课题背景：目前关于子宫动脉栓塞已有大量的临床研究报道，认为该方法安全、创伤小、并发症少，临床治疗效果良好。但子宫动脉栓塞后，局部坏死刺激引起肌肉痉挛，引起术后剧烈疼痛。实验建立宫缩的动物试验模型，观察明胶海绵子宫动脉栓塞后，引起宫缩情况，考察栓塞术后疼痛与宫缩的关系；应用山莨菪碱白蛋白微球作为栓塞剂，并行子宫动脉栓塞，观察其栓塞和缓解子宫痉挛的作用。

应用要点：动脉造影显示山莨菪碱白蛋白微球具有栓塞作用，栓塞后实验犬均未出现宫缩，表明其可缓解动脉栓塞所致剧烈宫缩，将有助于减轻宫缩所致的疼痛。

偏倚或不足：设计中为减少不同个体对动脉栓塞引起子宫痉挛和坏死的差异，采用自体两侧对照，可能由于第一次栓塞造成子宫的缺血而影响了第二次另一侧的栓塞结果。另外由于试验犬子宫动脉十分纤细，不能行选择性子宫动脉栓塞只能行髂内动脉栓塞，从而影响试验结果，也是导致未产生明显的组织坏死的重要原因。

摘要

背景：子宫动脉栓塞治疗子宫肌瘤常出现腹部痉挛性疼痛，影响了这一技术的开展。目前常用栓塞剂有聚乙烯醇、明胶海绵、真丝线段、钢圈等。
目的：以明胶海绵为对照，观察山莨菪碱白蛋白微球子宫动脉栓塞的效果及对子宫收缩的影响。
设计、时间及地点：自身交叉对照实验，于1999-10/2001-05在解放军总医院第二附属医院实验室完成。
材料：选用月龄12~18个月雌性杂种犬10只。采用加热固化法制备山莨菪碱微球。将实验犬按随机数字表法分为2组，先行明胶海绵栓塞组和先行山莨菪碱微球栓塞组，每组5只。
方法：各实验犬栓塞前肌注宫缩素，宫腔造影观察并记录子宫痉挛频率，作为子宫收缩的参照标准。先行明胶海绵栓塞组先用明胶海绵颗粒为栓塞剂，行一侧髂内动脉造影及栓塞，15 d后采用山莨菪碱微球行选择性对侧髂内动脉栓塞。15 d后切除子宫观察大体和镜下病理改变。先行山莨菪碱微球栓塞组操作同上，只是一侧髂内动脉先用山莨菪碱微球栓塞，另一侧后用明胶海绵颗粒栓塞。
主要观察指标：每次栓塞后1，3，24 h造影观察动脉栓塞情况及宫缩情况；病理观察子宫组织坏死情况和范围。
结果：10只实验犬肌注宫缩素后8只出现宫缩。先行明胶海绵栓塞组实验犬5只，明胶海绵颗粒子宫动脉栓塞后4只出现宫缩，动脉造影显示山莨菪碱白蛋白微球具有栓塞作用，栓塞后实验犬均未出现宫缩；先行山莨菪碱微球栓塞组实验犬5只，山莨菪碱白蛋白微球子宫动脉栓塞后实验犬均未出现宫缩，明胶海绵颗粒子宫动脉栓塞后5只出现宫缩。子宫病理观察大体标本均未见明显坏死，镜下见小动脉内有微球栓塞及血栓形成，子宫内膜坏死。
结论：明胶海绵子宫动脉栓塞可引起较为强烈的子宫痉挛，山莨菪碱白蛋白微球可缓解动脉栓塞所致剧烈宫缩。
关键词：山莨菪碱白蛋白微球；明胶海绵；子宫动脉栓塞术；生物材料

敖国昆，杨立.山莨菪碱白蛋白微球与明胶海绵颗粒行子宫动脉栓塞的比较[J].中国组织工程研究与临床康复，2008，12(14):2635-2639 [www.zglckf.com/zglckf/ejournal/upfiles/08-14/14k-2635(ps).pdf]

Comparison of raceanisodamine hydrochloride albumin microcapsules and gelform for uterine artery embolization

Abstract

BACKGROUND: Uterine artery embolization is often accompanied with spastic pain in abdomen for treatment of uterus myoma, thereby limiting its development. At present, the common embolic agents include polyvinyl alcohol, gelform, natural silk segment and steel ring, etc.
OBJECTIVE: To investigate and compare the effects on uterine artery embolization and uterine spasm with gelform and raceanisodamine hydrochloride albumin microcapsules.
DESIGN, TIME AND SETTING: A cross-over controlled trial was performed at the laboratory of the Second Affiliated Hospital of Chinese PLA General Hospital between October 1999 and May 2001.
MATERIALS: Ten female hybrid dogs aged 12-18 months were adopted. Raceanisodamine hydrochloride albumin microcapsules were prepared by heat and solidification. The 10 dogs were randomly divided into two groups, first gelform embolism group and first raceanisodamine hydrochloride albumin microcapsules embolism group, each group contained 5 animals.
METHODS: Hysterosalpingography was performed in 10 female dogs, which were injected with oxytocin intramuscularly. The frequency of uterine spasm was recorded as control standard of uterine contraction. In group of first embolizing with gelform, the angiography and arterial embolization with gelform were performed in one side of iliac arteries, then the opposite artery angiography and embolization with raceanisodamine hydrochloride albumin microcapsules were followed 15 days later. On the contrary, in group of first embolizing with microcapsules, one side of iliac arterial embolization was performed with raceanisodamine hydrochloride albumin microcapsules at first, and then the opposite artery embolization with gelform was performed 15 days later. After hysterectomy, the gross and microscope pathological changes of uterine were examined.
MAIN OUTCOME MEASURES: Hysterosalpingography was performed in each animal to observe the arterial embolism and uterine contraction at hours 1, 3 and 24 after uterine artery embolization; The uterine tissue necrosis was evaluated by the pathological observation.
RESULTS: Uterine spasm was found in 8 dogs after injection of oxytocin. In group of first embolizing with gelform, the spasm was observed in 4 of 5 dogs after arterial embolization with gelform, but no spasm was observed after embolization with raceanisodamine hydrochloride albumin microcapsules in all dogs. Angiography results indicated the embolization of raceanisodamine hydrochloride albumin microcapsules. In group of first embolizing with microcapsules, the uterine spasm was observed in all 5 dogs after embolization with gelform, but no spasm after embolization with raceanisodamine hydrochloride albumin microcapsules. On gross examination, no obvious uterine necrosis was found; The necrosis of mucosa, the microcapsules and thrombus in small arteries were visible under microscope examination.
CONCLUSION: The uterine artery embolization with gelform can cause the intense uterine spasm, and raceanisodamine hydrochloride albumin microcapsules have the strong effect of alleviating the spasm caused by uterine artery embolization.

Ao GK, Yang L.Comparison of raceanisodamine hydrochloride albumin microcapsules and gelform for uterine artery embolization.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(14):2635-2639
[www.zglckf.com/zglckf/ejournal/upfiles/08-14/14k-2635(ps).pdf]