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目的用小颗粒明胶海绵对犬髂内动脉及骶正中动脉行不同组合、不同级别栓塞,观察栓塞后并发症发生情况,为临床安全应用明胶海绵栓塞骶区血管提供参考依据。方法普通级成年健康犬16只,雄性14只,雌性2只,体重10～13 kg;随机分为5组。于数字减影血管造影监视下采用直径为50～150μm的明胶海绵颗粒,A组(3只)栓塞至双侧髂内动脉及骶正中动脉主干,B组(3只)栓塞至双侧髂内动脉及骶正中动脉一级分支,C组(3只)栓塞至双侧髂内动脉主干,D组(4只)栓塞至单侧髂内动脉及骶正中动脉主干,E组(3只)栓塞至单侧髂内动脉主干。栓塞前观察实验犬腹主动脉、双侧髂外动脉、髂内动脉及骶正中动脉的解剖关系。栓塞后观察实验犬存活情况,并于栓塞后3 d行犬直肠、膀胱、臀部肌肉及坐骨神经大体和组织学观察。结果犬的髂外动脉及髂内动脉无髂总动脉,双侧髂外动脉直接起始于腹主动脉,骶正中动脉起始有变异。血管栓塞后2 d内共7只实验犬死亡,其中A组3只,C组3只,D组1只;其余实验犬均存活至实验完成。A、C、D组死亡实验犬直肠发黑、坏死,膀胱呈片状发暗伴灶状充血水肿,膀胱内尿量中位数为270.6 mL。B、D、E组存活实验犬直肠无明显异常,膀胱仅轻度片状充血水肿,膀胱内尿量中位数分别为137.0、220.5、28.0 mL。A、C、D组死亡实验犬直肠、膀胱细胞崩解,伴大量炎性细胞浸润及上皮细胞脱落;B、D、E组存活实验犬栓塞后3 d膀胱、直肠轻度炎性细胞浸润,栓塞血管主要集中于直径为100～200μm的小动脉。各组坐骨神经与臀部肌肉除有轻度水肿外未见明显异常。结论 采用直径为50～150μm的小颗粒明胶海绵栓塞犬髂内动脉及骶正中动脉时,应注意栓塞近端血管至主干时至少需保留单侧髂内动脉,双侧髂内动脉与骶正中动脉同时栓塞时被栓塞血管近端不能超过其一级分支,否则可造成盆腔脏器坏死、穿孔等严重并发症。
Objective To observe the complications after embolization by different combinations of gelatin sponge and small granular gelatin sponge in the canine internal iliac artery and sacral mid-artery, and to provide a reference for clinically safe embolization of sacral vessels with gelatin sponge. Methods Sixteen normal dogs, 14 males and 2 females, weighing 10 ~ 13 kg, were randomly divided into 5 groups. Under the digital subtraction angiography, gelatin sponge particles with a diameter of 50 ~ 150μm were used. A group (3) embolized to the bilateral internal iliac arteries and the middle of the sacral median artery, and group B (3) embolized into the bilateral iliac (Group C) (3) embolized to the trunk of the bilateral internal iliac arteries, group D (4) embolized to the unilateral internal iliac artery and the middle of the sacral median artery, group E (3) embolization To the unilateral internal iliac artery trunk. Before embolization observe the experimental canine abdominal aorta, bilateral external iliac artery, internal iliac artery and the middle of the sacral artery anatomy. The survival of experimental dogs was observed after embolization, and the general and histological observations of canine, bladder, buttock muscles and sciatic nerve were performed 3 days after embolization. Results Canine external iliac artery and internal iliac artery without common iliac artery, bilateral external iliac artery began directly in the abdominal aorta, the median sacral artery began to have variation. Seven experimental dogs died within 2 days after embolization, of which 3 were in group A, 3 in group C and 1 in group D. The remaining experimental dogs survived until the experiment was completed. The dogs in groups A, C and D died of rectal blackness and necrosis. The bladder showed flaky dark with focal congestion and edema. The median urinary bladder volume was 270.6 mL. There was no significant abnormalities in the rectum of the dogs in the groups B, D, and E, and only a mild flaky edema in the bladder. The median urine output in the bladder was 137.0, 220.5 and 28.0 mL, respectively. Group A, C, D dogs died of rectal, bladder cell disintegration, accompanied by a large number of inflammatory cell infiltration and epithelial cell shedding; B, D, E group survival dogs 3 days after embolization of the bladder, rectum mild inflammatory cell infiltration, Embolization of blood vessels mainly in the arterial diameter of 100 ~ 200μm. No significant abnormalities were found in the sciatic nerve and buttock muscles in all groups except mild edema. Conclusions When embolization of the internal iliac artery and the median sacral artery with a small granular gelatin sponge with a diameter of 50 ~ 150μm should pay attention to the need of preserving at least the unilateral internal iliac artery, the bilateral internal iliac artery and the median sacral artery At the same time embolism is embolized when the proximal end of the vessel can not exceed a branch, or can cause pelvic necrosis, perforation and other serious complications.