岩静脉离断动物模型的建立及岩静脉离断对兔脑组织的影响
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摘要
背景1929年,Dandy教授在其文章中插图展示了一支走行于桥小脑角区域并经三叉神经背侧汇入岩上窦的静脉,此静脉便是后来众所周知的岩静脉。岩静脉是非常重要且相对恒定的解剖标志,在涉及天幕以及桥小脑角区病变的手术中扮演重要角色。
袁贤瑞教授回顾2004年6月至2007年10月进行的听神经瘤手术33例,其中2例手术中岩静脉被电凝处理,31例保护良好。31例岩静脉保护良好的患者术后恢复良好,2例电凝处理岩静脉的患者继发小脑出血性梗死并水肿；1例死亡,1例经后颅窝减压后病情好转。因此,袁贤瑞教授认为手术中应当妥善保护岩静脉,这一观点得到很多学者的支持；但亦有部分学者认为手术中离断岩静脉对术后效果影响不大。目前,文献中未查及关于岩静脉的动物实验研究。
目的建立家兔单侧岩静脉离断(双极电凝烧灼后,显微剪剪断)动物模型,观察岩静脉离断后家兔脑组织病理结构、含水量、钠钾离子含量、SOD活力、MDA含量及AQP-4转录与表达。
方法1选用健康家兔10只(雌雄不限),解剖分离其颈动脉及颈静脉,应用硅橡胶对新鲜家兔尸头进行灌注。解剖观察灌注好的家兔尸头标本,比较家兔与人类岩静脉的解剖结构。2健康成年家兔144只随机分成两组,即假手术组与岩静脉离断组。每组按处死时间点即手术操作后4h、8h、12h、24h、48h、72h分成六个亚组,每个亚组12只家兔。每个亚组中取6只获取标本后,干湿重法检测小脑及脑干组织含水量；原子火焰吸收分光光度法检测钠钾离子含量；黄嘌呤氧化酶法检测SOD活力；硫代巴比妥酸(TBA)法检测MDA含量,RT-PCR检测AQP-4mRNA转录。亚组中另外六只采用HE染色、尼氏染色及电镜观察脑组织病理结构改变；免疫组织化学检测AQP-4蛋白表达。
结果
1家兔尸头灌注血管色泽鲜艳,细小血管显示良好,解剖结构保留完整,其岩静脉解剖结构与人类相似。
2含水量及钠钾离子含量：A小脑组织：假手术组各亚组脑组织含水量、钠钾离子含量无统计学差异(p>0.05)；岩静脉离断后4h、8h、12h、24h组脑组织含水量、钠离子含量高于假手术组(p＜0.05),岩静脉离断后4h、8h、12h、24h组脑组织钾离子含量低于假手术组(p<0.05)；岩静脉离断后4h脑组织含水量、钠离子含量增加,8-12达高峰,持续至24小时(p＜0.05),钾离子含量自4h降低,8-12小时降至最低(p<0.05)。B脑干组织：假手术组各亚组脑组织含水量、钠钾离子含量无统计学差异(p＞0.05)；岩静脉离断后4h脑组织含水量、钠离子含量高于假手术组(p＜0.05),钾离子含量低于假手术组(p＜0.05)。
3小脑组织病理结构改变：假手术组小脑组织神经细胞结构基本正常,岩静脉离断后4h、8h、12h出现水肿,表现为细胞肿胀,尼氏体消失,神经细胞变性坏死等。脑干组织病理结构改变：岩静脉离断4h组出现细胞水肿,岩静脉离断组其余各亚组与假手术组病理结构基本正常。
4 SOD活力检测：A小脑组织：假手术组之间SOD活力无统计学差异(p＞0.05)岩静脉离断后4h、8h、12h、24h脑组织SOD活力低于假手术组(p<0.05)岩静脉离断后4h脑组织SOD活力下降,8-12至最低,持续至24小时(p<0.05)。B脑干组织：假手术组各亚组脑组织SOD活力无统计学差异(p>0.05)岩静脉离断后4h脑组织SOD活力低于假手术组(p<0.05)。
5 MDA含量检测：A小脑组织：假手术组之间MDA含量无统计学差异(p>0.05)岩静脉离断后4h、8h、12h、24h脑组织MDA含量高于假手术组(p<0.05)岩静脉离断后4h脑组织MDA含量上升,8-12达高峰,48-72小时接近假手术组(p<0.05)。B脑干组织：假手术组各亚组脑组织MDA含量无统计学差异(p>0.05)岩静脉离断后4h脑组织MDA含量高于假手术组(p<0.05)。
6 AQP-4转录与表达：A小脑组织：假手术组各亚组脑组织AQP-4转录及表达无统计学差异(p>0.05)；岩静脉离断后4h、8h、12h、24h脑组织AQP-4转录与表达增强(p<0.05)。B脑干组织：假手术组各亚组脑组织AQP-4转录及表达无统计学差异(p>0.05)：岩静脉离断后4h脑组织AQP-4转录及表达强于假手术组(p<0.05)。
结论
1家兔具有与人类相似的岩静脉结构及引流,从解剖学角度讲,家兔可用于建立岩静脉离断动物模型。
2岩静脉离断组4h、8h、12h、24h亚组小脑组织含水量及钠离子含量较假手术对照组增加,钾离子含量降低。表明岩静脉离断引起钠钾ATP酶功能障碍,导致小脑组织水肿。
3岩静脉离断导致家兔脑组织病理结构改变,此结构改变为可逆性。
4岩静脉离断组4h、8h、12h、24h亚组小脑组织较假手术对照组小脑组织MDA含量增加,SOD活力下降。表明脑细胞代谢及功能障碍,清除氧自由基的能力下降。提示对抗氧自由基可能有助于脑组织功能恢复。
5岩静脉离断组4h、8h、12h、24h亚组小脑组织AQP-4转录与表达较假手术组增强,说明AQP-4参与了脑水肿的形成与发展。提示抑制AQP-4的表达可能能够减轻岩静脉离断导致的脑水肿。
Back ground In 1929, professor Walter Dandy first pointed out the importance of the petrosal vein in connection with surgery for trigeminal neuralgia. His illustration showed a vein that coursed in the cerebellopontine angle rostral to the trigeminal nerve to drain into the superior petrosal sinus. Later, this common stem came to be identified as the petrosal vein. Petrosal vein is an important and relatively constant anatomical landmark. It also plays an important role in surgery for tentorial and cerebellopontine angle tumours.
Professor Yuan Xianrui reviewed 33 cases of acoustic neuroma surgery carried since June 2004 to October 2007, including 2 cases(coagulated petrosal vein) and 31 cases (well protected petrosal vein). Four patients that petrosal vein was coagulated developed cerebellar hemorrhagic infarction. One patient died,1 patient was carried posterior fossa decompression and recovered. Thus, Professor Yuan Xianrui pointed out that petrosal vein should be protected during surgery. His view has been supported by many scholars; however, some scholars don't think that sacrifice of the petrosal vein has effect on the results of operation. There are no exact animal experiments about the consequences after mutilation of petrosal vein at present.
Objective To establish unilateral petrosal vein mutilation (coagulation by bipolar, cut by micro scissor) model of rabbit. To observe the brain water content, sodium and potassium content, SOD activity, MDA content, AQP-4 transcription and expression and pathological changes of brain tissue after mutilation of petrosal vein.
Methods 1) 10 rabbits (either sex), separate the carotid artery and jugular vein, perfuse fresh rabbit cadaver by silicone. Observe rabbit cadaveric head specimens, compare it's petrosal vein with human's.2) 144 healthy adult rabbits were randomly divided into two groups, namely sham operation group and petrosal vein mutilation group. Rabbits were killed at 4h,8h,12h,24h,48h,72h after operation. Groups were divided into six sub-groups according to the time points (n=12 in each sub-group). Six of each sub-group were taken to measure water content by the wet and dry weight method; the content of sodium and potassium by flame photometer, SOD activity by xanthine oxidase assay, MDA content by thiobarbituric acid (TBA) assay, AQP-4mRNA transcription by RT-PCR. The other six of each sub-group were taken to observe the brain tissue pathological changes by HE staining, Nissl staining and electron microscopy structure, AQP-4 protein expression by immunohistochemistry.
Results
1 Color of perfused vessels was bright, small blood vessels were clear, anatomical structures were remained well, the petrosal vein was similar to human's.
2 Water content, sodium and potassium ion content:A) cerebellar tissues:brain water content, sodium and potassium ion content had no statistic difference in sham operation groups (p>0.05); water content and sodium content of 4h,8h,12h,24h sub-groups of petrosal vein mutilation group was higher than sham operation groups (p<0.05), potassium content of 4h,8h,12h,24h sub-groups of petrosal vein mutilation group were lower than the sham operation groups (p<0.05);4 hours after the mutilation of petrosal vein, water content and sodium content increased, they reached maximum 8-12 hours later, continued to 24 hours (p<0.05). Potassium ions content decreased to minimum 8-12 hours later (p<0.05). B) brain stem:water content, sodium and potassium ion content in sub-groups of sham operation group had no significant difference (p>0.05); 4 hours after mutilation of petrosal vein, brain water content, sodium content was higher than sham operation group (p<0.05), potassium content was lower than the sham operation group (p<0.05).
3 Cerebellar pathological structural changes:structure of nerve cells of cerebellum were normal in sham operation groups; in 4h,8h,12h,24h sub-groups of petrosal vein mutilation group, the tissues appeared edema, manifested as cell swelling, disappearance of Nissl bodies, cell degeneration and necrosis. Pathological changes in the brain stem structure:4h sub-group of mutilation group show edema, pathological structures of the sham operation groups and other sub-groups of petrosal vein mutilation group were normal.
4 SOD activity detection:A) cerebellum:SOD activity in the sham groups had no significant difference (p>0.05); SOD activity in 4h,8h, 12h,24h sub-groups of petrosal vein mutilation group were lower than in the sham operation groups (p<0.05); SOD activity decreased 4hours later,8-12 hours reached minimum, continued to 24 hours (p<0.05). B) brain stem:SOD activity had no significant difference in sham operation groups (p>0.05); SOD activity in 4h sub-group of petrosal vein mutilation group is lower than in sham operation group (p<0.05).
5 MDA content detection:MDA content in the sham groups had no significant difference (p>0.05); MDA content in 4h,8h,12h,24h sub-groups of petrosal vein mutilation group were higher than in the sham operation groups (p<0.05); MDA content increased 4hours later, 8-12 hours reached maximum, continued to 24 hours (p<0.05). B) brain stem:MDA detection had no significant difference in sham operation groups(p>0.05); MDA content in 4h sub-group of petrosal vein mutilation group is higher than in sham operation group (p<0.05).
6 AQP-4 transcription and expression:AQP-4 transcription and expression in the sham groups had no significant difference (p>0.05); AQP-4 transcription and expression in 4h,8h,12h,24h sub-groups of petrosal vein mutilation group were higher than in the sham operation groups (p<0.05); AQP-4 transcription and expression increased 4hours later,8-12 hours reached maximum, continued to 24 hours (p<0.05). B) brain stem:AQP-4 transcription and expression had no significant difference in sham operation groups(p>0.05); AQP-4 transcription and expression in 4h sub-group of petrosal vein mutilation group is higher than in sham operation group (p<0.05).
Conclusions
1 The structure and drainage of petrosal vein of rabbit was similar with human's, rabbits can be used to establish petrosal vein mutilation animal model.
2 Compared with sham control group, cerebellar water content and sodium ion content increased in petrosal vein mutilation group, potassium content decreased. Mutilation of petrosal vein caused dysfunction of Na-K ATPase, resulted in cerebellar edema.
3 Mutilation of petrosal vein can lead to pathological structural changes of rabbit brain tissues, the structural change is reversible.
4 Compared with sham control group, MDA content increased in petrosal vein mutilation group, SOD activity decreased. Metabolism and function of neuron were damaged, the ability to eliminate oxygen free radicals decreased. Reduction of oxygen free radicals may contribute to brain function.
5 Compared with sham control group, AQP-4 transcription and expression increased in petrosal vein mutilation group, indicating AQP-4 involved in the formation and development of cerebral edema. It suggested that inhibition of the expression of AQP-4 may be able to reduce brain edema.
袁贤瑞教授回顾2004年6月至2007年10月进行的听神经瘤手术33例,其中2例手术中岩静脉被电凝处理,31例保护良好。31例岩静脉保护良好的患者术后恢复良好,2例电凝处理岩静脉的患者继发小脑出血性梗死并水肿；1例死亡,1例经后颅窝减压后病情好转。因此,袁贤瑞教授认为手术中应当妥善保护岩静脉,这一观点得到很多学者的支持；但亦有部分学者认为手术中离断岩静脉对术后效果影响不大。目前,文献中未查及关于岩静脉的动物实验研究。
目的建立家兔单侧岩静脉离断(双极电凝烧灼后,显微剪剪断)动物模型,观察岩静脉离断后家兔脑组织病理结构、含水量、钠钾离子含量、SOD活力、MDA含量及AQP-4转录与表达。
方法1选用健康家兔10只(雌雄不限),解剖分离其颈动脉及颈静脉,应用硅橡胶对新鲜家兔尸头进行灌注。解剖观察灌注好的家兔尸头标本,比较家兔与人类岩静脉的解剖结构。2健康成年家兔144只随机分成两组,即假手术组与岩静脉离断组。每组按处死时间点即手术操作后4h、8h、12h、24h、48h、72h分成六个亚组,每个亚组12只家兔。每个亚组中取6只获取标本后,干湿重法检测小脑及脑干组织含水量；原子火焰吸收分光光度法检测钠钾离子含量；黄嘌呤氧化酶法检测SOD活力；硫代巴比妥酸(TBA)法检测MDA含量,RT-PCR检测AQP-4mRNA转录。亚组中另外六只采用HE染色、尼氏染色及电镜观察脑组织病理结构改变；免疫组织化学检测AQP-4蛋白表达。
结果
1家兔尸头灌注血管色泽鲜艳,细小血管显示良好,解剖结构保留完整,其岩静脉解剖结构与人类相似。
2含水量及钠钾离子含量：A小脑组织：假手术组各亚组脑组织含水量、钠钾离子含量无统计学差异(p>0.05)；岩静脉离断后4h、8h、12h、24h组脑组织含水量、钠离子含量高于假手术组(p＜0.05),岩静脉离断后4h、8h、12h、24h组脑组织钾离子含量低于假手术组(p<0.05)；岩静脉离断后4h脑组织含水量、钠离子含量增加,8-12达高峰,持续至24小时(p＜0.05),钾离子含量自4h降低,8-12小时降至最低(p<0.05)。B脑干组织：假手术组各亚组脑组织含水量、钠钾离子含量无统计学差异(p＞0.05)；岩静脉离断后4h脑组织含水量、钠离子含量高于假手术组(p＜0.05),钾离子含量低于假手术组(p＜0.05)。
3小脑组织病理结构改变：假手术组小脑组织神经细胞结构基本正常,岩静脉离断后4h、8h、12h出现水肿,表现为细胞肿胀,尼氏体消失,神经细胞变性坏死等。脑干组织病理结构改变：岩静脉离断4h组出现细胞水肿,岩静脉离断组其余各亚组与假手术组病理结构基本正常。
4 SOD活力检测：A小脑组织：假手术组之间SOD活力无统计学差异(p＞0.05)岩静脉离断后4h、8h、12h、24h脑组织SOD活力低于假手术组(p<0.05)岩静脉离断后4h脑组织SOD活力下降,8-12至最低,持续至24小时(p<0.05)。B脑干组织：假手术组各亚组脑组织SOD活力无统计学差异(p>0.05)岩静脉离断后4h脑组织SOD活力低于假手术组(p<0.05)。
5 MDA含量检测：A小脑组织：假手术组之间MDA含量无统计学差异(p>0.05)岩静脉离断后4h、8h、12h、24h脑组织MDA含量高于假手术组(p<0.05)岩静脉离断后4h脑组织MDA含量上升,8-12达高峰,48-72小时接近假手术组(p<0.05)。B脑干组织：假手术组各亚组脑组织MDA含量无统计学差异(p>0.05)岩静脉离断后4h脑组织MDA含量高于假手术组(p<0.05)。
6 AQP-4转录与表达：A小脑组织：假手术组各亚组脑组织AQP-4转录及表达无统计学差异(p>0.05)；岩静脉离断后4h、8h、12h、24h脑组织AQP-4转录与表达增强(p<0.05)。B脑干组织：假手术组各亚组脑组织AQP-4转录及表达无统计学差异(p>0.05)：岩静脉离断后4h脑组织AQP-4转录及表达强于假手术组(p<0.05)。
结论
1家兔具有与人类相似的岩静脉结构及引流,从解剖学角度讲,家兔可用于建立岩静脉离断动物模型。
2岩静脉离断组4h、8h、12h、24h亚组小脑组织含水量及钠离子含量较假手术对照组增加,钾离子含量降低。表明岩静脉离断引起钠钾ATP酶功能障碍,导致小脑组织水肿。
3岩静脉离断导致家兔脑组织病理结构改变,此结构改变为可逆性。
4岩静脉离断组4h、8h、12h、24h亚组小脑组织较假手术对照组小脑组织MDA含量增加,SOD活力下降。表明脑细胞代谢及功能障碍,清除氧自由基的能力下降。提示对抗氧自由基可能有助于脑组织功能恢复。
5岩静脉离断组4h、8h、12h、24h亚组小脑组织AQP-4转录与表达较假手术组增强,说明AQP-4参与了脑水肿的形成与发展。提示抑制AQP-4的表达可能能够减轻岩静脉离断导致的脑水肿。
Back ground In 1929, professor Walter Dandy first pointed out the importance of the petrosal vein in connection with surgery for trigeminal neuralgia. His illustration showed a vein that coursed in the cerebellopontine angle rostral to the trigeminal nerve to drain into the superior petrosal sinus. Later, this common stem came to be identified as the petrosal vein. Petrosal vein is an important and relatively constant anatomical landmark. It also plays an important role in surgery for tentorial and cerebellopontine angle tumours.
Professor Yuan Xianrui reviewed 33 cases of acoustic neuroma surgery carried since June 2004 to October 2007, including 2 cases(coagulated petrosal vein) and 31 cases (well protected petrosal vein). Four patients that petrosal vein was coagulated developed cerebellar hemorrhagic infarction. One patient died,1 patient was carried posterior fossa decompression and recovered. Thus, Professor Yuan Xianrui pointed out that petrosal vein should be protected during surgery. His view has been supported by many scholars; however, some scholars don't think that sacrifice of the petrosal vein has effect on the results of operation. There are no exact animal experiments about the consequences after mutilation of petrosal vein at present.
Objective To establish unilateral petrosal vein mutilation (coagulation by bipolar, cut by micro scissor) model of rabbit. To observe the brain water content, sodium and potassium content, SOD activity, MDA content, AQP-4 transcription and expression and pathological changes of brain tissue after mutilation of petrosal vein.
Methods 1) 10 rabbits (either sex), separate the carotid artery and jugular vein, perfuse fresh rabbit cadaver by silicone. Observe rabbit cadaveric head specimens, compare it's petrosal vein with human's.2) 144 healthy adult rabbits were randomly divided into two groups, namely sham operation group and petrosal vein mutilation group. Rabbits were killed at 4h,8h,12h,24h,48h,72h after operation. Groups were divided into six sub-groups according to the time points (n=12 in each sub-group). Six of each sub-group were taken to measure water content by the wet and dry weight method; the content of sodium and potassium by flame photometer, SOD activity by xanthine oxidase assay, MDA content by thiobarbituric acid (TBA) assay, AQP-4mRNA transcription by RT-PCR. The other six of each sub-group were taken to observe the brain tissue pathological changes by HE staining, Nissl staining and electron microscopy structure, AQP-4 protein expression by immunohistochemistry.
Results
1 Color of perfused vessels was bright, small blood vessels were clear, anatomical structures were remained well, the petrosal vein was similar to human's.
2 Water content, sodium and potassium ion content:A) cerebellar tissues:brain water content, sodium and potassium ion content had no statistic difference in sham operation groups (p>0.05); water content and sodium content of 4h,8h,12h,24h sub-groups of petrosal vein mutilation group was higher than sham operation groups (p<0.05), potassium content of 4h,8h,12h,24h sub-groups of petrosal vein mutilation group were lower than the sham operation groups (p<0.05);4 hours after the mutilation of petrosal vein, water content and sodium content increased, they reached maximum 8-12 hours later, continued to 24 hours (p<0.05). Potassium ions content decreased to minimum 8-12 hours later (p<0.05). B) brain stem:water content, sodium and potassium ion content in sub-groups of sham operation group had no significant difference (p>0.05); 4 hours after mutilation of petrosal vein, brain water content, sodium content was higher than sham operation group (p<0.05), potassium content was lower than the sham operation group (p<0.05).
3 Cerebellar pathological structural changes:structure of nerve cells of cerebellum were normal in sham operation groups; in 4h,8h,12h,24h sub-groups of petrosal vein mutilation group, the tissues appeared edema, manifested as cell swelling, disappearance of Nissl bodies, cell degeneration and necrosis. Pathological changes in the brain stem structure:4h sub-group of mutilation group show edema, pathological structures of the sham operation groups and other sub-groups of petrosal vein mutilation group were normal.
4 SOD activity detection:A) cerebellum:SOD activity in the sham groups had no significant difference (p>0.05); SOD activity in 4h,8h, 12h,24h sub-groups of petrosal vein mutilation group were lower than in the sham operation groups (p<0.05); SOD activity decreased 4hours later,8-12 hours reached minimum, continued to 24 hours (p<0.05). B) brain stem:SOD activity had no significant difference in sham operation groups (p>0.05); SOD activity in 4h sub-group of petrosal vein mutilation group is lower than in sham operation group (p<0.05).
5 MDA content detection:MDA content in the sham groups had no significant difference (p>0.05); MDA content in 4h,8h,12h,24h sub-groups of petrosal vein mutilation group were higher than in the sham operation groups (p<0.05); MDA content increased 4hours later, 8-12 hours reached maximum, continued to 24 hours (p<0.05). B) brain stem:MDA detection had no significant difference in sham operation groups(p>0.05); MDA content in 4h sub-group of petrosal vein mutilation group is higher than in sham operation group (p<0.05).
6 AQP-4 transcription and expression:AQP-4 transcription and expression in the sham groups had no significant difference (p>0.05); AQP-4 transcription and expression in 4h,8h,12h,24h sub-groups of petrosal vein mutilation group were higher than in the sham operation groups (p<0.05); AQP-4 transcription and expression increased 4hours later,8-12 hours reached maximum, continued to 24 hours (p<0.05). B) brain stem:AQP-4 transcription and expression had no significant difference in sham operation groups(p>0.05); AQP-4 transcription and expression in 4h sub-group of petrosal vein mutilation group is higher than in sham operation group (p<0.05).
Conclusions
1 The structure and drainage of petrosal vein of rabbit was similar with human's, rabbits can be used to establish petrosal vein mutilation animal model.
2 Compared with sham control group, cerebellar water content and sodium ion content increased in petrosal vein mutilation group, potassium content decreased. Mutilation of petrosal vein caused dysfunction of Na-K ATPase, resulted in cerebellar edema.
3 Mutilation of petrosal vein can lead to pathological structural changes of rabbit brain tissues, the structural change is reversible.
4 Compared with sham control group, MDA content increased in petrosal vein mutilation group, SOD activity decreased. Metabolism and function of neuron were damaged, the ability to eliminate oxygen free radicals decreased. Reduction of oxygen free radicals may contribute to brain function.
5 Compared with sham control group, AQP-4 transcription and expression increased in petrosal vein mutilation group, indicating AQP-4 involved in the formation and development of cerebral edema. It suggested that inhibition of the expression of AQP-4 may be able to reduce brain edema.
引文
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