小切口阻断血管延迟反流轴型皮瓣的研究

Reverse-flow axial skin flap of the delay by minimal invasive surgery

目的 探讨小切口阻断血管对反流轴型皮瓣转移前延迟效应的作用机制及对皮瓣成活的影响.方法 80只健康Wistar大鼠随机分为实验组（小切口手术延迟组）与对照组（皮瓣即刻转移组）,每组40只,实验组皮瓣分别再分成延迟1周组,延迟2周组,延迟3周组和延迟4周组,每组10只.选取自大鼠下背部髂腰动脉区域面积5 cm×1 cm,跨越中线区2.5 cm,作为反流轴型皮瓣模型.小切口手术结扎阻断其一侧供血的血管,比较术后各组皮瓣成活率、毛细血管密度、乳酸含量的改变.结果 随着延迟时间的延长,实验组皮瓣成活率增加.实验组延迟3周组、延迟4周组皮瓣的成活率分别是（86.13±1.13）％、（93.49±1.15）％,而对照组的成活率基本相同.实验组皮瓣随着延迟时间的延长,血管密度增加,但延迟3周组与延迟4周组密度相近（P＞0.05）.实验组皮瓣乳酸浓度在延迟1周组最高,随着延迟时间的延长,乳酸浓度逐渐下降,但乳酸含量在延迟3周组和延迟4周组并不逐渐下降,而处于一个相对稳定值.对照组皮瓣乳酸含量基本不变.结论 以大鼠背部跨区轴型皮瓣为实验模型,小切口手术结扎阻断其一侧供血的血管,造成皮瓣内环境缺血、缺氧的改变,引起组织缺血、缺氧耐受,导致皮瓣血管管腔扩大,吻合血管数目增多,皮瓣成活率高,可以起到延迟转移的效果.

Objective The mechanism of delaying flap with the minimal invasive surgery was approached to understand its effects on the whole delayed survival of skin flaps thoroughly so as to provide the rationale for its clinical use.Methods 80 male or female Wistar rats were randomly subdivided into two groups：delayed by the minimal invasive surgery,and immediately transfer without delay.Flaps in each group delayed were cut at 1,2,3 and 4 weeks,respectively.The flap was designed at the lower back of rat,with the size of 5 cm × 1 cm,crossing the middle area for 2.5 cm and including stem of iliac branch from iliolumbar artery.2 weeks after second operation,the survival area,capillary density and content of lactic acid of the flaps in each group were examined,and the survival of the falps delayed by the minimal invasive surgery was compared.Results The longer delaying time,and the higher survival rate were observed in the experimental group.Delaying for 3 weeks and 4 weeks,the survival rate was （86.13 ±1.13） ％,（93.49 ± 1.15） ％,respectively,in the experimental group.While in control group,the survival rate was no more than 63％.The longer delaying time,the higher the capillary density were noted in two groups,but 3 weeks delayed group equally matched to the 4 weeks delayed group.In the experimental group,the content of lactic acid increased peaked in 1 week delayed group,then fell-down gradually,but kept steady in 3 and 4 weeks delayed group.The content of lactic acid in the control group kept steady.Conclusions The experimental model is selected as cross-area axial flap on the lower back of rats.The minimal invasive surgery plays the same role as in delaying flaps,which causes vasoconstriction,resulting in disorder of internal environment,ischemia and hypoxia,finally vasodilatation.The more ramus anastomosis,the more survival rate of the flap.