挤压驱栓与Fogarty导管取栓对兔静脉壁的影响

Curative effects of extrusive and Fogarty balloon catheter embolectomy in acute femoral vein thrombosis： experiment with rabbits

目的通过血管造影、静脉壁结构及细胞功能变化，比较挤压驱栓与导管取栓对静脉壁的影响。方法以新西兰兔为实验对象，建立实验分组。A组（n=25）：建股静脉血栓模型后挤压驱栓；B组（n=25）：建血栓模型后Fogarty导管取栓；C组（n=25）：仅游离股静脉；D组（n=5）：正常对照。术后行血管造影了解血管通畅情况，电镜观察内皮结构变化，聚合酶链反应（PCR）检测组织因子（TF），酶联免疫吸附试验测血浆血栓素B2（TXB2）及6-酮-前列环素（PGF1α）量的变化。结果造影见A组有1条、B组有3条股静脉闭塞，C、D组无闭塞；电镜见A组内皮轻度损伤；B组内皮中重度损伤；C组轻度空泡变性为主。TF测定：A、B、C组第1天即表达，7d达高峰，B组最高，A、B、C组分别与D组比较及A、B两组间比较，差异均有统计学意义。测TXB2：B组最高，A、B、C组较D组明显升高。6-酮-PGF1α的表达相反，D组最高，各组间比较，差异均有统计学意义。结论挤压驱栓、导管取栓对血管内皮均有不同程度的损伤，但后者严重，修复不完全。

Objective To compare the influence extrusive and Fogarty balloon catheter embolectomy on the patency rate of bloodstream and the damage of the wall of vein in acute femoral vein thrombosis. Methods Eighty rabbits were randomly divided into 4 groups： Group A （n = 25 ） undergoing ligation of unilateral femoral to establish acute femoral vein thrombosis model and treated by extrusion of the hind leg muscles 24 h after the operation, Group B （n = 25 ） treated by Fogarty balloon catheter embolectomy 24 h after establishment of the thrombosis model, Group C （n = 25 ） undergoing sham operation, and Group D （n = 5 ） as normal controls. 7, 14, and 28 days after the treatment digital subtraction angiography （DSA） was conducted to observe the patency rate of the vessel. 1,4, 7, 14, and 28 days after the treatment specimens of the thrombotic and corresponding sections of the veins were collected from the 4 groups （ on days 1 and 7 for Group D） to undergo transmission electron microscopy （TEM） and scanning electron microscopy （SEM）. Quantitative reverse transcription and polymerase chain reaction was used to detect the level of tissue thromplastin （TF）. ELISA was used to detect the levels of thromboxane B2, （TXB2） and 6-keto-prostaglandin F1α （PGF1α）. Results Occlusion was seen in 3 femoral veins of Group B and one femoral vein of Group （P 〈 0. 01 ）, and the other veins were all patent. TEM and SEM showed that the endothelial cell injury was slight in Group A, and aggravated in Group B. TF mRNA expression could be seen 1 day after the treatment in Groups A, B, and C, and peaked on the day 7, and not found in Group D at any time points （ all P 〈 0. 01 ） ; and the TF mRNA levels at different time points of Group A were all significantly lower than those of Group B （all P 〈0. 01）. The TXB2 expression levels on days 1 and 7 of Groups A, B, and C were all significantly higher than those of Group D ; especially those of Group B （ all P 〈 0. 01 ）. The 6-keto-PGF1α levels on days 1 and 7 of Group D were both significantly higher than those of Groups A, B, and C （ all P 〈 0. 01 ）. Conclusion Compared with Fogarty balloon catheter embolectomy, extrusion embolectomy can discard the thrombus more thoroughly and guarantee the patency rate of bloodstream. Both extrusion emboleetomy and Fogarty balloon catheter embolectomy, especially the latter, cause damage to the blood vessel endothelium.