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液压扩张对动脉作用的组织学变化
http://www.100md.com 《中华骨科杂志》 2000年第10期
     作者:范存义 曾炳芳 郭瑞华 眭述平 姜佩珠

    单位:200233 上海市第六人民医院骨科

    关键词:颈动脉;总;扩张术;组织学;静脉;痉挛

    中华骨科杂志001013 【摘要】目的探讨液压扩张对动脉各层结构的影响。方法用生理盐水在不同压力(40、80、120kPa)下对新西兰大白兔颈总动脉行液压扩张,观察内皮细胞、内弹力膜、平滑肌及外膜的变化,测量动脉管径、平滑肌与内膜的厚度。结果(1)动脉液压扩张后管径增大;(2)压力为40kPa时,内皮细胞、内弹力膜与平滑肌的损伤轻,1周后均恢复正常;(3)压力超过80kPa时,动脉各层的损伤逐渐加重,修复需要的时间长而且修复不完整,内膜与平滑肌出现增生。结论(1)动脉液压扩张后,管径增大,可增加局部的血流量与吻合口血流对微栓子的冲刷力,降低血管危象的发生率。(2)动脉液压扩张时的压力以不超过40kPa为安全标准。
, 百拇医药
    Histologic changes of arteries after hydraulic dilation

    FAN Cunyi

    (Department of Orthopaedics, Shanghai 6th People's Hospital, Shanghai 200233,China)

    ZENG Bingfang

    (Department of Orthopaedics, Shanghai 6th People's Hospital, Shanghai 200233,China)

    GUO Ruihua, et al.

    (Department of Orthopaedics, Shanghai 6th People's Hospital, Shanghai 200233,China)
, 百拇医药
    【Abstract】 Objective To study the histologic changes of arteries dilation under different hydraulic pressure. Methods Right carotid arteries were dilated by using hydraulic method with different pressures (40, 80, 120 kPa) normal saline. The endothelial cells, internal elastic membrane (IEM), smooth muscle (SM) and adventitia of the arteries were studied under microscope. The arterial calibre, thickness of tunica intima and smooth muscle were measured under TJTY- 300 automatic medical photograph analyser. Results 1) The calibre of the dilated arteries increased. 2) When the pressure was 40 kPa, there were mild injuries of endothelial cells, internal elastic membrane and smooth muscle; all the injuries recovered to normal 1 week later. 3) The degree of injury of the individual layers of the arteries gradually aggravated as the pressure raised up to over 80 kPa. The repair also required long periods of time and was found imperfect. The proliferation of fibres of connective tissues took place one week later. Conclusion 1) Blood flow could be increased after hydraulic dilation of the artery, and the strength of washing away the small thrombosis over the site of anastomosis could be increased. 2) For safety, the hydraulic pressure of arterial dilation should be better kept within 40 kPa.
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    【Key words】 Carotidartery, common; Dilatation; Aistology; Veins; Spasm

    液压扩张在自体静脉移植中的应用已经成熟而且有效,主要是克服移植静脉的痉挛。易于寻找结扎的分支是其优点。也有学者认为静脉经过液压扩张后,管径扩大到其原来的外径,便于血管的吻合[1]。节段性液压扩张在动脉中的应用也有成功的经验[2],本实验的目的在于研究动脉液压扩张后各层形态结构的变化。

    材料与方法

    一、动物分组

    取健康成年新西兰大白兔24只,随机分为4组(A、B、C、D),每组6只。

    二、手术方法

    将动物用质量分数为2.5%的戊巴比妥钠(30mg/kg)耳缘静脉注射麻醉后,硫化钡脱毛,固定,常规洁尔灭酊消毒,铺无菌巾。
, 百拇医药
    取右颈前纵向切口,长约4cm,切开皮肤、皮下组织,在胸锁乳突肌与肩胛舌骨肌之间进入,解剖、游离出右颈总动脉约3cm,结扎远端,近端与三腔管相连,三腔管另外两端分别与注射器、压力表连接,用不同压力的生理盐水通过注射器对动脉近端进行液压扩张。压力分别为40kPa(A组)、80kPa(B组)、120kPa(C组),对照组不进行液压扩张(D组)。

    在液压扩张后即刻、7d、14d动脉近端取材,同一部位重复3次,做HE、弹力纤维、胶原纤维染色,切片,在带标尺(μm)的光学显微镜下对内皮细胞、内弹力层、平滑肌层及外膜层进行观察及测量。用TJTY-300医用图像处理系统对动脉管径、平滑肌与内膜厚度进行分析、测量(仪器:同济太阳电子公司生产的TJTY-300医用图像处理系统)。

    表1液压扩张后动脉各层结构的变化(n=6)

    结果

, 百拇医药     一、光镜观察结果

    液压扩张后动脉各层结构变化见表1。

    二、图像分析结果

    1.平均血管直径

    不同压力液压扩张后不同时间动脉直径变化见表2。

    表2不同压力液压扩张后不同时间动脉直径变化(x±s,n=6,μm)

    组别 0 1周 2周 A组 429±17 306±16 275±19 B组 443±25 514±25 375±35 C组 452±18 436±31 262±29 D组 392±26 239±22 279±17 注:与对照组相比:P<0.05,P<0.01

    2.平均平滑肌、内膜联合厚度
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    不同压力液压扩张后不同时间动脉平滑肌、内膜厚度见表3。

    表3不同压力液压扩张后不同时间动脉平滑肌、内膜厚度(x±s,n=6,μm)

    组别 0 1周 2周 A组 121±14 162±17 178±15 B组 116±11 244±23 252±22 C组 118±20 257±18 257±19 D组 114± 9 162± 8 181±11 基金项目:上海市医学领先专业重点学科课题

    参考文献

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    2,Yu ZJ. Microvascular surgery of the extremities. 1st ed. Berlin: Springer Verlag,1993.51- 52.

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    7,钱济先,黄耀添,包春杰,等.自体静脉移植血管内皮细胞的扫描电镜图像分析.中华外科杂志,1994,32:147-149.

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    9,Yamamura S, Okadome K, Onohara T, et al. Blood flow and kinetics of smooth muscle cell proliferation in canine autogenous vein grafts. J Surg Res, 1994, 56:155- 161.

    10,钱济先,黄耀添,王军.液压扩张对自体静脉内膜增生的作用.中国矫形外科杂志,1997,4:48-49.

    (收稿日期:1999-12-22), 百拇医药