自体静脉Cuff减轻动脉内膜增生的实验研究

Experimental study on autogenous vein cuff alleviating arterial intimal hyperplasia

目的：探讨聚四氟乙烯（ＰＴＦＥ）血管加自体静脉Ｃｕｆｆ吻合对动脉内膜增生的缓解作用及对流出道的改善作用。方法：健康杂种犬１２只（２４ 条腿），随机分成对照组及实验组。对照组动脉阻断后以ＰＴＦＥ血管直接行旁路转流术；实验组以自体颈外静脉Ｃｕｆｆ间置于ＰＴＦＥ与远端股动脉之间。术后第８ 周行动脉造影，制备标本行组织学观察及计算机图像分析，测定增生内膜、中膜的厚度、增生内膜的截面积、血管腔截面积及两者的比值、静脉“动脉化”后中膜的厚度，同时对间置静脉行扫描电镜分析。结果：血管动脉造影示两组通畅率分别为１６．７％ ，６６．７％ （Ｐ＜ ０．０５）；内膜厚度分别是（４８３．５±６７．３）和（１４７．１±３８．６）μｍ （Ｐ＜ ０．０１）；中膜厚度组间改变不明显；增生内膜面积分别是（５ ２１７±１ １２３）和（３ １１７±８９０） ｐｉｘｅｌ，分别占血管腔截面的（８０．９±１７．２）％ 和（４７．７±１３．７）％ （Ｐ＜ ０．０１）；间置静脉呈动脉化表现。结论：间置自体静脉Ｃｕｆｆ能明显减轻ＰＴＦＥ旁路手术后的动脉内膜增生，改善流出道，有效提高血管手术后通畅率。

Objective:To explore the alleviation of arterial intimal hyperplasia and improvement of outflow by inserting an autogenous vein cuff between PTFE graft and arterial anastomosis.Methods:Twenty four hind limbs of 12 mongrel dogs were randomly divided into control group and subject group. Sole PTFE bypasses were performed in control group,an autologous vein cuff was inserted in the distal anastomosis in the subject group.Eight weeks after operation,angiography was made and specimens were harvested,histomorphological studies under microscope and picture analysis with computer were carried out,scanning electromicroscopy on the vein cuff was made.Results:Angiography demonstrated the patency of control and subject group was 16.7% and 66.7%,respectively;Computer gave the intimal thickness: (483 5±67.3) and (147.1±38.6) μm,respectively;No obvious change in medial thickness;Area of intimal hyperplasia was (5 217 ±1 123)and (3 117±890) pixel, respectively,accounting (80.9±17.2)% and (47.7±13.7)% of the sectional area of vessel lumen.The interpositional vein was arterialization.Conclusion:The interpositional autologous vein cuff can obviously mitigate the arterial intimal hyperplasia after PTFE bypasses,improving postoperative patency of vascular surgery.