犬梭形动脉瘤生物膜包裹的远期血流动力学对照研究Ⅱ——组织形态学观察

Hemodynamics and histomorphology study in long-term by the matched control of the fusiform aneurysm and the wrapping with biological graft in venous auto graft canine models

目的分析犬梭形动脉瘤(FFA)模型在采用生物膜包裹后1年期的血流动力学与组织学变化,探讨生物膜包裹的远期效果。方法对10只犬采用显微手术制作双侧梭形动脉瘤模型20枚,左侧用生物膜完全匹配包裹,右侧未包裹以作为对照,行DSA、彩色多普勒超声动态检测,对照观察两组的血流动力学变化特征。术后1年时行活体解剖取标本,对照观察组织学变化。结果所有模型均制作成功。FFA腔内为涡流,多普勒超声具有特征性的双相涡流频谱,造影剂滞留明显;对照侧术后1年膨胀性增大,并具有自发破裂的趋势。手术侧包裹后瘤腔消失,血流恢复为层流,超声频谱与颈总动脉一致,未见造影剂滞留,血管顺应性、弹性及舒缩状态与颈总动脉基本匹配;瘤腔与吻合口处的血流动力学参数差异有统计学意义(P<0.05)。组织学改变与血流动力学变化相符。结论犬FFA模型是研究包裹治疗的理想动脉模型,采用生物膜完全匹配包裹,远期效果良好。

Objective To analyze the changes in the hemodynamics and histomorphology of the canine fusiform aneurysm （FFA） models in twelve months after being wrapped by biomembrane, and explore the long-term effect of the biomembrane. Methods Twenty fusiform aneurysm models were established in the bilateral common carotid artery in 10 dogs as experimental animals by microsurgical techniques. The left side models were wrapped in perfect match state with biomembrane as experimental group and the right side models as blank control group. Hemodynamaic alterations between the two groups were compared by color Doppler and digital subtraction angiography within twelve months. The histomorphological changes were observed by light microscope in the twelve months after the operation. Results All the models were created successfully. Turbulent flow formed in the FFA cavity and was of characteristic double phase frequency spectrum with significant stagnation of contrast medium. The anenrysm enlarged and could come to rupture one year after the operation in the control side. In the side where the tumor was wrapped with biomembrane, the tumor cavity disappeared, the blood flow was recovered as laminar flow, the frequency spectrum was consistent with that of the common carotid artery, and no stagnation of contrast medium was seen. The complaisance, elasticity and contractility of the vessel were similar to those of the common carotid artery. There were significant differences in hemodynamic parameter of the anenrysm cavity and stoma between the two groups （P〈0.05）. Histological changes corresponded to hemodynamic alteratio ns. Conclusion The long-term therapeutic efficacy of wrapping fusiform anenrysm with biomembrane is good. And FFA models may be helpful for further research ofwrepping treatment of tumors.