發(fā)布時(shí)間：2019-01-11 07:48

【摘要】：目的:使用碘化油、平陽霉素乳劑支氣管肺泡灌注配合靶支氣管栓塞建立功能性肺葉切除動物模型,評價(jià)功能性肺葉切除術(shù)的可行性、安全性。 方法:健康雜種犬18只,隨機(jī)分成3組,每組6只,A組(實(shí)驗(yàn)組)行靶肺支氣管肺泡灌注碘化油、平陽霉素乳劑后靶支氣管聚甲基丙烯酸甲酯(Polymethylmethacrylate,PMMA)堵塞;B組行靶支氣管PMMA栓塞,C組行單側(cè)外科靶肺葉切除。分析各組術(shù)前、術(shù)后即時(shí)、術(shù)后1、2、3、4周的動脈血?dú)庾兓?并用spss軟件分析三組間有無統(tǒng)計(jì)學(xué)差異,4周后作胸部X線,處死動物行肺部組織病理學(xué)檢查和靶肺組織細(xì)菌學(xué)培養(yǎng)。 結(jié)果:3組動物術(shù)后即時(shí)動脈PaO_2均低于術(shù)前(P0.01),術(shù)后動脈PaCO_2顯著高于術(shù)前(P0.01),術(shù)后1周動脈血?dú)饣謴?fù)到術(shù)前正常水平,與術(shù)前無統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)后B組PaCO_2較A組下降程度輕(P0.01),A、C組之間術(shù)后即時(shí)及術(shù)后1～4周血?dú)庾兓療o明顯統(tǒng)計(jì)學(xué)差異P0.05。術(shù)后1～4周A、B、C3組間血?dú)鉄o明顯統(tǒng)計(jì)學(xué)意義。術(shù)后第4周肺部攝片及大體標(biāo)本見實(shí)驗(yàn)組靶肺肺不張形成,組織病理學(xué)顯示靶肺肺泡萎陷、肺間質(zhì)纖維化,靶肺組織細(xì)菌學(xué)培養(yǎng)陰性。B組有3例肺不張形成,靶肺未見明顯纖維化。C組有一只動物因傷口感染于術(shù)后4d死亡。 結(jié)論:通過靶肺支氣管肺泡灌注碘化油、平陽霉素乳劑后靶支氣管堵塞可使靶肺形成肺不張、纖維化,達(dá)到功能性肺葉切除術(shù)目的。該術(shù)式創(chuàng)傷小,安全、有效,有望部分替代外科性肺葉切除。
[Abstract]:Objective: to establish the animal model of functional lobectomy by using lipiodol, Pingyangmycin emulsion bronchoalveolar perfusion and target bronchus embolization, and to evaluate the feasibility and safety of functional lobectomy. Methods: eighteen healthy mongrel dogs were randomly divided into 3 groups (6 in each group). Group A (experimental group) was perfused with lipiodol oil in target lung and alveoli, and polymethyl methacrylate (Polymethylmethacrylate,PMMA) was blocked in target bronchus after pingyangmycin emulsion. Group B underwent PMMA embolization of the target bronchus and group C underwent unilateral surgical resection of the pulmonary lobes. The changes of arterial blood gas in each group were analyzed before and immediately after operation. The changes of arterial blood gas were analyzed by spss software. Chest X-ray was performed 4 weeks later. Lung histopathological examination and bacteriological culture of target lung tissue were performed. Results: the arterial PaO_2 of the three groups was significantly lower than that of preoperation (P0.01), the arterial PaCO_2 was significantly higher than that of preoperation (P0.01), and the arterial blood gas returned to the normal level 1 week after operation. There was no statistical difference between the two groups (P0.05). The decrease of PaCO_2 in group B was lighter than that in group A (P0.01). There was no significant difference in blood gas changes between group A and group C (P 0.05). There was no significant difference in blood gas between group A and B 3 at 1 and 4 weeks postoperatively. At the 4th week after operation, pulmonary atelectasis was found in the target lung of the experimental group. Histopathology showed the alveolar collapse, interstitial fibrosis and negative bacteriological culture of the target lung. In group B, there were 3 cases of atelectasis. No fibrosis was found in the target lung. In group C, one animal died of wound infection 4 days after operation. Conclusion: target bronchoalveolar infusion of lipiodol and blockage of target bronchus after pingyangmycin emulsion can cause atelectasis and fibrosis of target lung and achieve functional lobectomy. The surgical procedure is safe and effective, and it is expected to replace surgical lobectomy.
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2005
【分類號】：R-332

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