免疫吸附分析(enzyme-linked immunosorbent assay,ELISA)测定猪血清白介素-6(interleukin-6,IL-6)水平。结果:除了3只建模失败,其余12只均建模成功并进行了ASD封堵;术中及术后未出现感染、封堵器脱落等并发症。超声结果显示封堵器位置良好,无残余分流。大体解剖标本可见置入ASD封堵器术后1月新生组织部分覆盖封堵器装置表面,术后3个月、6个月及9个月均已完全覆盖。与降解前的封堵器扇面直径比较,术后1个月、3个月及6个月均降低(P<0.05),且随时间延长降低明显,差异有统计学意义(P<0.05);与降解前的封堵器高度比较,除了术后1个月无明显差异(P>0.05),术后3个月、6个月均降低(P<0.05)。与降解前封堵器双盘面积比较,术后1个月、3个月、6个月及9个月均降低(P<0.05),且随时间延长降低明显,差异有统计学意义(P<0.05)。术后1个月、3个月封堵器周围组织炎症反应明显,在术后6个月、9个月消失;术后3个月及6个月血清IL-6浓度较术前升高(P<0.05),术后9个月降至正常(P>0.05),差异有统计学意义。结论:全生物可降解型ASD封堵器在猪ASD模型封堵技术成功率高,组织覆盖迅速,生物相容性与降解效果良好,是一种比较理想的可降解封堵器。
OBJECTIVE: To evaluate the efficacy, tissue coverage, degradation and biocompatibility of a biodegradable atrial septal defect (ASD) occluder in swine ASD. Methods: Fifteen minipigs underwent atrial septal puncture under the guidance of cardiac ultrasound after thoracotomy and placed them into biodegradable ASD occluder. Postoperative cardiac echocardiography was performed to observe the occlusion effect and to measure the size of occluder. Three rabbits were sacrificed at 1 month, 3 months, 6 months and 9 months. Gross coverage and closure The double disk area of the occluder was observed. Hematoxylin-eosin staining (HE) was used to observe the inflammatory reaction in the surrounding tissues. The serum levels of interleukin-6 were detected by enzyme-linked immunosorbent assay (ELISA) 6, IL-6) levels. RESULTS: Except for the three modeling failures, the remaining 12 were successfully modeled and blocked with ASD. No complications such as infection and occlusion of the occluder occured during and after operation. Ultrasound results show occluder in good condition, no residual shunt. The gross anatomic specimen shows that the new tissue partially covered the surface of the occluder device at 1 month after ASD occluder implantation and completely covered at 3 months, 6 months and 9 months after operation. Compared with the diameter of occluder before occlusion, the diameters of occluder before decompression decreased at 1 month, 3 months and 6 months after operation (P <0.05), and decreased significantly with time (P <0.05). Compared with the occluder height before degradation, there was no significant difference (P> 0.05) except at 1 month after operation, and both at 3 months and 6 months after operation (P <0.05). Compared with the double disc area before occluder, the one-month, three-month, six-month and nine-month after operation decreased (P <0.05) and decreased significantly with time <0.05). The inflammation around the occluder at 1 month and 3 months after operation was obvious and disappeared at 6 months and 9 months after operation. The serum IL-6 levels at 3 and 6 months after operation were significantly higher than those before operation P <0.05), 9 months after surgery to normal (P> 0.05), the difference was statistically significant. CONCLUSION: The biodegradable ASD occluder is an ideal biodegradable occluder in ASD model with high success rate, rapid tissue coverage, good biocompatibility and biodegradability.