摘要
目的探讨糖尿病状态下血管吻合口愈合规律的特点。方法将8周病程的糖尿病组和对照组SD大鼠各20只双侧颈总动脉切断后行端端吻合,于术后1、3、7、14d分别取材观察其通畅情况,并对血管吻合口行组织学、超微结构观察和图像分析。结果对照组吻合口血管内膜损伤小,管壁各层次结构清晰,炎症反应轻;糖尿病组血管内膜损伤重,管壁各层次结构紊乱,有断裂痕,管壁周围肉芽织织增生明显。吻合术后7d糖尿病组吻合口血管内膜平均再内皮化明显延迟[(3745±1045)μm2与(1298±225)μm2,P<0.01];吻合术后14d,糖尿病组血管吻合口内膜增生明显,内膜/中膜厚度比值(I/M值)达0.41±0.22。结论糖尿病改变了血管吻合口正常的愈合规律,使一个正常的吻合口愈合过程转变为一个慢性炎性、纤维增殖过程,血管吻合口部位的重塑变为病理性,上述病理改变可能是造成糖尿病血管危象易于发生的因素之一。
Objective To explore the healing rule of microvascular anastomoses in Diabetes mellitus. Methods Twenty animal model of Diabetes were induced via intraperitoneal injection of streptozotocin, while twenty normal animal received injection of buffer vehicle alone. After 8 weeks of symptoms, the diabetes groups and the control groups animals underwent bilateral exposure of the carotid arteries and microvascular anastomses. Vascular patency, ultrastructure and scanning electron microscopy of anastomosis site were observed at 1st, 3rd, 7th and 14th days after operation respectively. Results The intimal cells injury at the microarterial anastomosis site were conspicuous in the diabetes groups compared with the control groups, while obvious inflammation and granulation tissue hyperplasia around the anastomosis site in the diabetes groups was observed. At 7th days postoperation, the average area of exposed suture surface at microarterial anastomosis site was （3 745± 1 045）μm^2 in the diabetes group compared to （1 298±225）μm^2 in the normal group （P〈0.01）. The degree of intimal repair was significantly lower in the diabetes group compared to the control group. At 14th days after the operation, intima/ media ratio at the anastomosis site was markedly increased in the diabetes group than the control group（0. 41±0. 22 versus 0. 08±0. 03,P〈0. 05）. Neointimal hyperplasia was obvious in the diabetes group. Conclusion Diabetes mellitus changed the normal healing rule of the rnicrovascular anastomosis site. Microvascular anastomosis site in the diabetes animals became a chronic inflammation and proliferation process. Those pathological changes were the main causes of flap spasm in the diabetes patients.
关键词
糖尿病
吻合口
病理变化
Diabetes mellitus
Microvascular anastomoses
Pathological change
