术后静脉化疗对犬腹主动脉人工血管移植物影响的观察

Impact of postoperative intravenous chemotherapy on prosthetic vascular graft in dogs:a brief study

目的探讨5-FU和DDP静脉联合化疗对犬人工血管移植物的影响。方法建立12只犬ePTFE人工血管重建腹主动脉模型,随机平分为化疗组和对照组。化疗组于术后第2周给予5-FU(10 mg/kg)和DDP(1 mg/kg)静脉联合化疗,1次/d,共5 d,对照组行同量液体输液;记录实验犬干预期间的生理指标;于化疗(输液)后4周(术后6周)获取5个平面标本,检测移植物内膜厚度及CD34和PCNA的表达。结果化疗组死亡1例(1/6),对照组无死亡(0/6);化疗组2例(2/5)人工血管少量附壁血栓形成,对照组未见(0/6)。组间比较:两组人工血管内膜厚度无统计学差异(P>0.05);化疗组人工血管中段的CD34阳性细胞率显著低于对照组(P<0.05),其余平面无统计学差异(P>0.05);两组内膜PCNA的表达无统计学差异(P>0.05)。组内比较:两组人工血管中段的内膜厚度及CD34阳性细胞率均低于吻合口(P<0.05或P<0.01);远端吻合口PCNA表达量均较近端吻合口高(均P<0.05),两端吻合口PCNA高于人工血管中段(均P<0.05)。结论术后2周行5-FU和DDP静脉联合化疗可能一过性影响人工血管移植物中段的内皮细胞覆盖,增加人工血管附壁血栓形成的几率,但在4周时对人工血管吻合口愈合无明显影响,不增加移植物感染或破裂的几率。

Objective To investigate the impact of intravenous combination chemotherapy with 5-fluorouracil（5-FU） and cisplatin（DDP） on prosthetic vascular grafts in dogs.Methods The model of reconstruction of abdominal aorta using ePTFE prosthetic vascular graft was established in 12 dogs,which were equally randomized into chemotherapy group and control group.The chemotherapy group underwent intravenous combination chemotherapy with 5-FU（10 mg/kg） and DDP（1 mg/kg） once daily for 5 days during the 2nd week after operation,and the control group received transfusion with an equivalent volume of vehicle.Physiological parameters of the dogs during the period of intervention were recorded.Graft specimens from five levels were harvested at the 4th week after chemotherapy or vehicle transfusion（6th week after operation） to determine the intimal thickness,CD34 and proliferating cell nuclear antigen（PCNA） expression.Results One death（1/6） occurred in chemotherapy group and none（0/6） in control group.Two cases（2/5） in chemotherapy group developed a small amount of mural thrombus formation in prosthetic vascular graft,but that was not found（0/6） in control group.Between-group comparison results were as follows： No statistical difference was noted in intimal thickness of prosthetic vascular graft between the two groups（P0.05）;the CD34＋ cell ratio on the middle segment of prosthetic vascular graft of chemotherapy group was significantly lower than that of control group（P0.05）,while the CD34＋ cell ratio on other levels of prosthetic vascular graft showed no statistical difference between the two groups（P0.05）;the PCNA expression of intimal area had no statistical difference between the two groups（P0.05）.Within-group comparison results were as follow： The intimal thickness and CD34＋ cell ratio on middle segment of prosthetic vascular graft were all lower than those on anastomotic stomas（P0.05 or P0.01）;the PCNA expression levels of the proximal stomas were all higher than those of the distal stomas（both P0.05）,and the PCNA expression levels in both sides of stomas were all higher than those of the middle segment of prosthetic vascular grafts（both P0.05）.Conclusions Postoperative intravenous combination chemotherapy with 5-FU and DDP given during the 2nd week after prosthetic vessel replacement has transient retardant effect on the endothelial coverage of the middle segment of prosthetic vascular graft,resulting in the increased incidence of mural thrombus formation of prosthetic vascular graft.However,it has no significant influence on anastomotic healing,and does not increase the incidence of infection or rupture of the graft.