【精品】血管吻合术对远心端血管吻合口血流量及内膜增生的影响

【精品】血管吻合术对远心端血管吻合口血流量及内膜增生的影响 血管吻合术对远心端血管吻合口血流量 及内膜增生的影响 [真诚为您服务] 作者:赵伟，徐在品，王清宇，王定坤，高俊波，罗鹏，彭尧，邓小燕 【摘要】 目的: 观察不同血管吻合术对远心端血管吻合口血流量、血压以及内 膜增生程度的影响。方法: 16只犬随机分为偏心搭桥组和普通搭桥组行血管搭 桥，搭桥后测定近心端及远心端吻合口血流量和血压值;术后3个月牺牲动物， 远心端吻合口切片，测定血管内膜厚度，比较不同血管吻合术内膜增生程度。结 果: (1)偏心搭桥和普通搭桥远心端吻合口血流量分别为(2.7?0.4)、 (2.1?0.5)ml/s，偏心搭桥组远心端吻合口血流量显著升高(P<0.01); (2)偏心搭桥远心端吻合口收缩压和舒张压分别为(97?19)、(86?17) mmHg，而普通搭桥远心端吻合口收缩压、舒张压分别为(96?14)、(76?14) mmHg，偏心搭桥远组高于普通搭桥组，但无统计学意义;(3)偏心搭桥和普通 搭桥远心端吻合口对应面的血管内膜分别为(60.32?3.52)、 (110.50?9.62)μm，差异显著(P<0.01)。结论: 偏心搭桥能够显著增加 远心端血流量，抑制搭桥术后远心端吻合口对应面的血管内膜增生。 【关键词】 血流量; 血管内膜; 吻合术，外科; 血管 ,Abstract, Objective: To observe the effects of different bypass vascular anastomosis methods on blood flow, blood pressure, and intimal hyperplasia at the opposite site of distal stoma. Methods: Sixteen dogs were randomly divided into two groups: eccentric bypass grafting group (group EBG) and conventional bypass grafting group (group CBG). Blood pressure and blood flow volume at proximal and distal stoma were determined after bypass surgery. Pathological changes were observed with tissue sections and vascular intimal thickness of distal stoma was determined in 3 months after the surgery. Results: (1)The blood flow volume of EBG group (2.7?0.4) at distal stomas were significantly higher (P<0.01) than those of group CBG (2.1?0.5 mL/s); (2)Systolic blood pressure and diastolic blood pressure at distal stoma in group EBG (97?19 and 86?17 mmHg) were higher than those of group CBG ( 96 ?14 and 76?14 mmHg), but the difference was not significant statistically; (3)The intimal thickness were 110.50?9.62 μm and 60.32?3.52 μm in CBG group and EBG group, respectively. The difference was statistically significant (P<0.01). Conclusions: The eccentric bypass method could inhibit intimal hyperplasia at the opposite site of distal stoma by enhancing blood flow volume. ,Key words, blood flow volume; tunica intima; anastomosis, surgery; blood vessels 动脉旁路搭桥或再造手术后血管内膜增生，一直是中、小血管手术后期失败的一 个主要原因[1,4]，手术后远心端吻合口处所产生的内膜增生远较近心端处明 显，是导致手术后期失败的主要部位[5]。有研究明，静脉移植后血管内膜增生 跟血流量改变密切相关[3]，高血流量的血管形成术后内膜增生比正常血流量血管 成形术后内膜增生轻微[6]。本实验欲通过建立平面外搭桥模式——“偏心搭桥”， 实现搭桥血管的三维几何构型，对比传统搭桥的平面内搭桥方法，观察不同血管吻 合术对远心端血管吻合口血压、血流量以及内膜增生程度的影响。 1 材料与方法 1.1 实验材料