本文選題：白芨膠 + 明膠海綿�。� 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:建立新西蘭實(shí)驗(yàn)兔腎臟穿刺造瘺模型;白芨膠(Bletilla glue)、明膠海綿、微孔多聚糖止血粉(Microporous polysaccharide hemispheres,MPH)三種止血材料應(yīng)用于腎臟穿刺通道,記錄術(shù)中穿刺通道止血時(shí)間、術(shù)后尿液中晶體含量、穿刺通道中TNF-α、IL-10表達(dá)及其相關(guān)性變化。比較三種材料在腎穿刺通道中的止血時(shí)間、術(shù)后尿液結(jié)晶含量以及腎臟穿刺通道愈合時(shí)間。以尋找一種較為合適的無(wú)管化經(jīng)皮腎鏡術(shù)(Tubeless Percutaneous Nephrolithotomy,TPCNL)腎穿刺通道止血栓塞劑,利于減少出血及尿外滲等無(wú)管化經(jīng)皮腎鏡術(shù)并發(fā)癥的發(fā)生。方法:選用新西蘭實(shí)驗(yàn)兔126只(雌雄不限,體重2.0-2.5kg),隨機(jī)分成三組,即白芨膠組、明膠海綿組、微孔多聚糖(MPH)組,每組42只;將三組實(shí)驗(yàn)兔均建立單側(cè)腎穿刺造瘺模型,并于腎臟穿刺通道內(nèi)分別注入白芨多糖膠、明膠海綿、微孔多聚糖止血粉,術(shù)中觀察并記錄各組實(shí)驗(yàn)兔術(shù)中穿刺止血時(shí)間。三組分別于術(shù)后3 d、1w、2w、3 w、4 w、6 w和8w七個(gè)時(shí)間點(diǎn)處死。膀胱穿刺取尿液行尿沉渣中晶體數(shù)量定量檢查,對(duì)比各組實(shí)驗(yàn)兔尿液中晶體含量。取腎臟穿刺通道組織行HE染色,觀察通道處腎臟組織不同時(shí)間點(diǎn)的病理改變;免疫組織化學(xué)法(immunohistochemistry,IHC)檢測(cè)各組腎穿刺通道中TNF-α、IL-10兩種蛋白不同時(shí)間點(diǎn)的變化。結(jié)果:1.三組實(shí)驗(yàn)兔術(shù)中腎穿刺通道止血時(shí)間為明膠海綿組(82.40±18.40 S)白芨膠組(92.69±22.63S)MPH組(120.33±26.23S),兩兩比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),三組間方差分析結(jié)果顯示差異具有統(tǒng)計(jì)學(xué)意義(F=31.504,P0.001)。2.HE觀察結(jié)果各組腎穿刺通道病理變化。白芨膠組:3d時(shí)處死動(dòng)物,觀察腎穿刺通道見(jiàn)大量肉芽組織及新生血管形成,伴炎性細(xì)胞浸潤(rùn)。2周后見(jiàn)少量瘢痕組織形成,3周時(shí)腎臟穿刺通道已愈合。明膠海綿組:建模3天后觀察通道內(nèi)可見(jiàn)大量炎性細(xì)胞浸潤(rùn),無(wú)明顯肉芽組織以及新生血管形成,通道內(nèi)可見(jiàn)陳舊性紅細(xì)胞;建模后3周通道內(nèi)可見(jiàn)較多成熟的血管腔,伴有少量瘢痕組織增生以及炎性細(xì)胞浸潤(rùn),表明仍處于通道修復(fù)中;約于建模后6周時(shí)通道已基本愈合。MPH組:建模3天后觀察通道內(nèi)可見(jiàn)大量炎性細(xì)胞浸潤(rùn),無(wú)明顯肉芽組織以及新生血管形成,通道內(nèi)可見(jiàn)陳舊性紅細(xì)胞;建模后3周通道內(nèi)可見(jiàn)較多成熟的血管腔,伴有少量瘢痕組織增生以及炎性細(xì)胞浸潤(rùn),表明仍處于通道修復(fù)中;約于建模后6周時(shí)通道已基本愈合。上述結(jié)果顯示,三組實(shí)驗(yàn)?zāi)Ｐ徒?天時(shí)通道中白芨膠組炎癥反應(yīng)最輕,瘢痕愈合最早。3.三組實(shí)驗(yàn)兔各時(shí)間點(diǎn)尿液晶體數(shù)比較顯示:與明膠海綿及MPH相比,白芨膠組3d和1w時(shí)尿液晶體數(shù)與其余兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);但在2w、3w、4w、6w、8w時(shí)白芨膠組晶體數(shù)顯著低(P0.05)。4.免疫組化結(jié)果顯示,IL-10及TNF-α的表達(dá)主要在腎小管及腎小球胞漿中,顯微鏡下觀察陽(yáng)性染色呈棕黃色顆粒。且各組積分光密度(IOD)結(jié)果顯示,3d、1w、2w、3w、4w、6w、8w白芨膠組IL-10表達(dá)顯著高于其余兩組(P0.05),而TNF-α的表達(dá)顯著低于其余兩組(P0.05)。結(jié)論:1.三種止血材料在術(shù)中止血時(shí)間依次為明膠海綿組白芨膠MPH。2.與明膠海綿及MPH相比,白芨膠在腎組織中較快吸收,術(shù)后晶體產(chǎn)生較少,術(shù)后形成結(jié)石風(fēng)險(xiǎn)小于后兩種材料。3.白芨膠用于腎穿刺通道止血所產(chǎn)生的IL-10高于明膠海綿及MPH,TNF-α低于明膠海綿及MPH,更利于穿刺通道組織的愈合。
[Abstract]:Objective: to establish a New Zealand experimental rabbit kidney puncture stomatostomy model, Bletilla glue, gelatin sponge and Microporous polysaccharide hemispheres (MPH), three kinds of hemostatic materials used in the renal puncture channel, to record the time of blood stop in the puncture channel, the content of the crystal in the urine after the operation, and the TNF- a, IL-1 in the puncture channel. The 0 expression and its correlation change. Compare the time of hemostasis of the three materials in the renal puncture channel, the content of urine crystallization and the healing time of the renal puncture channel, in order to find a more suitable Tubeless Percutaneous Nephrolithotomy, TPCNL for the hemostasis of the renal puncture channel, which is beneficial to reduce the bleeding and urine. Methods: 126 New Zealand experimental rabbits (male and male and body weight 2.0-2.5kg) were randomly divided into three groups, namely, Bletilla glue group, gelatin sponge group, and microporous polysaccharide (MPH) group, with 42 rats in each group. The three experimental rabbits were set up a unilateral renal puncture stoma model and were injected into the renal puncture channel respectively. In the three groups, the three groups were killed at 3 D, 1W, 2W, 3 W, 4 W, 6 W and 8W at seven time points, respectively. The pathological changes of renal tissue at different time points at the channel were observed by HE staining, and the changes of TNF- alpha and IL-10 two proteins at different time points were detected by immunohistochemistry (IHC). Results: the time of hemostasis of the renal puncture channel in the 1. three groups of experimental rabbits was 82.40 (82.40). The group (92.69 + 22.63S) MPH (120.33 + 26.23S) of Bletilla striata glue group (120.33 + 26.23S), 22 difference was statistically significant (P0.05). The variance analysis between the three groups showed that the difference was statistically significant (F=31.504, P0.001).2.HE observation results of the pathological changes of the renal puncture channel. The Bletilla glue group was killed at 3D and observed a large number of granulation in the renal puncture channel. Tissue and neovascularization, with inflammatory cell infiltration.2 weeks after the formation of a small number of scar tissue, 3 weeks after the healing of the renal puncture channel. Gelatin sponge group: after 3 days of modeling, a large number of inflammatory cells in the observation channel, no obvious granulation tissue and neovascularization, the passage of old red blood cells in the passageway, after modeling in the 3 week channel More mature vascular cavities were seen, with a small amount of scar tissue proliferation and inflammatory cell infiltration, indicating that the channel was still in the channel repair. About 6 weeks after modeling, the channel had basically healed in the.MPH group. A large number of inflammatory cells were found in the observation channel for 3 days after modeling, and there was no obvious granulation and neovascularization, and the passage was obsolete. Red blood cells were more mature in 3 weeks after modeling, with a small amount of scar tissue proliferation and inflammatory cell infiltration, which showed that the channel was still in the channel repair. The channel was basically healed at 6 weeks after modeling. The results showed that the inflammatory reaction in the Bletilla colloid group was the lightest in the three groups of experimental models at 3 days, and the scar healing was the most. Compared with gelatin sponge and MPH, there was no significant difference in urine crystal number between 3D and 1W of Bletilla colloid group and the other two groups compared with gelatin sponge and MPH (P0.05), but in 2W, 3W, 4W, 6W and 8W, the number of crystal number was significantly lower (P0.05) in 2W, 3W, 4W, 6W and 8W, but the expression of.3. was mainly in the kidneys. In the tube and the glomerular cytoplasm, the positive staining was brown and yellow granules under microscope, and the results of the integral light density (IOD) showed that the IL-10 expression of 3D, 1W, 2W, 3W, 4W, 6W and 8W Bletilla colloid group was significantly higher than the other two groups (P0.05), while the expression of TNF- alpha was significantly lower than the other two groups (P0.05). Conclusion: the time of hemostasis in the 1. three kinds of hemostat is in turn in the order of the hemostasis. Compared with gelatin sponge and gelatin sponge and gelatin sponge and MPH, Bletilla colloid MPH.2. absorbs quickly in the kidney tissue and has less crystal production after operation. The risk of formation of stone after operation is less than that of after two materials, the IL-10 is higher than gelatin sponge and MPH, TNF- A is lower than gelatin sponge and MPH, and it is better for puncture passage. The healing of the tissue.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R692

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