本文選題：腦積水 + 蛛網(wǎng)膜顆粒�。� 參考：《川北醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:長時間持續(xù)腦脊液外引流的條件下蛛網(wǎng)膜顆粒(arachnoid granulations,AG)是否有變化,以及出現(xiàn)蛛網(wǎng)膜顆粒變化的時間規(guī)律。通過了解持續(xù)腦脊液外引流對蛛網(wǎng)膜顆粒的影響特點(diǎn),指導(dǎo)腦脊液外引流在臨床上的應(yīng)用。方法:隨機(jī)選取26只健康成年雜種犬作為研究對象,2只作為空白對照組,將24只動物作為實(shí)驗(yàn)手術(shù)對象,持續(xù)腰大池引流動物模型在造模成功后隨機(jī)平均分成4組,分別命名A、B、C、D組,每組6只。空白對照組不做特殊處理,手術(shù)組在行腰大池引流成功后測量腦脊液壓力數(shù)據(jù)備用。A組動物夾閉腰大池引流管,行頭顱核磁共振(magnetic resonance imaging,MRI)檢查。B組動物持續(xù)引流14天,夾閉24小時,然后測腦脊液壓力,MRI頭顱掃描測量腦室相關(guān)徑線,處死雜種犬經(jīng)心臟灌注4%多聚甲醛溶液后取材,其中3只犬將含有蛛網(wǎng)膜顆粒的上矢狀竇、橫竇組織連續(xù)切片,切片厚度為0.5μm,進(jìn)行蘇木素-依紅(HE)染色,光鏡下觀察蛛網(wǎng)膜顆粒大體結(jié)構(gòu)。另3只犬經(jīng)取材后分別行透射電鏡觀察,明確蛛網(wǎng)膜顆粒表面結(jié)構(gòu)和內(nèi)部超微結(jié)構(gòu)。C組及D組動物分別持續(xù)引流21天及28天,后續(xù)處理方法同B組�？瞻讓φ战M動物蛛網(wǎng)膜顆粒行光鏡及電鏡觀察內(nèi)外部結(jié)構(gòu)。結(jié)果:1.通過腰椎穿刺制作腦脊液外引流模型,在引流不同時期測量顱內(nèi)壓力,B、C、D組穿刺成功后分別引流2、3、4周后測量顱內(nèi)壓,結(jié)果提示明顯低于A組對照組。再分別夾閉B、C、D組腰池引流24小時后測量顱內(nèi)壓,C、D組顱內(nèi)壓均高于A組。2.引流組腰池夾閉24小時后核磁共振測量各組動物腦室相關(guān)徑線并計(jì)算腦室指數(shù),B、C、D組腦室指數(shù)分別與A組對照組進(jìn)行比較,各組比較均無明顯差異(P0.05),腦實(shí)質(zhì)未見明顯異常。3.蛛網(wǎng)膜顆粒光鏡下觀察形態(tài)不一,內(nèi)皮細(xì)胞豐富,纖維囊發(fā)達(dá),形成管狀孔道結(jié)構(gòu)。透射電鏡下對比腦脊液引流前后蛛網(wǎng)膜顆粒內(nèi)皮細(xì)胞,均可見豐富囊泡存在,指狀突起明顯,蛛網(wǎng)膜顆粒核心部分蛛網(wǎng)膜細(xì)胞與膠原纖維交織,包含多形細(xì)胞等細(xì)胞成分。結(jié)論:1.蛛網(wǎng)膜顆粒在低壓環(huán)境中4周后未見明顯萎縮,蛛網(wǎng)膜顆粒內(nèi)皮細(xì)胞仍具腦脊液轉(zhuǎn)運(yùn)功能,持續(xù)引流腦脊液4周內(nèi)不會誘發(fā)腦積水,使用腰池引流在4周內(nèi)相對安全。2.腰大池持續(xù)引流腦脊液3周后,夾閉腰池引流,顱內(nèi)壓升高,蛛網(wǎng)膜顆粒形態(tài)變化不明顯,仍具備腦脊液吸收功能,提示顱內(nèi)持續(xù)低壓可能影響經(jīng)蛛網(wǎng)膜顆粒途徑以外的其他腦脊液吸收途徑。3.犬蛛網(wǎng)膜顆粒形態(tài)不一,內(nèi)皮細(xì)胞指狀突起明顯,囊泡豐富,內(nèi)部纖維囊發(fā)達(dá),形成管狀孔道結(jié)構(gòu),蛛網(wǎng)膜顆粒核心部分蛛網(wǎng)膜細(xì)胞與膠原纖維交織,包含多形細(xì)胞等細(xì)胞成分。
[Abstract]:Objective: to study whether arachnoid granulation (AGG) of arachnoid granulation changes and the time rule of arachnoid granulation under the condition of continuous cerebrospinal fluid drainage for a long time. To understand the effect of continuous cerebrospinal fluid drainage on arachnoid granules, the clinical application of cerebrospinal fluid drainage was guided. Methods: 26 healthy adult mongrel dogs were randomly selected as the control group and 24 animals were selected as the experimental objects. The model of continuous lumbar cistern drainage was divided randomly into 4 groups after the successful establishment of the model. Six rats in each group were named as group A, B, C, D, respectively. There was no special treatment in the blank control group. The pressure data of cerebrospinal fluid were measured in the operation group after successful lumbar cistern drainage. The drainage tube of the lumbar cistern was clamped by the animals in the group A, and the drainage was continued for 14 days in the group B by magnetic resonance imaging. After 24 hours clipping, cerebrospinal fluid pressure and MRI cranial scanning were used to measure the relative diameters of the ventricles. The dogs were sacrificed after perfusion of 4% paraformaldehyde solution through the heart. Three of the dogs were sectioned into the superior sagittal sinus and transverse sinus tissue containing arachnoid granules. The thickness of the section was 0.5 渭 m, and the structure of arachnoid granules was observed under light microscope. The surface structure and internal ultrastructure of arachnoid granules in group C and group D were observed by transmission electron microscope respectively for 21 days and 28 days, respectively. The follow-up treatment was the same as that in group B. The internal and external structures of arachnoid granules in blank control group were observed by light microscope and electron microscope. The result is 1: 1. The model of cerebrospinal fluid external drainage was made by lumbar puncture. The intracranial pressure was measured at different stages of drainage. The intracranial pressure was measured after 2 weeks of drainage and 3 weeks later. The results showed that the intracranial pressure in group A was significantly lower than that in group A. The intracranial pressure in group C was higher than that in group A after 24 hours of lumbar cistern drainage. After 24 hours of lumbar cistern occlusion in drainage group, the ventricular relative diameters were measured by MRI and the ventricular index was calculated. The ventricular index of group D was compared with that of group A, and there was no significant difference between each group and group A (P 0.05), and there was no obvious abnormality in cerebral parenchyma. The morphology of arachnoid granules was different under light microscope, the endothelial cells were abundant, the fibrous sacs were well developed, and the tubular pore structure was formed. Compared with those before and after cerebrospinal fluid drainage, there were abundant vesicles, obvious digital processes, interlaced arachnoid cells with collagen fibers and polymorphic cells under transmission electron microscope. Conclusion 1. There was no obvious atrophy of arachnoid granules in low pressure environment after 4 weeks. The endothelial cells of arachnoid granules still had the function of cerebrospinal fluid transport. Continuous drainage of cerebrospinal fluid did not induce hydrocephalus within 4 weeks. It was relatively safe to use lumbar cistern drainage in 4 weeks. After 3 weeks of continuous drainage of cerebrospinal fluid from the greater lumbar cistern, the drainage of lumbar cistern was clipped, the intracranial pressure was increased, the morphology of arachnoid granules was not obvious, and it still had the function of cerebrospinal fluid absorption. The results suggest that continuous intracranial depression may affect cerebrospinal fluid (CSF) absorption pathways other than the arachnoid granule pathway. The morphology of the canine arachnoid granules is different, the endothelial cells have obvious phalanoid processes, the vesicles are abundant, and the internal fibrous capsules are developed, forming the tubular pore structure. The arachnoid cells in the core of the arachnoid granules are intertwined with collagen fibers. Contains polymorphic cells and other cell components.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.1

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本文編號：2014228