以新鲜自体心包行三尖瓣成形的实验研究

The Empirical Study of the Tricuspid Valve Reconstruction with Fresh Autologous Pericardium

目的探讨以自体心包行三尖瓣成形后自体心包的自然转归。方法将12只杂种犬随机分为对照组及实验组(每组6只)。对照组为以戊二醛处理自体心包后行三尖瓣成形术;实验组以新鲜自体心包后行三尖瓣成形术。于术后3月观察心包补片的大体形态学、钙含量、组织学变化,以探讨自体心包应用于三尖瓣成形的可行性及转归的机制。结果植入心包的大体观察结果 :对照组及实验组心包片均平滑、无纤维沉积、无血栓形成。心包组织钙含量结果 :植入前对照组组织钙含量与实验组无显著性差异;实验组植入前后无显著性差异;植入3个月后对照组组织钙含量明显高于实验组(P<0.05),并明显高于植入前(P<0.05)。免疫组织化学结果 :对照组心包片von Willebrand因子染色可见:植入心包表面覆盖一层全层von Willebrand因子染色阳性的血管内皮样细胞,心包组织内有明显的纤维沉积。实验组心包片von Willebrand因子染色可见:植入心包表面覆盖一层全层von Willebrand因子染色阳性的血管内皮样细胞,心包组织内有少量纤维沉积。结论使用以戊二醛处理自体心包行三尖瓣成形三个月后更易引起植入心包的钙化和纤维化,而使用新鲜自体心包则可有效减轻植入心包的钙化和纤维化。

Objective The aim was to determine the outcomes of fresh autologous pericardium after the operation of tricuspid valve reconstruction in dogs.Methods Twelve adult mongrel dogs were randomly divided into control group and study group.In control group the pericardial tissues were treated with 0.625% glutaraldehyde for 15 minutes and rinsed in phosphate-buffered saline solution（PBS） before tricuspid valve reconstruction.In study group the pericardial tissues were treated with 0.9% physiological saline for 15 minutes and rinsed in phosphate-buffered saline solution（PBS） before tricuspid valve reconstruction.The implants,recovered at 30 days,were determined calcium content and evaluated macroscopically and microscopically and by immunohistologic studies.Results The levels of calcium content after operation in control group were higher than calcium content levels before operation（P0.05） and higher than calcium content levels after operation in study group.Gross observations：autologous implants showed no obvious fibrin accumulation and thrombotic chang in both groups.Immunohistochemistrical findings：a surface layer of cells expressing von Willebrand-related antigen,characteristic of endothelial cells,was present on all implants.Obvious fibrin deposition in control group and light fibrin deposition in study group were observed.Conclusion This study indicated that pericardial implants treated with 0.625% glutaraldehyde may induce the fibrosis and calcification and fresh pericardial implants alleviated the fibrosis and calcification after tricuspid valve reconstruction.