磁吻合技术实现下腔静脉吻合组织与电镜观察

Histologic and scanning electron microscopic study for inferior vena cava anastomosis by magnetic compressive anastomosis

目的 通过磁性压榨式吻合技术（MCA）实现腹腔大血管无缝线吻合的组织学与电镜观察,比较新型血管吻合器较传统手工缝合方法的优点.方法 杂种犬16条,随机分为MCA组与手工缝合组,统计两组下腔静脉（IVC）吻合时间,观察吻合即刻、吻合后4、12、24周两组犬IVC吻合口愈合情况;血管吻合口苏木素-伊红染色（HE）与Masson三色染色用于组织学分析;扫描电镜观察吻合口内皮细胞连续性和生长情况.结果 MCA组IVC吻合时间较手工缝合组明显缩短[（3.25±1.21） min比（13.23±2.34） min,P＜0.01].电镜观察：MCA组吻合口内膜光滑,内皮细胞排列整齐,形态规则,但手工缝合组吻合口因缝线牵拉导致管腔内凹凸不平,内膜不完整,吻合口内皮细胞排列紊乱,形态不规则;组织学检查：MCA组吻合口血管壁对位整齐,血管内膜覆盖吻合口,术后12周吻合口呈慢性炎性反应,少量淋巴细胞浸润,24周无明显炎性反应,但手工缝合血管吻合口有明显缝线异物残留与瘢痕形成.结论 MCA组较手工缝合组手术耗时少,血管壁各层衔接较好,内皮细胞层光滑,无明显增生,血管腔无异物残留,吻合口炎性反应轻微.MCA血管吻合技术实现IVC无缝线吻合效果可靠.

Objective The present study was to investigate the magnetic compressive anastomosis for non-suture inferior vena cava （IVC） anastomosis.Methods Sixteen adult mongrel dogs of either gender were randomly divided into two guoups for IVC in situ end-to-end anastomosis,group of magnetic compressive anastomosis （MCA,n =8）：magnetic rings for IVC reconstruction; group hand sewing （n =8）：hand suturing for IVC reconstruction.Gross observation,histological staining and scanning electron microscopy were performed immediately at 4,12,24 weeks postoperatively.Results The time required to perform the IVC anastomosis was shorter for the magnetic device （3.25 ± 1.21） min than for hand sewing （13.23 ± 2.34） mins （P 〈 0.01）.Electron Microscopy results showed that MCA anastomotic intimal was smooth,with endothelial cells arranged in neat rows and,regular morphology,but in the manual suture groups,anastomotic suture traction led to uneven surface with lumen,the intima was incomplete,and anastomotic endothelial cells were disorganized,with irregular shapes.Histological examination results showed that chronic inflammation was present in 12 weeks after MCA anastomosis,with infiltration in a small number of lymphocytes.Inflammation significantly decreased in 24 weeks.Light microscopy found that the obvious suture foreign body was left in hand suturing group stoma with scarring.Conclusion The time required to perform the vascular anastomosis was significantly shortened by MCA.Compared with manual suturing,the magnetic ring device stoma was associated with smooth re-endothelialization,less fibrotic collagen deposition and depressed infiltration of inflammatory cells at the anastomotic site.Nonsuture anastomosis of IVC by MCA achieved reliable results.