富血小板纤维蛋白干预兔股动脉显微吻合术后血管组织结构及软组织变化

Intervention with platelet-rich fibrin in rabbit models after microvascular anastomosis surgery of the femoral artery:changes in vascular structure and soft tissue

背景:近年来大量的基础实验及临床研究数据表明,富血小板纤维蛋白可以促进机体软硬组织的再生及修复,然而在显微血管吻合领域尚缺少其作用的相关报道。目的:评估富血小板纤维蛋白对兔股动脉显微吻合术后效果的影响。方法:36只成年新西兰大白兔(雌雄各半)建立股动脉离断-显微吻合模型后,随机分为2组,每组18只。实验组抽取自体耳缘静脉血离心后制作富血小板纤维蛋白凝胶,立即涂抹于股动脉吻合口;对照组注射同等容量的生理盐水。于术后3,7,14 d评估术区切口感染、愈合及粘连情况,取吻合口股动脉组织行苏木精-伊红染色观察血管结构修复情况,免疫组化实验分析血管内皮生长因子、血小板衍生生长因子及转化生长因子β1的表达水平。结果与结论:①实验组中兔术区切口感染的数量整体低于对照组(P<0.05),两组组内感染情况无明显变化(P>0.05);术区切口愈合等级实验组整体优于对照组(P<0.05),不同时间点实验组组内切口愈合情况无明显变化(P>0.05),而对照组组内差异有显著性意义(P<0.05);②术区股动脉粘连程度实验组整体轻于对照组(P<0.05);不同时间点实验组组内无明显变化(P>0.05),对照组组内粘连程度术后逐渐加重(P<0.05);③苏木精-伊红染色结果显示,实验组血管内皮细胞及内弹力膜层的修复情况优于对照组,内膜的重建更为完整,实验组血管中膜平滑肌细胞坏死、增殖及迁移与外膜层创伤性增生反应的情况轻于对照组,实验组血管壁的愈合质量整体高于对照组;④免疫组化实验结果提示,实验组血管内皮生长因子、血小板衍生生长因子及转化生长因子β1的表达水平高于对照组(P<0.05);⑤提示在显微血管吻合术中应用富血小板纤维蛋白可促进血管内皮细胞的生长,有利于血管组织各层结构的原位重建,降低术区感染及粘连等并发症,缩短血管损伤后的修复及愈合时间,这种新颖的治疗方法有望改善显微外科中动脉吻合术后的治疗效果。

BACKGROUND:Recently,numerous basic and clinical data have shown the superio rity of platelet-rich fibrin in the regeneration and repair of soft and hard tissues,while there are few relevant reports in the field of microvascular anastomosis.OBJECTIVE:To evaluate the efficacy of platelet-rich fibrin applied to the femoral artery after microvascular anastomosis surgery in a rabbit model.METHODS:Thirty-six adult New Zealand white rabbits of either sex were randomly divided into experimental group and control group(n=18 per group) after establishing femoral artery transection-reanastomosis models.In the experimental group,autologous ear venous blood were extra cted and centrifuged to prepareplatelet-rich fibrin gel,and the prepared gel was immediately applied to the anastomotic site of the femoral artery.The control group was given the same volume of normal saline.Incision infection,healing,and adhesion were evaluated at 3,7,14 days after surge ry.Vascular structure of the femoral artery at the anastomotic site was observed using hematoxylin-eosin staining.Immunohistochemistry detection was performed to analyze the expression levels of vascular endothelial growth factor,platelet-derived growth factor,and transforming growth factor βl.RESULTS AND CONCLUSION:The overall number of incision infections in the experimental group was lower than that in the control group animals(P <0.05),and the number of incision infections showed no significant changes in each group(P> 0.05).The ove rall incision healing level in the experimental group was better than that in the control group(P <0.05),and the incision healing showed no significant changes in the expe rimental group(P> 0.05) but changed significantly in the control group at different time points(P<0.05).The degree of femoral artery adhesion in the operation area was generally lighter in the experimental group than the control group(P <0.05).The degree of adhesion had insignificant changes in the expe rimental group at different time points(P>0.05) but gradually increased in the control group after operation(P <0.05).The res ults of hematoxylin-eosin staining showed better repair of vascular endothelial cells and inner elastic lamina in the expe rimental group than the control group.Compared with the control group,the reconstruction of the intima was more complete in the expe rimental group,with less necrosis,prolife ration,and migration of vascular smooth muscle cells in the media and traumatic hyperplasia of the extima.The overall healing condition of the vascular wall was better in the expe rimental group than the control group.Immunohistochemical results revealed that the expression levels of vascular endothelial growth factor,platelet-derived growth factor,and transforming growth factor β1 in the expe rimental group were higher than those in the control group(P <0.05).To conclude,platelet-rich fibrin can promote the growth of vascular endothelial cells,contribute to the in situ reconstruction of various layers of vascular tissue,reduce postoperative complications,such as infection and adhesion,in the surgical area,and shorten the repair and healing time after vascular injury.This novel treatment method is expected to improve the therapeutic effect of arterial anastomosis in microsurgery.