核素显像监测断肢再植术后血运的实验研究

Experimental Study on Monitoring Extremital Blood Circulation in Rabbits with Replanted Limb by Na^(99m)TcO_4 Trace Imaging

目的探讨Na99mTcO4示踪显像监测断肢再植术后远端动脉血供和静脉回流的可行性。方法6只对照和30只施行断肢再植术的健康成年家兔术后24~36h由耳缘静脉注射Na99mTcO474MBq2min后行SPECT静态显像,计算并分析再植部分和正常肢对应部分的放射性摄取比值(T/NT),根据术肢远端放射性聚集程度将显像结果分为Ο、Ⅰ、Ⅱ、Ⅲ级,随后施行探查术。结果Ο、Ⅰ、Ⅱ、Ⅲ级家兔分别有8、6、15(含6只对照)、7只,其T/NT分别为0·178±0·072、0·461±0·046、0·816±0·074、1·14±0·086(t≥8·39,P<0·01);手术证实Ο级家兔的吻合血管栓塞发生率(87·5%)明显高于Ⅰ、Ⅱ、Ⅲ级(χ2≥10·50,P<0·01),О(T/NT<0·25)级可作为吻合血管栓塞的定性、半定量诊断指标;Ⅲ级的静脉回流不畅发生率(85·7%)明显高于Ⅰ、Ⅱ(χ2≥9·55,P<0·01),Ⅲ(T/NT>1·05)级可作为静脉回流不畅的定性、半定量诊断指标。结论Na99mTcO4示踪显像监测断肢(指)再植术后远端动脉血供和静脉回流是可行的。

Objective To explore feasibility of monitoring the extremital arterial blood supply and venous blood circulation in rabbits with replanted limb by Na^99mTeO4 trace imaging（TH）. Methods TH was performed on 6 normal control rabbits and 30 rabbits with replanted limb at 24-36h after replantation. The radioactivity uptake ratio of replanted limb/normal limb（T/NT） was analyzed. Imaging was classified into O, Ⅰ , Ⅱand m scales according to the accumulation amount of extremital radionuclide. Then an exploratory operation was performed on each rabbit. Results Rabbits with O, Ⅰ , Ⅱand Ⅳ scales had 8,6,15（including 6 normal control rabbits） ,and 7 animals, respectively, and their T/NT were 0.178±0.072, 0.461 ± 0.046, 0.816 ± 0.074, 1.14 ± 0.086（ P 〈 0.01 ）, respectively. The exploratory surgery showed that the embolism ratio of anastomotie vessels of O scale（87.5%） was significantly higher than that of Ⅰ , Ⅱ and Ⅲ scales（ P 〈0.01）, respectively.O scale（T/NT〈 0.25） may serve as a qualitative and semiquantitative diagnostic standard for anastomotic vessel embolism. The frequency of venous blood circulation block of Ⅲ scale was 85.7%, and significantly higher than that of Ⅰ and Ⅱ scales（ P 〈 0.01 ）, respectively, m scales （T/NT 〉 1.05） may serve as a qualitative and semiquantitative diagnostic standard for venous blood circulation block. Conclusion TTI was feasible in monitoring the extremital arterial blood supply and venous blood circulation in patients with replanted limb（finger）.