小肠黏膜下层覆膜支架促进经颈静脉肝内门腔静脉分流道内皮化的有效性

Efficacy of small intestinal submucosa covered stent in promoting endothelialization in transjugular intrahepatic portosystemic shunt

背景:达到支架内腔内皮化是血管支架置入,也是颈静脉肝内门腔静脉内支架分流防治再狭窄的目标,有学者已提议将促使内皮细胞功能及完整性的恢复作为预防术后再狭窄的新策略。目的:探讨小肠黏膜下层覆膜支架促进经颈静脉肝内门腔静脉分流后分流道内皮化的有效性。方法:建立猪经颈静脉肝内门腔静脉分流模型,以数字表法随机分成2组,实验组将外覆小肠黏膜下层膜单丝编织网络型镍钛记忆合金支架置入肝内分流道,对照组植入单丝编织网络型镍钛记忆合金支架。术后2,4周于直接门脉造影复查后,获取支架内及周围肝组织,行大体、病理组织形态学及扫描电子显微镜检查。结果与结论:术后2周造影复查示对照组、实验组分流道分别闭塞3,1只,术后4周分别闭塞4,6只,其余均不同程度狭窄,对照组血管再狭窄率高于实验组(P<0.05)。病理及显微镜检查结果显示,实验组内皮化程度较对照组高,且实验组内皮细胞形态、大小均匀,排列接近血流方向。结果证实小肠黏膜下层是一种可行的加快颈静脉肝内门腔静脉分流后分流道内皮化的生物材料,但小肠黏膜下层覆膜支架未能明显提高颈静脉肝内门腔静脉分流道的通畅率。

BACKGROUND：Endothelialization is the aim of preventing restenosis in intravascular stent and transjugular intrahepatic portosystemic shunt（TIPS） stent.It has been suggested that promoting the recovery of function and integrality of endothelial cells is a new strategy for preventing restenosis after the operations.OBJECTIVE：To investigate the efficacy of endothelialization of the shunts in TIPS by stents covered with small intestinal submucosa（SIS）.METHODS：TIPSS porcine models were established,and the porcine were randomly divided into two groups.In the experimental group monofilament braided nitinol stents covered with SIS were implanted into the shunts.In the control group monofilament braided nitinol naked stents were used.After direct portal phlebography at 2 and 4 week spostoperatively,the shunt and the surrounding hepatic tissues were harvested for macroscopical and microscopical observation by scanning election microscope（SEM）.RESULTS AND CONCLUSION：According to the portal venography 2 weeks after TIPS,3 and 1 shunts were respectively occluded in control and experimental groups;4 weeks after TIPS,4 and 6 shunts were occluded in control and experimental groups,respectively,and the remainders of the shunts exhibited restenosis in different degrees.The restenosis rate was statistically greater in control group than the experimental group（P 0.05）.According to the microscopical observation and SEM,compared to the control group,more endothelialization occurred in the shunts of experimental group.Morphous and size of the endotheliocyte in the experimental group was well-distributed and arranging approach the direction of blood flow.Results show that SIS is a feasible biological material which can speed up the endothelialization of the shunts of TIPS,but the stents covered with SIS cannot improve the patency rate of the shunts efficiently.