1例离断肢体建立异种交叉循环的初步观察

Xenogeneic cross circulation:A case report and preliminary observation

背景异种交叉循环在器官保存领域的应用已取得一定的成果,但其在肢体组织保存方面效果仍未明确。目的探究异种交叉循环术保存断足的效果。方法将因骨肉瘤行截肢手术的断肢再次处理,自踝关节上方约5 cm截断,随后将不含肿瘤的断足主要血管连接至巴马猪股动脉和股静脉,通过趾尖血氧饱和度、趾尖脉率、全血细胞计数和断足肌肉组织形态评估保存效果。结果成功实施了异种交叉循环术,维持断足肌肉组织正常形态超过4 h。趾尖血氧饱和度64%~99%,趾尖脉率45~106/min。白细胞计数(13.3~19.7)×10^(9)/L,淋巴细胞计数(2.1~4.36)×10^(9)/L,血小板计数(242~1534)×10^(9)/L。0 h和4 h断足肌纤维形态正常,8 h断足肌纤维排列紊乱,失去部分组织形态。0 h肌间隙血管未充盈,4 h肌间隙血管有红细胞通过,8 h肌间隙血管内形成血栓。结论异种交叉循环术可维持断足肌肉组织正常形态超过4 h,但如何减少免疫排斥反应仍需进一步研究。

Background Xenogeneic cross circulation has some achievements in the field of organ preservation,but its effect on tissue preservation is still uncertain.Objective To explore the effect of xenogeneic cross-circulation in preserving severed foot.Methods The severed limb after amputation due to osteosarcoma was processed again and the limb was truncated approximately5cm above the ankle join.Then,the main blood vessels of the broken foot without tumor were connected to the femoral artery and femoral vein of a Bama pig.The preservation effect was evaluated by tiptoe oxygen saturation,pulse rate,blood cell count and muscle histology.Results Xenocross circulation was successfully performed to maintain the normal shape of the muscle tissue of the severed foot for more than 4 hours.Tiptoe oxygen saturation was 64%-99%,the pulse rate was 45-106 bpm,the leukocytes count was(13.3-19.7)×10^(9)/L,the lymphocytes count was(2.1-4.36)×10^(9)/L,and the platelets count was(242-1534)×10^(9)/L.At 0 h and 4 h,the muscle fibers were normal.At 8 h,the muscle fibers were disordered and part of the tissue morphology was lost.At 0 h,the blood vessels of muscles were not filled.At 4 h,red blood cells passed through the blood vessels of muscles.At 8h,thrombus formed.Conclusion Xenogeneic cross circulation can maintain the normal shape of muscle tissue of severed foot for more than 4h,while how to reduce the immune rejection still needs further research.