～（32）磷-玻璃微球内放射治疗脾功能亢进的实验研究
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摘要
目的：以~(32)P-玻璃微球作为栓塞材料，观察其脾动脉栓塞治疗脾功能亢进的有效性和安全性，寻找一种既能达到持久的临床效果，又痛苦较小，能为病人广泛接受的新方法。方法：采用含纯β射线的~(32)P-玻璃微球作为栓塞材料，第一步：大鼠剂量筛选实验。25只肝硬化模型大鼠随机分成5组，分别直接脾内注射0、30、60、120、240μCi／g脾组织的~(32)P-玻璃微球，观察血常规，脾脏及心、肝、肺、肾等内脏的病理变化，选择最适剂量；第二步：犬治疗实验。直接结扎脾静脉法复制脾肿大伴脾功能亢进模型犬5只，脾动脉内灌注给予60～120μCi／g脾组织~(32)P-玻璃微球进行脾动脉栓塞治疗，观察治疗前后血常规，脾脏病理及犬个般情况的变化及不良反应。结果：脾内注射60、120、240μCi／g脾组织的~(32)P-玻璃微球后第2周开始细胞即有升高，血小板升高相对白细胞稍缓慢，手术后第4周左右明显升高，第4-8周达峰值，并持续达12周以上。红细胞计数及血色素变化无显著差异(P＞0.05)。处理前后丙氨酸氨丛转移酶(ALT)，血尿素氮(BUN)无显著差异(P＞0.05)。病理检查发现60μCi／g脾组织以上组注射处脾脏明显皱缩，脾小体缩小，周围纤维组织增生包饶，240μCi／g脾组织组可见肺组织内可见毛细
学位论文 小文摘炊
血管内淤血及问质炎细胞浸润。采川 6（）～U（）卜 C计g脾州织虽治川几
5只杂种犬，治疗后l～2周血白细胞及血小板均升高，2～4周达
高峰，此后稍有F降但仍保持较高水平达3月以上。病理显示脾脏
体积缩小达32．78％～65．：52讯仆有明锹的纤维化。结论：人鼠实验
发现60～120uCi培 a，fn织的fIJ量给药，既能引起脾脏纤维化，副
作用又最小。根据 60～120 u Ci培脾m织剂量治疗实验性脾功能亢
进杂种犬达到满意效果，并且无明显副作用。实验证明‘乍－玻璃微
球用于脾动脉栓塞治疗脾功能亢进安全，有效。
Objective: l2P-Glass Microsphere (32P-GM) was used as material in spleen artery embolization, study the efficacy and safety of ""P-GM on experimental hypersplensim, to find out a new way with better effect and little side effect to treat hypersplenism. Methods. 32P-Glass Microsphere was used as embolizing material, firstly: experiment of dosage selection with rat. 25 experimental cirrhotic rat divided into 5 groups randomizely, treated with 0 30 60 120 240 uCi/g (spleen) of 32P-Glass Microsphere respectively by intrasplenic injection directly. Blood routine test was performed. Pathology of spleen, liver, kidney, lung and heart was checked to screen the fittest effective dosage. Secondly: treatment of experimental hypersplenism dog. 5 of experimental hypersplenism model dog obtained by ligation of spleen vein directly were treated with 60~120 uCi/g (spleen) of "2P-Glass Microsphere. Blood routine and pathologic examination of spleen, liver, kidney, lung and heart were checked to prove the efficacy and safety
of this dosage of l2P-Glass Microsphere. Result: White blood
cell count of rats increased at the first week after intrasplenic injection. Blood platelet count elevated a little late to significant level at about the fourth week, both got to peak at about 4-8 week, and maintained at significant high level more than 12 weeks. Hemoglobin, red blood cell, alanine transaminase(AJLT), blood urine nitrogen(BUN) and creatinine(Cr) didn't change significantly. Pathologic examination showed spleen crimpled obviously, splenic corpuscles shrank and surrounded with increased fiber tissue in groups more than 60 uCi/g. 240 uCi/g group showed spot congestion of capillary and inflammatory cellular infiltration in lung. The white blood cell and platelet count of 5 hypersplesism dog treated with 60-120 u Ci/g(spleen) of ~l2P-Glass Microsphere elevated at the first week post treatment which peaked at 4 weeks and decreased a little but still maintained at high level more than 3 months. Pathology showed the size of spleen reduced 32. 78% ~ 65. 32% with obvious fibrosis. Conclusion: Rat experiment showed treating with 60-120
uCi/g(spleen) of ' P-Glass Microsphere can either cause significant increase of white cell and platelet count or induce spleen fibrosis with
little adverse effect. Therapeutic experiment of hypersplenism dog
proved the efficacy and safety of 32P-Glass Microsphere embolization.
学位论文 小文摘炊
血管内淤血及问质炎细胞浸润。采川 6（）～U（）卜 C计g脾州织虽治川几
5只杂种犬，治疗后l～2周血白细胞及血小板均升高，2～4周达
高峰，此后稍有F降但仍保持较高水平达3月以上。病理显示脾脏
体积缩小达32．78％～65．：52讯仆有明锹的纤维化。结论：人鼠实验
发现60～120uCi培 a，fn织的fIJ量给药，既能引起脾脏纤维化，副
作用又最小。根据 60～120 u Ci培脾m织剂量治疗实验性脾功能亢
进杂种犬达到满意效果，并且无明显副作用。实验证明‘乍－玻璃微
球用于脾动脉栓塞治疗脾功能亢进安全，有效。
Objective: l2P-Glass Microsphere (32P-GM) was used as material in spleen artery embolization, study the efficacy and safety of ""P-GM on experimental hypersplensim, to find out a new way with better effect and little side effect to treat hypersplenism. Methods. 32P-Glass Microsphere was used as embolizing material, firstly: experiment of dosage selection with rat. 25 experimental cirrhotic rat divided into 5 groups randomizely, treated with 0 30 60 120 240 uCi/g (spleen) of 32P-Glass Microsphere respectively by intrasplenic injection directly. Blood routine test was performed. Pathology of spleen, liver, kidney, lung and heart was checked to screen the fittest effective dosage. Secondly: treatment of experimental hypersplenism dog. 5 of experimental hypersplenism model dog obtained by ligation of spleen vein directly were treated with 60~120 uCi/g (spleen) of "2P-Glass Microsphere. Blood routine and pathologic examination of spleen, liver, kidney, lung and heart were checked to prove the efficacy and safety
of this dosage of l2P-Glass Microsphere. Result: White blood
cell count of rats increased at the first week after intrasplenic injection. Blood platelet count elevated a little late to significant level at about the fourth week, both got to peak at about 4-8 week, and maintained at significant high level more than 12 weeks. Hemoglobin, red blood cell, alanine transaminase(AJLT), blood urine nitrogen(BUN) and creatinine(Cr) didn't change significantly. Pathologic examination showed spleen crimpled obviously, splenic corpuscles shrank and surrounded with increased fiber tissue in groups more than 60 uCi/g. 240 uCi/g group showed spot congestion of capillary and inflammatory cellular infiltration in lung. The white blood cell and platelet count of 5 hypersplesism dog treated with 60-120 u Ci/g(spleen) of ~l2P-Glass Microsphere elevated at the first week post treatment which peaked at 4 weeks and decreased a little but still maintained at high level more than 3 months. Pathology showed the size of spleen reduced 32. 78% ~ 65. 32% with obvious fibrosis. Conclusion: Rat experiment showed treating with 60-120
uCi/g(spleen) of ' P-Glass Microsphere can either cause significant increase of white cell and platelet count or induce spleen fibrosis with
little adverse effect. Therapeutic experiment of hypersplenism dog
proved the efficacy and safety of 32P-Glass Microsphere embolization.
引文
1. Maddison F. Embolic therapy of hypersplenism. Invest Radiol.1973:8(2):280-281.
2. Spigos D G, Tan W S, Moses M F. et al. Splenic embolization. Intervent Radiol. 1980;3(4):282-285
3．王修忠，李恭才，朱壮涌。脾功能亢进的实验研究及其临床应用。中华小儿外科杂志。1987；2：71-72
4．秦兆寅。脾切除后败血症。西安医学院学报。1983；3：317
5．贾志强。脾动脉栓塞的实验研究。中华放射学杂志。1989；6：363-364
6．李京雨，张新国，徐力扬，等。褐藻胶微球动脉栓塞治疗的临床应用。介入放射学杂志，1995：4(3)：151-153
7．吴传斌，魏属礼，卢炜，等。磁性微球的磁响应性及狗肾动脉栓塞实验研究。药学学报。1994：29(4)：311-315
8．兰青，黄强。放射免疫治疗中核素弹头的选择与应用。中华核医学杂志；1998，18(2)：125-126
9．陈晓理，吴言涛，严律南，等。~32磷玻璃微球治疗原发性肝癌的实验研究。普外基础与临床杂志：1996，3(2)：68-72。
10．严律南。~32磷玻璃微球治疗晚期肝癌。中国实用外科杂志；1997，17(1)：4-8
11．陈卫国，李彦豪，彭武和，等。β(?)部分脾切除治疗脾功能亢进的实验研究。中国医学影像学技术；1996，12：427-432
12．彭武和，郑普德，陈卫国，等。治疗量~131Ⅰ-碘油动物脾动脉内注射后的早期效应。中华核医学杂志：1996，16(4)：252
13．郝刚，赵延常，黄涌，等。脾动脉栓塞的临床应用。实用放
射学杂志 1994; 10(5) : 282-286
14． 李京雨。部分脾动脉栓塞方法的探讨。介入放射学杂志, 1994; 1: 15-17
15． Jonasson O, Spigos DG, Mozes MF. Partial splenic emboliza-tion. Experience in 136 patients. World J Surg.1985:9(3) : 461-465
16． Harned RK, Thompson MR, Kumpe DA, et al. Partial splenic embolization in five children with hypersplenism: effects of reduced volume embolization on efficacy and morbidity. Radiology.1998; 209(3) :803-807
17． Wright KC, Anderson JH, Gianturco C, et al. Partial splenic eraboli-zation using polyvinyl alcohol foam, dextran, polystyrene, orsilicone. An experimental study in dogs. Radiology. 1982; 142 (2) : 351-354．
18． Alwmark A, Bengmark S, Gullstrand P, et al. Evaluation of splenic embolization in patients with portal hypertension and hypersplenism. Ann Surg. 1982:196(5) : 518-524
19． Yamauchi T, Furui S, Irie T, et al. Partial splenic emboliza tion with Y-shaped silicone particles. Acta Radiol 1994; 35(4) :335-339
2. Spigos D G, Tan W S, Moses M F. et al. Splenic embolization. Intervent Radiol. 1980;3(4):282-285
3．王修忠，李恭才，朱壮涌。脾功能亢进的实验研究及其临床应用。中华小儿外科杂志。1987；2：71-72
4．秦兆寅。脾切除后败血症。西安医学院学报。1983；3：317
5．贾志强。脾动脉栓塞的实验研究。中华放射学杂志。1989；6：363-364
6．李京雨，张新国，徐力扬，等。褐藻胶微球动脉栓塞治疗的临床应用。介入放射学杂志，1995：4(3)：151-153
7．吴传斌，魏属礼，卢炜，等。磁性微球的磁响应性及狗肾动脉栓塞实验研究。药学学报。1994：29(4)：311-315
8．兰青，黄强。放射免疫治疗中核素弹头的选择与应用。中华核医学杂志；1998，18(2)：125-126
9．陈晓理，吴言涛，严律南，等。~32磷玻璃微球治疗原发性肝癌的实验研究。普外基础与临床杂志：1996，3(2)：68-72。
10．严律南。~32磷玻璃微球治疗晚期肝癌。中国实用外科杂志；1997，17(1)：4-8
11．陈卫国，李彦豪，彭武和，等。β(?)部分脾切除治疗脾功能亢进的实验研究。中国医学影像学技术；1996，12：427-432
12．彭武和，郑普德，陈卫国，等。治疗量~131Ⅰ-碘油动物脾动脉内注射后的早期效应。中华核医学杂志：1996，16(4)：252
13．郝刚，赵延常，黄涌，等。脾动脉栓塞的临床应用。实用放
射学杂志 1994; 10(5) : 282-286
14． 李京雨。部分脾动脉栓塞方法的探讨。介入放射学杂志, 1994; 1: 15-17
15． Jonasson O, Spigos DG, Mozes MF. Partial splenic emboliza-tion. Experience in 136 patients. World J Surg.1985:9(3) : 461-465
16． Harned RK, Thompson MR, Kumpe DA, et al. Partial splenic embolization in five children with hypersplenism: effects of reduced volume embolization on efficacy and morbidity. Radiology.1998; 209(3) :803-807
17． Wright KC, Anderson JH, Gianturco C, et al. Partial splenic eraboli-zation using polyvinyl alcohol foam, dextran, polystyrene, orsilicone. An experimental study in dogs. Radiology. 1982; 142 (2) : 351-354．
18． Alwmark A, Bengmark S, Gullstrand P, et al. Evaluation of splenic embolization in patients with portal hypertension and hypersplenism. Ann Surg. 1982:196(5) : 518-524
19． Yamauchi T, Furui S, Irie T, et al. Partial splenic emboliza tion with Y-shaped silicone particles. Acta Radiol 1994; 35(4) :335-339