动静脉转流重建肢体血液循环的实验和临床研究

EXPERIMENTAL AND CLLNICAL STUDY ONREVASCUL ARIZATION OF SEVERLY ISCHEMI-CLIMB BY ARTERIOVENOUS REVERSAL

对分期动静脉转流术治疗肢体广泛性动脉闭塞症，进行以下几方面研究，（１）转流后静脉组织结构变化：８周后扩张和增生稳定，１６周后不再增生；（２）静脉内皮细胞功能变化：术后１６～１８周已发生了“动脉化”；（３）缺血肢体末端微循环变化：术后３～８周可见到经静脉－静脉吻合支的正常流速、流量的血流，血液染色后的活组织切片，同正常无明显差异；（４）缺血肢体末端组织细胞结构、营养变化：８周后恢复正常；（５）两端均为裤裆式自体双血管桥的应用，解决了自体静脉管径小及人造血管远期易闭塞的难题。临床应用１６６例，平均随访４２个月，治愈率８８．５％。提示：动静脉转流有坚实的理论基础，临床将显微和血管外科技术相结合，可显著提高治愈率。

AbstractStaged arteriovenous reversal is now being moreand more accepted as an effective treatment for exten-sive arterial occlusivc disease of the limbs. 24 canineswere used in the experimental study.The resultsshowed that:①the changes of vein postoperation weredilation and hyperplasia became less prominent and nofurther change 8 and 16 weeks postoperation respec-tively;②arteralization of endothelial cells of the veinoccurred 16 to 18 weeks postoperatively;③microcircu-lation on distal portion of operated limb established 3to weeks after surgery. One hundred and sixty-sixpatients (182 limbs) were operated on and followed upto a mean of 42 months. The satisfactory rate was of88.5%, This suggests that there is reliable theoreticalbasis on arteriovenous reversal, and it’s results may bemore satisactoryby combining the techniques of vascu-lar surgery and microsurgery.