| Objective: To build a New Zealand experimental rabbit renal puncture fistulization model;three kinds of hemostatic materials,bletilla glue,gelatin sponge and Microporous polysaccharide hemispheres(MPH),are applied to the renal puncture channel,and to record the intraoperative changes related to hemostasis time of puncture channel,crystal content in postoperative urine and expression of IL-10 and TNF-? in the puncture channel.The abovementioned three kinds of material were compared in terms of hemastatic effect in renal puncture channel,crystal content in postoperative urine and healing time of renal puncture channel in search of a suitable embolization agent for renal puncture channel for the Tubeless Percutaneous Nephrolithotomy(TPCNL),so as to reduce the complications of TPCNL like bleeding and urinous infiltration.Methods: 126 New Zealand experimental rabbits(not restricted in gender,body weight: 2.0-2.5kg)were selected and randomly divided into 3 groups,namely,bletilla glue group,gelatin sponge group and MPH group,with 42 rabbits for each group;a right-side renal puncture fistulization model was built for all of the three groups of experimental rabbit,and the blettila polysaccharide glue,gelatin sponge and MPH were respectively injected into the renal puncture channel,the intraoperative hemostasis time of rabbits in each group was observed and recorded during the operation.Three groups of rabbit were killed on day 3,week 1,2,3,4,6 and 8after operation,and performed with a bladder puncture to obtain the urine for a urine sediment quantitative detection;the crystal content in urine of rabbits in all groups were compared.The tissue of right-side renal puncture channel was taken for HE staining,the pathologic change in renal tissue at the channel was observed;an immunohistochemistry(IHC)was carried out to compare the content of two factors,TNF-?and IL-10,in the renal puncture channel of rabbits in each group and the change incorrelation between both.Results: the hemostasis time of renal puncture channel of rabbits in three groups was :(82.40±18.40 S)<(92.69±22.63S)<(120.33±26.23S),the differences obtained from a pairwise comparison among three groups were all statistically significant(P<0.05).Pathologic change in renal puncture channel of animals in each group.Bletilla glue group: the animals were killed on day 3,the renal puncture channel was found by an observation to have massive granulation tissues and neovascularization,accompanied by inflammatory cell infiltration.2 weeks later,a few formations of scar tissue was found,the renal puncture channel had been healed on week 3.gelatin sponge group: the channel was found by observation to have massive inflammatory cell infiltrations 3 days after the model was built,devoid of evident granulation tissue and neovascularization,obsolete red blood cells were found in the channel,the channel was found to have many mature vascular lumens 3 weeks after the model was built,accompanied with a few scar tissue proliferations and inflammatory cell infiltrations,suggesting that it was still in the process of channel repair.The channel was basically healed on week 6 after the model was built.MPH group: the channel was found to have massive inflammatory cell infiltrations 3 days after the model was built,devoid of evident granulation tissue and neovascularization,obsolete red blood cells were found in the channel;the channel was found to have many mature vascular lumens 3 weeks after the model was built,accompanied with a few scar tissue proliferations and inflammatory cell infiltrations,suggesting that it was still in the process of channel repair.The channel was basically healed on week 6 after the model was built.the comparison of urine crystal count of rabbits in three groups at various time points showed that: the difference in urine crystal count between the bletilla glue group and the other two groups on day 3 and week 1 was not statistically significant(P>0.05);on week 2,3,4,6 and 8,the urine crystal count of the bletilla glue group was significantly less than that of the other two groups(P<0.05).The result of immunohistochemistry showed that,IL-10 and TNF-? were mainly expressed in the kidney tubules and cytoplasm of glomerulus,according to the microscopic observation,the positive staining presented brownish yellow granules.Image-proplus 6.0 image analysis software was used to calculate the integral optical density of each group,theresult revealed that,the bletilla glue group had a significantly higher expression of IL-10 than the other two groups did on day 3,week 1,2,3,4,6 and 8(P<0.05),and a significantly lower expression of TNF-a than the other two groups did(P<0.05).Conclusion: 1.The intraoperative hemostasis time of three kinds of hemostatic material is in proper order : gelatin sponge group < bletilla glue group < MPH.2.The bletilla glue can be absorbed in the renal tissue faster than the gelatin sponge and MPH can be,and it has less intraoperative formations of crystal,and a lower risk of intraoperative formation of calculus than the latter two kinds of material do.3.The bletilla glue produces more IL-10 s than the gelatin sponge and MPH when it is used for the hemostasis of renal puncture channel,and it produces less TNF-a than the gelatin sponge and MPH,which is more beneficial to the healing of puncture channel tissue. |
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