| Pleural pathological examination is an important method to clear the pleural disease diagnosis. At present, closed pleural biopsy is still the most commonly used to obtain pleural tissue, in which the Abrams needle and Cope needle are the most widely clinical application. However, we usually feel that the Abrams needle and Cope needle exist some defects in our clinical work, for example, the scope of pleural biopsy is circumscribed, we only could get the pleura tissues around the needle puncture, so that the results are often negative because we couldn’t take the right diseased tissues especially in the focal distribution of pleural disease patients; The biopsy tissues’ volume is small and the opportunity of forceps empty or obtaining, the non-pleural-tissues such as skeletal muscle, adipose tissue get more higher. At the same time, the operations are complicated and high technical requirements, different operating physicians who have different skill level will obtain different results; the biopsy make bigger damage on the pleural tissue, the rate of bleeding and iatrogenic pneumothorax is more higher.Therefore, Jin Pule who is a professor of the fourth hospital of Hebei has developed C-type pleural biopsy trocar that is a new kind of biopsy cannula device,it can also bite the parietal pleura even diaphragmatic pleura at the same time,and clinical preliminary application have better effect.However, the biopsy operated by C-type pleural biopsy trocar belong to blind detection,the forceps used to bite pleural tissue may damage the the intercostal artery and vein which in the rib furrow, so far as to lead to pleural hemorrhage. We take chinese rural dogs as the research objects in this study. Under direct vision with the help of medical thoracoscopy, we continuously bite the same pleura tissue which are at the parietal pleura on the intercostal vessels and diaphragmatic pleura. After that, we can evaluate safety and effectiveness of C-type of pleural biopsy trocar in the biopsy at parietal pleura and diaphragmatic pleura.Objective:This study takes six chinese rural dogs as the research objects, we continuously bite the same pleura tissue which at the parietal pleura on the intercostal vessels and diaphragmatic pleura under direct vision with the help of medical thoracoscopy. After that,we can evaluate safety and effectiveness of C-type pleural biopsy trocar in the biopsy at parietal pleura and diaphragmatic pleura.Methods: The experiment selected six local healthy adult dogs, of either sex,weighing 15 ~ 20 kg, the average was(17.2±3.1)kg, aged 24 ~ 28 months,the average(25.6 ± 1.8) months. The dogs were raised and observed lively,healthy without exception for two weeks in the Experimental Animal Center after purchasing.therefore all animals were included in the experiment。Xylazine hydrochloride has been used to be basal anesthesia by intramuscular injection before operation, and make a intravenous infusion pathway to guarantee a follow-up drugs. Propofol Injection has been applied to be maintenance of anesthesia in the operation through the intravenous infusion pathway.Make sure that the dogs accept continuous oxygen inhalation and monitoring vital signs during the operation.We use the Seldinger method to establish artificial pneumothorax.After making pneumothorax succeed we can insert medical thoracoscopy in to thoracic cavity, so as to observe the parietal pleura and diaphragmatic pleura and do the experiment. This operation is completed by an experienced and senior attending physician who has internal medicine thoracoscopic operation experience, in order to reduce the error caused by man-made factors.We choose the one side of thoracic cavity to do animal experiment at each time, and select two pleural biopsy points in one thoracic cavity. We set up the parietal pleural biopsy points which at midaxillary line and the third intercostal vessels cross to be group A, and set up the diaphragmatic pleural biopsy points at midaxillary line to be group B. Each pleural biopsy point should be continuously bite four times, these were to be labeled as the first、second、third and fouth bitting. Make sure each pleural biopsy to be at the same point, dislocation biopsy or biopsy forceps empty inspection are gnawing check failed.If the biopsy was failed, we couldn’t bite anather time to supplement. In the end, we put the pleura tissues that we have bitted to the bottle filled by formalin,then measure the tissues’ volume an histopathological examinations. During the operation, we should observe and estimate the amount of bleeding after each pleural biopsy completed.Every dog has two chests and we carry out one experiment in the one chest.So we finally have been twelve times animal experiments.There were forty eight times biopsies in each group, totally ninty six times biopsies. Each group has been divided to be four sub-groups according to the test of each animal bite seized the order of pleura, and the subgroups have been named the first subgroup,the second subgroup,the third subgroup and the fouth subgroup. There were twelve pleural biopsies in the each subgroup at the experiment.Compare the pleural biopsy tissues’ volume among the subgroup in the group A and group B. Compare the the amount of bleeding among the subgroup in the group A and group B. Compare the successful rate of pleural biopsies during the group A and group B. After that, we can evaluate safety and effectiveness of C-type pleural biopsy trocar in the biopsy at parietal pleura and diaphragmatic pleura.Statistical method: all data were used SPSS version 13 statistical software to analysis.Results:1 The comparison of pleural biopsy tissues’ volume among the subgroup in the group A and group B:There was no significant statistical difference in the obtained pleural tissues average size between the subgroups in the two groups(P>0.05).There was no significant statistical difference in the obtained pleural tissues average size among the subgroups in the group A(P>0.05). There was no significant statistical difference in the obtained pleural tissues average size among the subgroups in the group B(P>0.05).2 The comparison of the amount of bleeding among the subgroups in the group A and group B: There was no significant statistical difference among the first subgroup, the second subgroup, the third subgroup in the group A(P>0.05). There was no significant statistical difference among the each subgroup in the group B(P > 0.05). There was no significant statistical difference between the first subgroup,the second subgroup,the third subgroup in the group A and the first subgroup, the second subgroup,the third subgroup and the fourth subgroup in the group B(P > 0.05). There was a significant statistical difference between the fourth subgroup in the group A and the first subgroup, the second subgroup, the third subgroup in the group A, the first subgroup, the second subgroup, the third subgroup and the fourth subgroup in the group B(P<0.05).3 The comparison of the successlful rate of pleural biopsies between group A and group B:There were forty-eight pleural biopsies successfully in the group B. There were forty-one pleural biopsies successfully in the group A. There was a significant statistical difference between group A and group B.Conclusion:1 Whether the same parts of parietal pleura or diaphragmatic pleura have been continuously bitted, the pleura tissues’ size has nothing to do with the bite detection order. The pleura tissues bitted at diaphragmatic pleura is slightly larger than the pleura tissues bitted at the parietal pleura.But there was no significant statistical difference between group A and group B.We consider that if increase the sample size, there may be significant difference between the two groups.2 When the same parts of diaphragmatic pleura have been continuously bitted, the amount of bleeding has nothing to do with the bitting detection order. When the same parts of parietal pleura which at the intercostal vessels have been continuously bitted, the amount of bleeding of the first subgroup sand the second subgroups and the third subgroups has nothing to do with the bitting detection order. But the amount of bleeding of the fourth subgroup has a significant increase than other three subgroups. This could prompt us that the same part on the parietal pleura should avoid fourth biopsies. However in our clinical practice, the possibility of the same site by continuously bitted is extremely rare, So it shows that the application of C-type pleural biopsy trocar applied to pleural biopsies is safe.3 The successful rate of pleural biopsies has a significant statistical difference between group A and group B. It explain that obtaining the pleura tissues from the diaphragmatic pleura is more easier than taking the pleural tissues from the parietal pleura.We can obtain more satisfied pleural tissues on the diaphragmatic pleura.4 The experimental animals’ vital signs are stable, no one animal is dead.It can confirm the research is safe. |
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