硝苯地平对大鼠颈总动脉端端吻合术后血流速度的影响

目的 研究硝苯地平（ｎｅｆｅｄｉｐｉｎｅ））对小动脉端端吻合后血流速度的影响。为血管吻合后临床应用硝苯地平的时间提供依据。方法 取ＳＤ大鼠４８只,切断左侧颈总动脉后作端端吻合。按术后所给药物的不同随机分成两组。实验组：术后用硝苯地平灌胃（１．０ｍｇ／ｋｇ）;对照组用同等体积生理盐水灌胃。按给药时间又分成术后２４、４８和７２ｈ３个给药时间组。每组均在给药后１、３、５和７ｈ,用彩色多普勒超声仪检测左侧     

磁吻合技术在犬门静脉无缝线吻合中应用的组织学分析

目的比较磁吻合技术(MCA)与传统缝合吻合犬门静脉的组织学差异。方法选择健康中华田园犬18只,雌雄不限,月龄8~12个月,体重13.5~18.9 kg。电脑编号后随机分为MCA组(n=9,切断门静脉,利用磁吻合环行端端吻合)和手工缝合组(n=9,切断门静脉再手工缝合)。比较两组门静脉吻合时间。吻合即刻和术后4、8、12、24周取吻合口标本行HE染色、Masson染色,扫描与透射电镜观察吻合口超微结构。结果所有实验犬手术后均健康存活。MCA组门静脉吻合时间(3.58±2.75)min,少于手工缝合组(12.89±3.12)min,差异有统计学意义(P<0.05)。MCA组术后即刻肉眼见吻合口血管壁对位整齐,手工缝合组褶皱明显。术后24周电镜观察MCA组吻合口内皮细胞排列整齐,形态规则,手工缝合组吻合口内皮细胞呈褶皱样,排列和形态紊乱。HE染色MCA组术后24周无明显炎症反应,Masson染色纤维组织较少。手工缝合组吻合口因缝线残留,术后24周HE染色吻合口仍可见炎症反应,Masson染色可见局部纤维组织增生明显。结论MCA吻合犬门静脉较传统手工缝合时间更短,吻合口内膜光滑,无明显纤维组织增生,血管无异物残留,炎症反应轻微,吻合口质量更好。MCA无缝线吻合犬门静脉效果可靠。     

磁吻合技术实现下腔静脉吻合组织与电镜观察

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.     

周围神经端侧吻合后乙酰胆碱转移酶变化

目的建立一种测定乙酰胆碱转移酶（ＣｈＡＴ）的方法,以定量研究神经端端吻合与端侧吻合后神经再生能力。方法：实验显露大白鼠胫神经及腓神经,并在腓神经分支处以远０．５ｃｍ处切断。端侧吻合组在胫神经上行外膜开窗,造成５ｍｍ×５ｍｍ外膜缺损,然后将腓神经在此处与胫神经作端侧吻合。端端吻合组使腓神经切断后直接作端端吻合。术后１～３个月分别测定切断端以远ＣｈＡＴ活性,并在３组之间作比较,即（１）端端吻合组,（２）端侧吻合组,（３）非吻合组及正常对照组。结果端侧吻合３个月后ＣｈＡＴ活性是正常对照组的一半。组织学显示端侧吻合与端端吻合组均显示有大量有髓纤维存在。结论这些结果提示端侧吻合后具有ＣｈＡＴ活性证实神经端侧吻有可能为临床治疗神经撕脱伤及大段缺损提供一条途径。     

吸烟对血管损伤机制的研究

目的探讨因吸烟致移植或再植组织发生血循环危象的机制。方法（１）对因吸烟而致血循环危象的７例断指再植、组织移植病例进行总结分析。（２）对大鼠进行被动吸烟实验，分成术前被动吸烟组、术后被动吸烟组及正常对照组。应用检测离体血管舒缩功能的方法及扫描电镜技术，观察吸烟对大鼠血管吻合口内皮细胞的愈合过程；尼古丁对离体动脉的舒缩功能及血管内膜完整性的影响。结果临床７例各自在术后不同时间吸烟１次后，３例移植组织和４例再植组织发生血循环危象。实验结果表明：（１）血管吻合后１０天，吸烟组血管吻合口内皮细胞覆盖率为２８％～３２％，而对照组达８５％。（２）尼古丁能使血管环产生浓度依赖性收缩，并且造成血管内皮结构的严重破坏。结论吸烟能延缓内皮细胞愈合、血管收缩与损伤血管内膜，是形成移植与再植组织血循环危象的主要因素之一     

山莨菪碱对大鼠颈总动脉吻合术后血流动力学的影响

目的研究山莨菪碱对血管吻合后血流动力学的影响。方法取ＳＤ大鼠９６只，切断左侧颈总动脉作端端吻合后，随机分成术后６、１２、２４、４８、７２和１２０小时共６个时间组。各时间组再分成实验组和对照组，每组８只大鼠。实验组用２％氢溴酸山莨菪碱（３０ｍｇ／ｋｇ）作腹腔注射，对照组则注射等体积生理盐水，给药１０分钟后用彩色多普勒血流仪检测颈总动脉吻合口前、吻合口、吻合口后动脉收缩期平均最高血流速度，并计算吻合口横截面积。结果术后１２、２４、４８、７２和１２０小时组，颈总动脉吻合口前的血流速度比对照组明显增加（Ｐ＜０．０５），平均增加３１．５％。术后６和２４小时组，实验组吻合口狭窄程度比对照组明显减轻（Ｐ＜０．０１，０．０５）。术后１２０小时组，山莨菪碱能够明显增加吻合口后的血流速度，实验组和对照组相比有显著性差异（Ｐ＜０．０５）。结论山莨菪碱能够提高大鼠颈总动脉吻合后，血管吻合口前及吻合口的血流速度，术后２４小时内用药能够减少吻合口的狭窄程度。     

胆管残端双舌瓣空肠一层外翻吻合术的临床应用

目的比较胆管残端双舌瓣空肠一层外翻吻合与后壁一层内翻吻合前壁一层外翻吻合两种手术方式的优缺点。方法45例先天性胆总管囊肿患者随机分为两组:观察组,24例,行胆管残端双舌瓣空肠一层外翻吻合术;对照组,21例,行后壁一层内翻吻合前壁一层外翻吻合术。比较两组间吻合口大小、吻合时间、术后吻合口狭窄发生率及术后效果。结果观察组的吻合口大小、吻合时间、术后吻合口狭窄发生率及术后效果显著优于对照组(P<0.05)。结论胆管残端双舌瓣空肠一层外翻吻合术操作简单易行,手术时间短,术后效果良好,且安全可靠,是一种有效预防胆肠吻合口狭窄的理想手术方式。     

建立兔颈总动脉旁路移植模型的研究

目的采用3种不同的方法建立兔颈总动脉旁路移植的动物模型,比较建立各种动物模型的手术结果。方法将36例兔分为:P1组、P2组、C组,三组分别采用不同的方法建立兔颈总动脉旁路移植模型。P1组:将2~3 cm长的颈外静脉远近端倒转后端侧吻合移植至同侧颈总动脉上,结扎两吻合口间的颈总动脉。P2组:与P1组不同的是动脉离断后与倒置的静脉行端端连续吻合。C组:将同样长度的颈内静脉倒置后应用cuff管技术移植于颈总动脉。比较三组血管吻合技术的手术时间、吻合口术后即刻及4周时的通畅率,4周后静脉桥血管内,中膜增生情况。结果三种实验动物均无死亡。P1、2组动物手术时间相当,但较C组手术时间长(P0.05)。三组手术中出血量相当(P0.05)。Cuff技术制作的动静脉吻合口,大小相对固定,不容易形成手术技术的吻合口狭窄;缝合法,技术要求较高,缝合不当、打结过紧可直接导致吻合口狭窄,以端端吻合的狭窄率最高。4周后缝合法比cuff技术的吻合口管壁增生更加明显,吻合口发生狭窄的比率升高,cuff技术与端端吻合差异明显(P0.05)。静脉桥血管体部的内膜及中膜增生程度相似,无统计学差异(P0.05)。结论 Cuff技术制作兔颈总动旁路移植模型容易掌握,吻合口不易狭窄,适用于研究静脉桥血管体的病例生理变化。而缝合法手术要求高,吻合口狭窄的发生率高,但更近于临床,对研究吻合口狭窄具有重要意义。     

胆管残端双舌瓣空肠一层外翻吻合术的临床研究

目的 比较胆管残端以舌瓣空肠一层外翻吻合与后壁一层内翻前壁一层外翻吻合两种手术方式的优缺点.方法 105例需行胆管空肠吻合术患者随机分为两组:观察组,50例.行胆管残端双舌瓣空肠一层外翻吻合术:对照组,55例,行后壁一层内翻吻合前壁一层外翻吻合术.比较两组间吻合口大小、吻合时间、术后吻合口狭窄发生率及术后效果.结果 观察组的吻合口大小、吻合时间、术后吻合口狭窄发生率及术后效果显著优于对照组(P<0.05).结论 胆管残端双舌瓣空肠一层外翻吻合术操作简单易行,手术时间短,术后效果良好,且安全可靠,是一种有效预防胆肠吻合口狭窄的理想手术方式.     

定点牵引医用胶粘结吻合微小血管的实验与临床应用

目的探讨新的细小血管吻合安全、快捷的方法。方法SD大白鼠40只,一侧股动脉后壁和前壁正中各缝合1针作为定点牵引,蘸胶端-端粘结吻合为实验组,另一侧行常规针线法端-端吻合为对照组,取2只动物两侧股动脉做吻合口耐压实验,其余动物分别于术后1、2、3、4周取血管标本,采用组织学和扫描电镜观察吻合口愈合情况,并在临床应用于断指再植52例79指。结果两侧血管全部吻合通畅,粘合组用时(12±2)m in比针线组(18±3)m in缩短1/3,粘合组吻合口耐压(300 mm Hg)优于针线组,吻合口组织学观察两组无明显差异,电镜观察粘合组内膜修复更为平整、光滑;临床应用于断指再植成活率94.9%。结论定点缝线牵引蘸胶端-端粘结吻合显微细小血管快速、安全、效果可靠,具有较大临床应用价值。     

Effects of transient ischemia on the healing small bowel anastomosis

The small bowel may be subjected to transient, yet reversible ischemia in situations such as volvulus, thromboembolism, and low flow states. The surgeon is frequently faced with the necessity of intestinal resection in treating such cases. The remaining bowel, while judged viable may have been exposed to significant ischemic injury. The surgeon must decide whether such bowel will heal satisfactorily if used in an anastomosis. This study was undertaken to determine the effect of transient ischemia on intestinal anastomotic healing in the rat. Male albino rats were subjected to superior mesenteric artery occlusion for periods of 30 minutes or 45 minutes. The circulation was then re-established. The small bowel was the transected and anastomosed. Animals in each group were sacrificed at 7 and 10 days and bursting pressures performed to test the healing of the anastomosis. Results were compared with a control group having an anastomosis without precedent ischemia. There were no significant differences among the groups. The data clearly indicate that if the bowel remains viable following an ischemic insult its healing is unimpaired.     

Comparison of skeletal muscle microcirculation between clamp ischemia and microsurgical ischemia

We compared ischemia reperfusion injury-associated vasospasm and perfused capillary density (PCD) at the microcirculatory level between clamp ischemia and microsurgical ischemia in rat skeletal muscle. Rat cremaster muscle was prepared as an island flap, attached only with pudic-epigastric vessels branching from external iliac vessels. Two types of ischemia, with clamping only or with microvascular anastomosis, were applied at the external iliac vessels for 2 hours followed by 1-hour reperfusion before in vivo microscopic examination for hemodynamic changes. At the end of observation, small segments of the vessels at the clamping site and microsurgical anastomoses site were also harvested for histological examination. It was found that the first- and second-order arterioles had about 12–15% diameter reductions in both groups, whereas diameter reductions of the third-order arterioles were up to 37.8% in the microsurgical ischemia group, much greater than that in the clamp ischemia group (2.3%). There was also no significant difference in PCD reduction between the two groups, although the red blood cell velocity was much slower in the microsurgical ischemia group. Histological examination of the anastomosis site showed massive accumulation of polymorphonuclear neutrophils on the venous endothelium. These results suggested a different degree of endothelial damage and local leukocyte activation between microsurgical ischemia and clamp ischemia. Therefore, we conclude that clamp ischemia cannot replace microsurgical ischemia for studying microcirculatory changes in free tissue transfer. © 1996 Wiley-Liss, Inc.     

Effect of hypertension on small-vessel healing after microvascular anastomosis

Artery-to-artery microvascular anastomosis (MVA) has become an established therapeutic alternative for patients with giant intracranial aneurysms and other forms of cerebrovascular disease. Many patients afflicted with cerebrovascular disease also suffer from hypertension. To evaluate the effect of hypertension on healing of small arteries following MVA, 36 spontaneously hypertensive rats were subjected to end-to-side MVA of their common carotid arteries. At specific times after surgery the rats were sacrificed; the anastomotic site was removed and examined with light microscopy and scanning electron microscopy. All MVA's were patent, and there was no evidence of thrombus formation or stenosis at the operative site in any group. Also, there was no difference between the spontaneously hypertensive rats and the control normotensive rat group in the rate of endothelial coverage of the MVA. The presence of hypertension appears to have no effect on healing of small arteries in the rat.     

Topically applied tissue factor pathway inhibitor reduced intimal thickness of small arterial autografts in rabbits.

PURPOSE: The purpose of this study was to investigate whether topically applied tissue factor pathway inhibitor (TFPI) reduces intimal thickness and increases long-term patency of small arterial autografts in rabbits. METHODS: An entire 10-mm long section of the left femoral artery was harvested and immersed in saline solution (control group, n = 10), 100 IU/mL of heparin (heparin group, n = 15), or 40 microg/mL of TFPI (TFPI group, n = 15) for 15 minutes. Then the graft was interposed to the right femoral artery. Patency rates were determined by flow measurements throughout the time course of the study, and the grafts were analyzed for measurement of intimal thickness at 3 months after operation. Immunohistochemical analysis was performed to examine whether topically applied TFPI binds to endothelial cells of the grafts. RESULTS: Three-month postoperative patency rates were 10% in the control group, 47% in the heparin group, and 73% in the TFPI group. The TFPI group had a significantly higher patency rate than that of the control group (P <.005). Compared with the heparin group, the TFPI group had a significant reduction in intimal area (0.19 +/- 0.05 mm(2) vs 0.30 +/- 0.09 mm(2), P =.0051), in percentage of stenosis (35.7% +/- 7.7% vs 61.4% +/- 15.8%, P <.0001), and in intimal/media areas ratio (0.64 +/- 0.24 vs. 1.04 +/- 0.33, P =.0051). Immunohistologic analyses confirmed that topically applied TFPI bound to endothelial cells. CONCLUSION: These results indicate that topically applied TFPI reduces intimal thickness and increases long-term patency of small arterial autografts in rabbits.     

不同肠管吻合方式对吻合口愈合的影响

目的 观察不同吻合方法对犬小肠手术后吻合口愈合的影响,探讨其有效性及安全性.方法 成年犬12条,根据吻合部位不同随机分为A、B2组,A组距离屈式韧带100 cm小肠采用双层吻合,距离屈式韧带200 cm小肠采用单层吻合;B组反之.术中记录2种吻合方式的操作时间.术后7d再次手术,找到吻合口并评价吻合口周围粘连分级,测量吻合破裂压(ABP)、小肠浆肌层破裂压.结果 单层吻合与双层吻合后局部粘连分级末见明显差异;单层吻合与双层吻合的ABP分别为(325.83±88.03)和(331.25±70.33) cmH2O(1 cm H2O=0.098 kPa,P＞0.05);单层吻合与双层吻合的浆肌层破裂压分别为(185.42±40.87)和(182.08±20.72) cm H2O(P＞0.05);单层吻合和双层吻合时间分别为(17.08±3.20)和(23.50±2.50) min(P ＜0.01).结论 单层吻合法是一种安全、有效的小肠吻合方法.     

Arterial anastomosis without sutures using ring pin stapler for clinical renal transplantation: comparison with suture anastomosis

PURPOSE: The metal ring pin stapler was initially developed for microvascular surgery and there has been little experience of their use in larger vessels. We determined if the titanium ring pin coupling system could be safely and rapidly applied for arterial reconstruction in clinical renal transplantation. MATERIALS AND METHODS: The donor renal artery was end-to-end anastomosed to the internal iliac artery with titanium ring pin staplers in 36 patients. Anastomotic, clamp and total operative time and vascular problems were compared with those in the control group of sutured anastomosis in 39 transplant recipients. RESULTS: The completion of mechanical anastomosis required half the time of suture anastomosis. Mean clamp time was 17.8 minutes in the nonsuture group and 28.1 minutes in the control group. There was no significant difference in total operative time between the 2 groups. A small anastomotic line leak was noted in each group, which was temporary and self-limited. There were no postoperative anastomotic failures, postoperative bleeding episodes or need to revise the anastomosis (100% patency rate) in the 2 groups. Of the patients 61 were followed for 2 to 5 years. Transplant renal artery stenosis was observed in 1 patient in the nonsuture group but 3 in the control group. CONCLUSIONS: The anastomotic technique with the ring pin system is safe and simple, permitting an expeditious and everting anastomosis with a smooth intima-to-intima junction. Application of this technique may decrease warm ischemia time and the incidence of anastomotic artery stenosis, thus, improving outcomes.     

不同灌注液对人离体小动脉保护作用的超微观察

目的 研究不同灌注液对离体小动脉超微结构的影响.方法 对手指近端毁损伤,缺乏再植条件或患者放弃再植的18指近节离断手指(热缺血时间＜2 h),分成3组,每组6指,分别在指动脉内灌注能量合剂(A组)、肝素钠+1%利多卡因(B组)和生理盐水(C组),4℃保存.分别于灌注后2、4 6 8、12、16、24 h切取指动脉3 mm,固定后切片电镜下观察小动脉在不同时间段超微结构的变化.另取离断指体近端未缺血的健康指动脉3 mm直接固定,为对照组.结果 电镜下观察:A组灌注8 h后,小动脉平滑肌细胞线粒体仅轻度肿胀,嵴变短.B组灌注4 h后,线粒体明显肿胀和内质网扩张;8 h后,血管平滑肌细胞内线粒体进一步肿大,嵴稀疏.C组灌注2 h后,内皮细胞轻度肿胀,少数脱落;4 h后,内皮细胞肿胀,部分脱落,血管平滑肌细胞内线粒体开始肿大;8 h后,血管平滑肌细胞内线粒体进一步肿大,部分出现空泡,嵴减少,基质变淡.与A组和C组比较,小动脉经肝素钠+利多卡因灌注后内皮细胞脱落延迟至16 h.结论 能量合剂灌注液对离体小动脉的超微结构有保护作用,能够减轻肢体缺血再灌注损伤的程度.     

Effect of torsion on microarterial anastomosis patency

All kinds of technical faults must be prevented in microvascular anastomosis for successful reconstructive microsurgery. Torsion at the anastomosis site is one of the most basic technical errors. In this study, we investigate the effect of different degrees of microarterial torsion on patency and its physical changes on anastomosis in a rat model. A total of 144 microanastomosis were performed in 72 Sprague-Dawley rats. They were divided into 9 groups. The anastomosis was performed at 0 degrees, 45 degrees, 90 degrees, 135 degrees, 180 degrees, 225 degrees, 270 degrees, 315 degrees, and 360 degrees of torsion randomly. Patency rates and the narrowest point of the artery after the anastomosis were recorded after 1 hour for each group. In the second stage of the study, the 9 groups were divided into 2 groups for patency rates and histopathological sampling at the second and seventh days postoperatively. The femoral arteries in all groups were all patent at the end of 1 hour. Only 5 microanastomosis were thrombosed (one in the 45 degrees group, one in the 225 degrees group, one in the 270 degrees group, and two in the 315 degrees group) at the second day of exploration. Only two arteries were thrombosed (one in the 45 degrees group and one in the 315 degrees group) at the seventh day of exploration. The patency rate was 96.8% in experimental groups excluding the control group. Different degrees of torsion had no statistically significant effect on the patency rates of microvascular anastomosis. Torsional repair of the femoral artery in the rat has no significant histopathologic changes, but alternately, endothelial integrity was affected by excessive degrees of torsion. Different degrees of torsion at the anastomosis site do not affect patency rates and cross sectional histology of rat femoral arteries. In clinical practice, minor torsion can be tolerated, however, factors affecting patency such as tension, diameter disproportion, and tight closure can affect the final result of anastomosis. We observed that torsional force of the vessel is distributed along the artery to the weakest point.     

The effect of low-molecular-weight heparin on microvenous thrombosis in a rat model

OBJECTIVE: To assess the impact of a low-molecular-weight heparin sodium, dalteparin sodium, on a thrombogenic microvenous anastomosis, using a randomized, blinded animal model. METHODS: Using male Sprague-Dawley rats, 70 IU/kg of dalteparin sodium (for the treatment group) or isotonic sodium chloride solution (for the control group) were administered subcutaneously in a blinded randomized fashion. Using microsurgical techniques, the femoral venous pedicle was isolated bilaterally. A tuck anastomosis was then performed on each side. Vessel patency was assessed periodically for 3 hours using a strip and refill test. Patency or thrombosis was confirmed by cutting the vessel proximal to the anastomosis and examining the lumen for thrombus. RESULTS: A total of 58 venous tuck anastomoses were performed. There was no difference in bleeding complications between the treatment and control groups. The control group had a thrombosis rate of 50%, and the treatment group had a thrombosis rate of 60%. The chi2 analysis does not indicate a statistical difference between these 2 groups (P = .59). CONCLUSION: Low-molecular-weight heparin, at standard therapeutic dosing, may not provide an adequate antithrombotic effect to prevent anastomotic thrombosis in free tissue transfer.