灌注对游离组织血管内膜机械性损伤的研究

A study on the mechanical damage of perfusion to vascular endothelium

目的:研究灌注对血管内膜的机械性损伤及其预防措施。方法:随机选择9例游离第二足趾移植术,术中足背动脉常规灌注后,取灌注段血管5mm为灌注组,取足背动脉近侧端5mm为对照组,样本均行光镜和扫描电镜观察。结果:光镜下见灌注段血管内膜面部分内皮细胞脱落及内弹力膜断裂缺失。扫描电镜观察灌注段见内皮细胞脱落,露出内膜面下的弹力纤维;部分内膜层断裂,中膜层暴露。结论:灌注对血管内膜造成机械性损伤,为避免其引起血栓形成,血管吻合前切除该段血管是最佳预防措施。

Objective: To observe the mechanical damage of perfusion to the vascular intima. Methods: 9 patients of finger deficit were involved who underwent free second toe transplantation. After routine perfusion,5mm of dorsalis pedis artery which was in contact with the perfusion needle was resected and observed under light microscope and scanning electron microscope. 5mm of the proximal end of the dorsalis pedis artery was taken as control, Results : The HE stain of the arterial cross sections showed more denudation of endothelial cells and loss of internal elastic lamina in the perfused segment than in the control. Under scanning electron microscope,splitting of the intima,exposure of the media,and the absence of endothelial cells causing underlying elastic fiber uncovered were seen. Conclusions: Perfusion can cause mechanical damage to the vascular intima. To avoid this potential thrombogenic factor,the segment of vessel which is in contact with the needle during perfusion should be resected before anastomosis.