【作者】 李维新；

【导师】 高国栋；

【作者基本信息】 第四军医大学 ， 外科学（神经外科）， 2001， 硕士

【摘要】 介入神经放射学（interventional neuroradiology）是研究在X线的监视下，对中枢神经系统的某些疾病进行直接诊断、治疗的学科。血管内栓塞技术的应用使得一些原本难度和危险性都很大的疾病得到了更为安全的治疗，提高了疗效。这项新技术的应用和发展与血管内栓塞材料以及导管、导丝技术的研制开发是密切相关的。现在应用于临床的栓塞材料较多，大致可分为固体和液体两大类。目前使用的固体栓塞剂分为可吸收固体栓塞剂和不可吸收性固体栓塞剂。可吸收性固体栓塞剂如：自体血凝块、明胶海绵、氧化纤维素或醋酸纤维素等。不可吸收性固体栓塞剂主要有聚乙烯醇、冷冻硬膜、硅塑胶球、丙烯酸球、丝线、弹簧圈等。微球作为一种神经外科血管内治疗的固体栓塞剂广泛地用于临床，在动静脉畸形、动静脉瘘、毛细血管瘤等的治疗，以及血供丰富肿瘤的术前栓塞中具有重要意义。 目的：本课题的研究目的在于研制一种含有X-线显影材料的固体栓塞剂，用于临床的介入栓塞。使这种固体栓塞剂在栓塞治疗的过程中能够在X-线下实时显影，有利于操作者在治疗当中随时了解栓塞的准确性，栓塞的范围，栓塞的致密程度以及是否发生误栓等，以便及时采取相应的措施。 mW羊厂人学恤卜学位论义 材料与方法：我们所采用的栓塞剂骨架分别为明胶和聚乙烯醇制扮 的微球。所采用的显影材料分别为硫酸钡、泛影葡肮、袒粉、优鳅显 和戍化钠。所采角的方法有物理浪合包埋和化学交联反应。本Uf穴分 为三部分，第一部分为微球骨架的制备，分别制作用于包埋、挽卅故 影材料的明胶微球和聚乙烯醇微球（明胶微球的制作方法为乳化聚合 汝，聚乙烯醇微球的制作人法为醇醛缩合法结合乳化聚合法），仆对 它们的分散性、膨胀性、稳定性等理化性质进行初步的测定：第 洲S 分为各种显影材料的包埋实验，同时对含有显影剂的栓塞材料的拈影 件、显影则间及它们是否有细胞毒性进行测定；第二祁分为利物’史 验，在数宇减影下使川以上实验所制备的栓寒材料对家兔进行）’仙of！部 位动脉血管的选择性栓塞，＃。且于栓塞后第一、二、凹周后冉次进影 门处死动物，作病理切片，综合判断以上栓塞材料的各人山付能；的 后讨论介入栓塞治疗对于固体栓塞剂的理化性质要求。 结果：通过实验制备出分别含有泛影葡胆、硫酸钡、钉l粉和仇为！．J 的明胶和聚乙烯醇微球，动物实验证实微球在家兔的颅月·背景 l‘llJ以 显影，操作者能够以此判断微球在颅内的栓塞情况；实验所制备的微 球其分散性，稳定性和膨胀性均符合栓塞要求。 结论：用乳化聚合法制备的明胶微球和聚乙烯醇微球具有良好的分 敝件、膨胀忏和’卜物川容们，足较为到Z想的W体栓末材料；介制利竹 过程小加入泛影匍胺和（或）硫酸钡等造影剂，IIJ”使制得的微球 X－线 下显影，从而使操作者在治疗当中可以随时了解栓塞的准确性，栓塞 的范围，栓塞的致密程度以及是否发牛误栓等，以提高栓塞治疗的可 拧N一更多还原

【Abstract】 The interventional neuroradiology is a subject that aimed at diagnosis and therapy of some diseases of neural system under the surveiI lance of X~ray. The development of this technology made the therapy of certain diseases that used to be dangerous and difficult easier. The development and application of this technology is tightly related with 1 he manufacture and exploitation of embolism material. Nowadays, there are many embolism materials applied in clinic, they could be classified into two types: solid materials and liquid materials. Currently the widely used liquid embolism materials include silicone, IBCA, HEMA, NBCA, grain alcohol, etc.Objective: This study is to manufacture some kinds of solid embolism materials that could develop under the X-ray. By using these embolism for embolization, the handlers could know many details about the operation at real time, thus to make right decisions during the operation.Methods: The materials we used for producing embolism are gelatin and polyvinyl alcohol (PVA). The contrast mediums being used here arc sulfate barium, diatrizoate, tantalum powder, etc. They are commixed into microspheres by physical and chemical method. The study contains 3 parts. Part 1: produce gelatin and polyvinyl alcohol microspheres by the method ol’ emulsificat ion, then evaluate their physical and chemical characteristic. Part 2: embed contrast mediums into gelatin and polyvinyl alcohol microspheres respectively. Part \\: direct embol i /at ion ol’ the carotid ol’ rabbits with the microspheres that produced anteriorly, and put the tissues under pathological observing after 1,2 and 4 weeks respectively.Results: The gelatin and polyvinyl alcohol microspheres that contain X-ray contrast mediums of one kind or two are visible under X-ray in rabbit’s skull. And the handlers could know many details about the embolization in real time.Conclusion: The gelatin and polyvinyl alcohol microspheres that produced by the method of emulsificat ion have appropriate dispersibi1ity, expanding coefficient and specific gravity. Commix contrast mediums such as diatrizoate, sulfate barium into the raw material could make the microspheres be visible under X-ray. Thus, the handler could be ware of more details about the emhol i /.a I ion at real time.更多还原