兔自体静脉移植修复泪小管吻合口区的病理变化

The pathological change of anastomotic region in repair of lacrimal canalicular by autogenous vein graft in rabbits

目的观察兔自体静脉移植修复泪小管后吻合口区的病理变化。方法切断60只兔(120只眼)泪小管制作泪小管断裂模型,一侧为自体静脉移植组,对侧眼为直接吻合对照组,6只兔(12只眼)作为正常对照组。常规病理学及免疫组织化学染色观察术后吻合口区的病理改变。结果自体静脉移植组术后7d新生泪小管上皮完全覆盖吻合口管腔,上皮下层组织结构恢复需28d以上;直接吻合对照组术后5d泪小管上皮覆盖完全,第28天愈合过程基本结束。结论自体静脉搭桥修复泪小管术后7d,新生泪小管上皮完全覆盖吻合口管腔,管壁组织结构改建需28d以上。

Objective A fewer literature reported the research on repairing of canaliculus by vein graft, but relevant experimental and clinical studies are seldom at present. This study was to observe the healing process of canaliculus repair by autogenous vein graft and provide some experimental data for clinical application. Methods Animal model with lacrimal canaliculus disjunction was made by cutting off the lacrimal canaliculus in 66 Japanese white rabbits. The models were divided into two groups and further into 7 subgroups according to the different killed time. The disjunction was repaired by the direct anastomosis（ direct anastomosis group） and by autogenous vein graft （autogenous vein graft group） . The pathological changes of anastomosis region and the grafted vein were observed by routine HE stain and immunohistochemistry at 1,3,5,7,14,28 days postoperatively. Results In graft group, anastomosis region was covered with canalicular epithelia in 7 days postoperatively, but the fibroblast proliferation of propria lamina could still be seen at 28 days. In direct anastomosis group, anastomosis region was covered with epithelia in 5 days postoperatively, and the healing of propria lamina was complete in 28 days postoperatively. The endothelial cell of the graft vein became to fall off at 3 days postoperatively, and the intine of the whole vein was covered with canalicular epithelia at postoperative 7 days. The fibroblast proliferation of propria lamina was seen at 28 days. The canaliculus recovered the lacrimal drainage function at 7 days and 5 days after operation in graft group and direct anastomosis group, respectively. No significant differences in the positive time of fluorescein disappearance test （FDT） between two groups at above time points. Conclusion After autogenous vein graft, pathological repairing of lacrimal canaliculus anastomosis region is at postoperative 7 day, but the rebuilding of the propria lamina of anastomosis region require more than 28 days.