游离组织组合移植的实验研究

Experimental study of the combined tissue transplantation

目的 拟通过组合移植动物模型及低灌注量、低回流量动物模型的建立,探讨组合移植各组织瓣成活规律。方法 60只家兔分为4组:A组,正常灌注量组;B组,低灌注量组;C组,低回流量组;D组,低灌注量及低回流量组。通过缩窄血管管径,观察三个组织瓣组合移植在不同灌注量,不同回流量条件下组织瓣血流量变化、各组织瓣成活情况及动静脉氧分压差值的变化,与单个组织瓣移植进行比较。结果(1)对照组、A组、B组第7、10天皮瓣成活。C组术后逐渐变黑坏死。D组术后皮瓣边缘坏死。(2)对照组、A组、B组、D组LDF值术后,第7、10天基本稳定。D组组织瓣LDF值升高不明显。C组LDF值逐渐降低至测不出。(3)对照组、A组、B组、C组、D组各组组织瓣成活率分别为:100％、98.2％、95.9％、0％、59.4％。对照组、A、B组两两比较P>0.05;A、B组分别与C、D组比较P<0.01;C、D组比较P<0.01。结论组合移植和单个组织瓣移植有着相似的血流变化规律;一定口径的血管蒂可以携带三个组织瓣进行组合移植,愈合可靠。我们认为在维持生理灌注量和回流量的条件下,更多级的组合移植也是可行的。

Objective To investigate the survival rate of combined tissue transplantation flaps by establishing animal model of combined tissue transplantation, low perfusion and low reflux, which provides the theoretical and experimental basis for the clinical use. Methods Sixty rabbits were divided into four groups: Group A: normal blood perfusion, Group B: low perfusion, Group C:low reflux, Group D:low perfusion and reflux. Having observed the survival rate, macroscopic features, quantity of blood flow(LDF) ,the Po2 of the pedicle vessel of each tissue flap in different blood perfusion and reflux,the results were compared with each other by narrowing the diameter of blood. Results (1) Control group,Group A and B survived until the 7th and 10th day. Group C: necrosed completely. Group D:necrosed partially. (2)The quantity of blood flow of control group and Group A,B,D was stable up to the 7th and 10th days. Group D:the LDF did not have substantial improvement. Group C: the LDF was dropping continuously to zero at last. (3)The survival rate of tissue flaps varied greatly in different groups:Group A 98. 2%,B 95. 9% ,C 0%,D 59. 4%, control group 100%. The comparison among controls group and group A and B showed no significant difference. However it showed statistical significant difference when Group A and B compared with Group C and D. Conclusion The experiment proved that blood flow of free combined tissue transplantation changed as regularly as a singe tissue flap transplantation. A certain vascular pedicle can support three combined tissue flaps adequately and safely. It may be possible that four or more independent tissue flaps can survive on a certain pedicle vessel.