脑叶切除残腔Foley尿管球囊填塞止血效果及组织相容性观察
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摘要
目的：脑叶切除后残腔被Foley尿管球囊填塞观察其止血效果及组织相容性。为临床应用提供初步试验依据。为脑内移植物组织相容性寻找简单易行的试验方法。
材料和方法：
1.手术：
1.1实验动物：3月龄健康新西兰兔18只，体重为2000±200g。雌雄各半随机分两组。实验组9只，对照组9只。行正常饮食，兔笼饲养。
1.2手术：两组动物消毒、麻醉后，实验组手术取脑置球囊。对照组手术取脑。
1.3术后处理：两组行HE、Masson、CD68、尼氏体染色、银染、B超对比、动物行为学观察。组中再随机分一天组、两天组、三天组共三组各三只。
2.术后动物行为学观察：
观察动物术后神经功能障碍。精神、饮食活动异常。
3.组织相容性观察：
3.1方法：HE染色、Masson染色、CD68免疫组化、银染、尼氏体染色。
3.2切片观察：显微镜下观察脑组织的炎细胞浸润、神经元胞体和轴突的病理改变、小胶质细胞和巨噬细胞游走。
4.止血效果观察：
4.1B超：分别在术后1天、2天、3天在B超下观察术区并对比。
4.2切片：显微镜下观察Masson染色红细胞数量和脑组织基质松散程度并对比。
结果：
1两组细胞比较：巨噬细胞无统计学差异，粒细胞无统计学差异，淋巴细胞无统计学差异（主要从HE染色得来）
2两组组织比较：1-3天组织基质变疏松，红细胞溢出增多，血管不可见。（从Masson得来）
3两组红细胞比较实验组优于对照组有统计学意义（主要从HE染色得来）
4两组CD68比较：无统计学差异从（免疫组化得来）
5两组B超照片比较：实验组液性暗区较轻
6两组组中比较：1、2、3天基质渐疏松，红细胞溢出渐多。巨嗜渐多。粒细胞渐多。神经轴突渐水肿崩解（银染得来）。神经元胞体变性凋亡渐多（尼氏体染色得来）。
7参考国际皮肤移植物排异标准（2007）：第一天0-II级。第二天II-III级。第三天III-IV级。
8参考中华人民共和国国家标准GB／T14233．2．93，医用输液、输血、注射器具检验方法：炎细胞反应分级在I---IV级之间。大致有上升趋势。
结论:
1. Foley尿管有良好的组织相容性。
2.球囊填塞止血效果良好。
3.为脑内移植物初步提供了组织相容性一简单易行的试验方法。
Objective: To observe hemostatic effect and tissue compatibility of theresidual cavity after lobe resection with Foley catheter balloon tamponade. Soit can provid preliminary experimental evidence for clinical application andfind out simple methods for the organizations compatibility of intracerebralgraft.
Materials and Methods:
1. Operation:
1.1Experimental animals: There are eighteen New Zealand whiterabbits (All are3-month-old). Weight of2000±200g. Half male and female.Randomly divide into two groups(nine rabbits of each group). Give normaldiet and feed in rabbit cage.
1.2Operation: After disinfection and anesthesia, exsect some braintissue of experimental group animals, and then place the balloon in theresidual cavity. Equally, exsect some brain tissue of control group animals,but don’t place balloon.
1.3Post-operative processing: We deal with the brain tissue of twogroups by hematoxylin and eosin staining(HE staining), Masson staining,CD68immunohistochemisty, Nissl body staining, silver staining,B-modeultrasonic, and animal behavior observed. Then compare the two groups inthese aspect. Each group were randomly divided into three subgroups: afterone day, after two days, after three days. Three rabbits of every subgroup.
2. Observe animal behavior after surgery:
Observe neurologic dysfunction, abnormal mental and eating activities ofthe postoperative animal.
3. Histocompatibility observation:
3.1Methods: HE staining, MASSON staining, CD68immunohistochemistry, Nissl body staining, silver staining.
3.2Section observation: Use the microscope to observe inflammatorycell infiltration of brain tissue, the pathological changes of neuronal cellbodies and axons, migration of the microglia and macrophage.
4. Hemostatic effect observation:
4.1B-mode ultrasound: To observe the operation area after1day,2days,3days under the B-mode ultrasound, and then contrast.
4.2Section observation: Observe the number of red blood cells andbrain tissue matrix loosening degree by Masson staining under the microscope.
Results:
1. Comparison of the two group cells: there was no significant differencein Macrophages of the two groups; no significant difference in granulocyteand lymphocytes of the two groups either.(From the HE staining)
2. Comparison of two group tissue: The first day to the third day, thebrain tissue matrix gradually became loosened, the red blood cellsoverflowing increased day by day, and no blood vessel was visible.(FromMasson staining)
3. Compare red blood cells of the two groups, the experimental groupwas better than the control group, and there was statistical significance.
4. CD68immunohistochemistry comparison of two groups: There was nosignificant difference.
5. B-mode ultrasound photos comparison of two groups: The liquidanechoic area of experimental group was lighter then the control group.
6. Compare the subgroups in each group: Brain tissue atrix graduallybecame loosening.Red blood cell overflowing,macrophages and granulocyteswere increasing day by day. Axons gradually swelled and disaggregated(From silver staining). Degenerated and apoptosis Neuronal cell becamemore.(From Nissl body staining)
7. Reference to The Banff2007working classification of skin-containingcomposite tissue allograft pathology: The first day, grade0-II. The second day, grade II-III. The third day, grade III-IV.
8. Reference to the People's Republic of China national standard GB/T-14233.2.93Infusion, transfusion, injection equipment testing methods:Inflammatory cell reaction grade I---IV of class. Generally, there is anupward trend.
Conclusions:
1. The Foley catheter has good histocompatibility.
2. Balloon tamponade is effective on the hemostatic aspect.
3. Initially provide a simple compatibility test for brain grafts.
材料和方法：
1.手术：
1.1实验动物：3月龄健康新西兰兔18只，体重为2000±200g。雌雄各半随机分两组。实验组9只，对照组9只。行正常饮食，兔笼饲养。
1.2手术：两组动物消毒、麻醉后，实验组手术取脑置球囊。对照组手术取脑。
1.3术后处理：两组行HE、Masson、CD68、尼氏体染色、银染、B超对比、动物行为学观察。组中再随机分一天组、两天组、三天组共三组各三只。
2.术后动物行为学观察：
观察动物术后神经功能障碍。精神、饮食活动异常。
3.组织相容性观察：
3.1方法：HE染色、Masson染色、CD68免疫组化、银染、尼氏体染色。
3.2切片观察：显微镜下观察脑组织的炎细胞浸润、神经元胞体和轴突的病理改变、小胶质细胞和巨噬细胞游走。
4.止血效果观察：
4.1B超：分别在术后1天、2天、3天在B超下观察术区并对比。
4.2切片：显微镜下观察Masson染色红细胞数量和脑组织基质松散程度并对比。
结果：
1两组细胞比较：巨噬细胞无统计学差异，粒细胞无统计学差异，淋巴细胞无统计学差异（主要从HE染色得来）
2两组组织比较：1-3天组织基质变疏松，红细胞溢出增多，血管不可见。（从Masson得来）
3两组红细胞比较实验组优于对照组有统计学意义（主要从HE染色得来）
4两组CD68比较：无统计学差异从（免疫组化得来）
5两组B超照片比较：实验组液性暗区较轻
6两组组中比较：1、2、3天基质渐疏松，红细胞溢出渐多。巨嗜渐多。粒细胞渐多。神经轴突渐水肿崩解（银染得来）。神经元胞体变性凋亡渐多（尼氏体染色得来）。
7参考国际皮肤移植物排异标准（2007）：第一天0-II级。第二天II-III级。第三天III-IV级。
8参考中华人民共和国国家标准GB／T14233．2．93，医用输液、输血、注射器具检验方法：炎细胞反应分级在I---IV级之间。大致有上升趋势。
结论:
1. Foley尿管有良好的组织相容性。
2.球囊填塞止血效果良好。
3.为脑内移植物初步提供了组织相容性一简单易行的试验方法。
Objective: To observe hemostatic effect and tissue compatibility of theresidual cavity after lobe resection with Foley catheter balloon tamponade. Soit can provid preliminary experimental evidence for clinical application andfind out simple methods for the organizations compatibility of intracerebralgraft.
Materials and Methods:
1. Operation:
1.1Experimental animals: There are eighteen New Zealand whiterabbits (All are3-month-old). Weight of2000±200g. Half male and female.Randomly divide into two groups(nine rabbits of each group). Give normaldiet and feed in rabbit cage.
1.2Operation: After disinfection and anesthesia, exsect some braintissue of experimental group animals, and then place the balloon in theresidual cavity. Equally, exsect some brain tissue of control group animals,but don’t place balloon.
1.3Post-operative processing: We deal with the brain tissue of twogroups by hematoxylin and eosin staining(HE staining), Masson staining,CD68immunohistochemisty, Nissl body staining, silver staining,B-modeultrasonic, and animal behavior observed. Then compare the two groups inthese aspect. Each group were randomly divided into three subgroups: afterone day, after two days, after three days. Three rabbits of every subgroup.
2. Observe animal behavior after surgery:
Observe neurologic dysfunction, abnormal mental and eating activities ofthe postoperative animal.
3. Histocompatibility observation:
3.1Methods: HE staining, MASSON staining, CD68immunohistochemistry, Nissl body staining, silver staining.
3.2Section observation: Use the microscope to observe inflammatorycell infiltration of brain tissue, the pathological changes of neuronal cellbodies and axons, migration of the microglia and macrophage.
4. Hemostatic effect observation:
4.1B-mode ultrasound: To observe the operation area after1day,2days,3days under the B-mode ultrasound, and then contrast.
4.2Section observation: Observe the number of red blood cells andbrain tissue matrix loosening degree by Masson staining under the microscope.
Results:
1. Comparison of the two group cells: there was no significant differencein Macrophages of the two groups; no significant difference in granulocyteand lymphocytes of the two groups either.(From the HE staining)
2. Comparison of two group tissue: The first day to the third day, thebrain tissue matrix gradually became loosened, the red blood cellsoverflowing increased day by day, and no blood vessel was visible.(FromMasson staining)
3. Compare red blood cells of the two groups, the experimental groupwas better than the control group, and there was statistical significance.
4. CD68immunohistochemistry comparison of two groups: There was nosignificant difference.
5. B-mode ultrasound photos comparison of two groups: The liquidanechoic area of experimental group was lighter then the control group.
6. Compare the subgroups in each group: Brain tissue atrix graduallybecame loosening.Red blood cell overflowing,macrophages and granulocyteswere increasing day by day. Axons gradually swelled and disaggregated(From silver staining). Degenerated and apoptosis Neuronal cell becamemore.(From Nissl body staining)
7. Reference to The Banff2007working classification of skin-containingcomposite tissue allograft pathology: The first day, grade0-II. The second day, grade II-III. The third day, grade III-IV.
8. Reference to the People's Republic of China national standard GB/T-14233.2.93Infusion, transfusion, injection equipment testing methods:Inflammatory cell reaction grade I---IV of class. Generally, there is anupward trend.
Conclusions:
1. The Foley catheter has good histocompatibility.
2. Balloon tamponade is effective on the hemostatic aspect.
3. Initially provide a simple compatibility test for brain grafts.
引文
1R. Ramnarayan N.R. Sreehari G.K. Ninan K.M. John:DelayedPostoperative Extradural Hematoma.Pediatr Neurosurg2007;43:113-114
2Gilsanz F, Pajuelo A, Planas A, Garcia del Valle S, Martinez R, Vaquero J:Cardiovascular and respiratory complications after elective supratentorialcraniotomy. J Neurosurg Sci1998;32:147-151
3Chang T, Hung K, Jung H, Tsai T: Prognostic factors of postoperativeacute renal failure. Dial Transplant1999;28:11-17
4Palmer JD, Sparrow OC, Iannotti F: Postoperative haematoma: a5-yearsurvey and identification of avoidable risk factors. Neurosurgery1994;35:1061–1064; discussion1064-1065
5Zhao GG, Cao JK, Zhao RL: Non-operative regions extraduralhaematoma: a review of5cases. Zhonghua Wai Ke Za Zhi1994;32:683-684
6Soslow RA, Dannenberg AJ, Rush D, Woerner BM, Khan KN,Masferrer J, Koki AT. Cox-2is expressed in human pulmonary, colonic,and mammary tumors. Cancer2000;89:2637-2645
7谭启富,孙康健:开颅术后血肿的处理经验与教训.临床1997年6月第4卷第2期
8张保臣:开颅术后颅内血肿原因分析实用医技杂志2005年11月第12卷第11期下半月版JPMT, November.2005, Vol.12,No.11B
9田立，章翔：开颅术后血肿的形成原因及早期诊断.国外医学神经病学神经外科学分册.1996年第23卷第5期
10Taylor WAS,Thomas NWH,Wellings JA,et al.Timing of postoperativeintracranial hematoma development and implications for the best use ofneurosurgical intensive care.J Neurosurg1995,82:48
11熊飞龙，沈斌，李春生，李强，熊波：颅脑外伤术后并发脑梗塞相关因素分析与防治对策.江西医药2009年8月第44卷第8期
12高建国,洪海味,陈跃秦,郭之通:重型颅脑损伤开颅术后并发脑梗死的临床分析.医学信息内·外科版2009年11月第22卷第11期
13杨苗苗，刘磊：组织工程研究中的免疫学问题.国际口腔医学杂志第
35卷第3期2008年5月
14兰宗宝,王修文,许惠艳:猪器官异种移植研究进展.广西农业科学
2008年第39卷第3期
15杨晓芳,奚廷斐:生物材料生物相容性评价研究进展.生物医学工程学杂志.2001;18(1)∶123-128
16黄红云：中枢修复学.科学出版社（2009）11-88
17温美秀，李学良：中枢神经系统对免疫的调节.医学综述2012年1月第18卷第2期
18john B,Harris TH，Tait ED，et al.Dynamic imaging of CD8+T cell anddendritic cell during infection with toxoplasma gondii[J].PLoSPathog,2009,5(7):1-15
19王忠诚主编.王忠诚神经外科学[M].湖北科学技术出版社，2005:36
1王忠诚主编.王忠诚神经外科学[M].湖北科学技术出版社，2005:36
2段国升主编.神经外科手术学
3赵继宗，主编.颅脑肿瘤外科学[M].北京：人民卫生出版社，2004
4Jeffries BF, Kishore PRS, Singh KS, et al. Postoperative computedtomographic changes in the brain: an experimental study. Radiology1980;135(3):751
5Jeffries BF, Kishore PRS, Singh KS, et al. Contrast enhancement in thepostoperative brain. Radiology1981;139:409
6Go KG.The normal and pathological physiology of brain water[J]. AdvTech Stand Neurosurg,1997:2347-2142
7Lin XF,Shi YM,Lin BC.Mechanism of action of arginine vasopressin onacute ischemic brain edema[J].Chin Med J(Engl),1991,104(6):480-483
8Folcik VA,Smith T,O Bryant S,et al.Treatment with BBBOZZAor rolipramstabilizes the blood-brain barrier in experimental autoimmuneencephalomyelitis:an additional mechanism for the therapeutic effect oftype IV phosphodiesterase inhibitors[J].JNeuroimmunol,1999,97(1-2):119-128
9Chen S,Hillman DE.Immunohistchemical loalization of protein kinase Cdelta during postnatal development of cerebellum[J].BrainRes Dev BrainRes,1994,80(1-2):19-25
10Stanimirovic DB,Bertrand N,Mccaron R,et al.Arachidonic acidrelease andpermeability changes induced by endothelins in humancerebromicrovascular endothelium [J]. Acta Neurochir Supple(wien),1994,6071-6075
11Hu ZL,Tan YX,Zhang JP,et al.Effects of inhibitor of protein kinase C onbrain edema formation euoked by experimental cerebralischemia in gerbilsand rats[J].Yao Xue Xue Bao,1996,31(12):886-890
12Han Z,Wax MB,Patil RV.Regulation of aquaporin-4water channels byphorbol ester-dependent protein phosphorylation[J].JBiolChem,1998,273(11):6001-6004
13Chang RC,Plesnila N,Ringel F,et al.Role of protein kinase C inacidosisinduced glial swelling-current understanding[J].Acta NeurochirSupple(wien),1997:70225-70227
14Mahley GT,Fujimura M,Ma T,et al.Aquaporin-4deletion in mice redulesbrain edema after acute water intoxication and ischemic stroke[J].NatMed,2000,6(2):159-163
15Jung JS,Bhat RV,Preston GM,et al.Molecular characterization ofaquaporin cDNA from brain,candidate osmoreceptor and regulator ofwater balance[J]. Proc Nat Acad Sci USA,1994,91(26):13052-13056
16Agre P,Nielsen S.The aquaporin family of water channels inkidney[J].Nephrologie,1996,17(7):409-415
17Patil RV,Han Z.Regulation of water-channel activity of aquaporin1byarginine vasopression and artrial natriuretic peptide [J]. Biochem BiophysRes Commun,1997,238(2):392-339
18Hasegawa H,Ma T,Skach W,et al.Molecular cloning of amercurial-insensitive water channel expressed inselectedwater-transporting tissues[J].J Biol Chem,1994,269:5497-5500
19李旭琴,考宏盛,刘业俭,等.后颅窝手术中脑压板牵拉力对脑组织影响的临床观察[J].中华神经外科疾病研究杂志,2002,1(1):80
2Gilsanz F, Pajuelo A, Planas A, Garcia del Valle S, Martinez R, Vaquero J:Cardiovascular and respiratory complications after elective supratentorialcraniotomy. J Neurosurg Sci1998;32:147-151
3Chang T, Hung K, Jung H, Tsai T: Prognostic factors of postoperativeacute renal failure. Dial Transplant1999;28:11-17
4Palmer JD, Sparrow OC, Iannotti F: Postoperative haematoma: a5-yearsurvey and identification of avoidable risk factors. Neurosurgery1994;35:1061–1064; discussion1064-1065
5Zhao GG, Cao JK, Zhao RL: Non-operative regions extraduralhaematoma: a review of5cases. Zhonghua Wai Ke Za Zhi1994;32:683-684
6Soslow RA, Dannenberg AJ, Rush D, Woerner BM, Khan KN,Masferrer J, Koki AT. Cox-2is expressed in human pulmonary, colonic,and mammary tumors. Cancer2000;89:2637-2645
7谭启富,孙康健:开颅术后血肿的处理经验与教训.临床1997年6月第4卷第2期
8张保臣:开颅术后颅内血肿原因分析实用医技杂志2005年11月第12卷第11期下半月版JPMT, November.2005, Vol.12,No.11B
9田立，章翔：开颅术后血肿的形成原因及早期诊断.国外医学神经病学神经外科学分册.1996年第23卷第5期
10Taylor WAS,Thomas NWH,Wellings JA,et al.Timing of postoperativeintracranial hematoma development and implications for the best use ofneurosurgical intensive care.J Neurosurg1995,82:48
11熊飞龙，沈斌，李春生，李强，熊波：颅脑外伤术后并发脑梗塞相关因素分析与防治对策.江西医药2009年8月第44卷第8期
12高建国,洪海味,陈跃秦,郭之通:重型颅脑损伤开颅术后并发脑梗死的临床分析.医学信息内·外科版2009年11月第22卷第11期
13杨苗苗，刘磊：组织工程研究中的免疫学问题.国际口腔医学杂志第
35卷第3期2008年5月
14兰宗宝,王修文,许惠艳:猪器官异种移植研究进展.广西农业科学
2008年第39卷第3期
15杨晓芳,奚廷斐:生物材料生物相容性评价研究进展.生物医学工程学杂志.2001;18(1)∶123-128
16黄红云：中枢修复学.科学出版社（2009）11-88
17温美秀，李学良：中枢神经系统对免疫的调节.医学综述2012年1月第18卷第2期
18john B,Harris TH，Tait ED，et al.Dynamic imaging of CD8+T cell anddendritic cell during infection with toxoplasma gondii[J].PLoSPathog,2009,5(7):1-15
19王忠诚主编.王忠诚神经外科学[M].湖北科学技术出版社，2005:36
1王忠诚主编.王忠诚神经外科学[M].湖北科学技术出版社，2005:36
2段国升主编.神经外科手术学
3赵继宗，主编.颅脑肿瘤外科学[M].北京：人民卫生出版社，2004
4Jeffries BF, Kishore PRS, Singh KS, et al. Postoperative computedtomographic changes in the brain: an experimental study. Radiology1980;135(3):751
5Jeffries BF, Kishore PRS, Singh KS, et al. Contrast enhancement in thepostoperative brain. Radiology1981;139:409
6Go KG.The normal and pathological physiology of brain water[J]. AdvTech Stand Neurosurg,1997:2347-2142
7Lin XF,Shi YM,Lin BC.Mechanism of action of arginine vasopressin onacute ischemic brain edema[J].Chin Med J(Engl),1991,104(6):480-483
8Folcik VA,Smith T,O Bryant S,et al.Treatment with BBBOZZAor rolipramstabilizes the blood-brain barrier in experimental autoimmuneencephalomyelitis:an additional mechanism for the therapeutic effect oftype IV phosphodiesterase inhibitors[J].JNeuroimmunol,1999,97(1-2):119-128
9Chen S,Hillman DE.Immunohistchemical loalization of protein kinase Cdelta during postnatal development of cerebellum[J].BrainRes Dev BrainRes,1994,80(1-2):19-25
10Stanimirovic DB,Bertrand N,Mccaron R,et al.Arachidonic acidrelease andpermeability changes induced by endothelins in humancerebromicrovascular endothelium [J]. Acta Neurochir Supple(wien),1994,6071-6075
11Hu ZL,Tan YX,Zhang JP,et al.Effects of inhibitor of protein kinase C onbrain edema formation euoked by experimental cerebralischemia in gerbilsand rats[J].Yao Xue Xue Bao,1996,31(12):886-890
12Han Z,Wax MB,Patil RV.Regulation of aquaporin-4water channels byphorbol ester-dependent protein phosphorylation[J].JBiolChem,1998,273(11):6001-6004
13Chang RC,Plesnila N,Ringel F,et al.Role of protein kinase C inacidosisinduced glial swelling-current understanding[J].Acta NeurochirSupple(wien),1997:70225-70227
14Mahley GT,Fujimura M,Ma T,et al.Aquaporin-4deletion in mice redulesbrain edema after acute water intoxication and ischemic stroke[J].NatMed,2000,6(2):159-163
15Jung JS,Bhat RV,Preston GM,et al.Molecular characterization ofaquaporin cDNA from brain,candidate osmoreceptor and regulator ofwater balance[J]. Proc Nat Acad Sci USA,1994,91(26):13052-13056
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