腔内光动力疗法对血管吻合口内膜增生的抑制作用

Inhibitory effect of intravascular photodynamic therapy on intimal hyperplasia of vascular anastomosis

目的：研究光敏剂局部给药和腔内激光照射对血管吻合口处内膜增生的抑制作用。方法：以犬颈总动脉切断后再吻合为模型，吻合术中分别给予：生理盐水灌注、光敏剂（ＰｓＤ－００７）灌注、血管腔内激光照射、ＰｓＤ－００７ 灌注加血管腔内激光照射。以正常颈总动脉为对照，术后行血管造影，并截取吻合口标本分别作扫描电镜、病理组织切片检查，测定吻合口处血管中膜厚度、血管增生内膜面积与血管内弹力膜面积比（ＩＥ／ＩＥＬ）。结果：各组吻合口造影均通畅，实验组吻合口截面积缩窄程度明显减轻（Ｐ＜ ０．０１）；中膜厚度显著低于正常组（Ｐ＜ ０．０５）和其他３ 组（Ｐ＜ ０．０１）；吻合口处ＩＥ／ＩＥＬ也显著低于其他３ 组（Ｐ＜０．０１）。电镜下，实验组吻合口处内膜连续，内膜皱襞较其他组细小，排列较整齐，血液成分沉积少。结论：在血管吻合过程中应用腔内光动力疗法能够显著降低血管吻合口内膜增生的形成。

Objective: To evaluate the inhibitory effect of local photodynamic therapy (PDT) on intimal hyperplasia in vascular anastomoses. Methods: Sixteen mongrel dogs were randomly divided into 4 groups according to different treatments, group A: saline treatment,group B: only given PsD 007 locally, group C: only given laser light illumination intravascularly, group D: given laser light illumination after PsD 007 treated. The carotid arteries proximal to anastomoses served as normal control group (N). Angiography was done in all cases, and carotid arteries were harvested one month postoperation, respectively. Results: Stenosis rate of those anastomoses in group D was the lowest compared with the other groups( P <0.01). The medial thickness in group A and C were thicker than that in group N and D ( P <0.01), and that in group B was the same as in group N ( P >0.05), but thicker than that in group D ( P <0.05). The ratios of cross section areas between intima and internal elastic laminae in group D was minimized significantly compared with that in group A, B, C, ( P <0.01). Scanning electron microscope showed the intima with rough surface was thicken and deposited with blood cells and other components in group A, B and C. Conclusion: Intravascular PDT seems to be effective on inhibiting IH following arterial anastomosis.