血管内皮生长因子基因治疗与皮瓣延迟术对大鼠腹壁轴型皮瓣成活的影响

Effects on the survival of rat＇s abdominal axial skin flap after the combination of VEGF gene therapy and skin flap delay

目的探讨血管内皮生长因子基因治疗、皮瓣延迟术两种方法及二者联合应用对大鼠腹壁轴型皮瓣成活的影响。方法制作大鼠以右侧腹壁浅动脉为血管蒂的超范围轴型皮瓣模型，分别采用皮下注射pcDNA4-VEGF165、皮瓣延迟术及二者联合应用，按处理方法的不同分为6组，①计算各组的皮瓣成活率；②取皮瓣组织标本行常规HE染色，检测平均微血管数目及内径；③取皮瓣组织标本行VEGF免疫组化染色检测VEGF的表达情况。各试验组与空白组相对比，各试验组之间两两对比。结果各试验组的皮瓣成活率明显高于空白组，延迟同时基因治疗组的皮瓣成活率明显高于其他试验组；基因治疗组及联合应用组的平均微血管数目明显高于延迟组及空白组；平均微血管内径：延迟组〉联合应用组〉基因治疗组〉空白组；免疫组化染色显示基因治疗组及联合应用组VEGF表达明显高于空白组及单纯延迟组。结论皮下注射pcDNA4-VEGF165和皮瓣延迟均能有效地改善大鼠皮瓣的成活，但其作用机制不同，而二者的联合应用则能进一步地提高大鼠皮瓣的成活率。

Objective To investigate the effect of VEGF （vascular endothelial growth factor） gene therapy and skin flap delay on the survival of rat＇ s abdominal axial skin flap. Methods In 48 Wistar rats, the model of a abdominal axial skin flap supplied by right superficial epigastric vessel was created. The rats were divided into six groups. The group was treated with subcutaneous injection of pcDNA4-VEGF165、skin flap delay or VEGF injection combined with skin flap delay. 7 days later, the survival rate of the skin flap was measured; specimens were harvested from the skin flap for histological investigation of the microvessels and for imunohistochemical staining to observe the expression of VEGF. Results Every treated group was significantly higher than blank group in the average survival rate of the skin flap and group Ⅴ （gene injection when delayed） has the highest one. The average number of the microvessels in group Ⅱ, Ⅲ , Ⅴ , Ⅵ was significantly higher than group Ⅳ and blank group. Group Ⅳ 〉 group Ⅴ , Ⅳ 〉 group Ⅱ, Ⅲ 〉 blank group in lumen diameter of the microvessels, lmunohistochemical staining documented more deposition of VEGF DNA in group Ⅱ、Ⅲ、 Ⅴ、Ⅵ than group Ⅳ and blank group. Conclusions Both administration of pcDNA4-VEGF165 and skin flap delay can improve the survival of rat＇ s abdominal axial skin flap, but the mechanisms of the effect were different. The combination of the two ways has stronger effect.