自体腹膜管道替代血管在冠状动脉搭桥手术中的实验应用

目的 采用实验犬的腹膜片制作腹膜管道替代冠状动脉搭桥手术中的传统移植血管,希望为冠状动脉搭桥提供一种理想的血管替代物.方法 随机选用杂种成年犬10头,雌雄不限,麻醉后气管插管行机控呼吸.所有犬经旁正中切口达腹直肌鞘后层取腹膜片,制成腹膜管道在非体外循环下行主动脉与右冠状动脉主干搭桥.采用电磁血流量计测量搭桥前后腹膜管道的血流通畅度.术毕记录实验犬的早期存活比例,饲养至实验结束处死动物,光镜下观察HE染色腹膜管道的病理变化.结果 实验犬的早期死亡比例为10%(1/10),腹膜管道的血流通畅,冠状动脉搭桥手术前后实验犬右冠状动脉的血流量分别为(126±13)、(117±14)ml/min,差异无统计学意义(P>0.05).腹膜管道的组织学形态改变良好,光镜下,未见腹膜管道瘤样扩张,无明显纤维疤痕形成,腹膜管道弹力纤维结构完好,无断裂,腹膜管道与血管吻合口附近有血管内皮细胞衍生.结论 在非体外循环下采用腹膜管道替代传统的移植血管行冠状动脉搭桥创伤小,实验犬存活比例高,冠状动脉血供效果令人满意,有希望成为理想的血管移植替代物.

Experiment application of autogenous peritoneal conduit as blood vessels substitute for coronary artery bypass

Objective To evaluate the feasibility of substituting the peritoneal flap for the grafts of coronary artery bypass graft (CABG). Methods Ten mongrel dogs underwent general anesthesia and artificial ventilation. The autogenous peritoneal flap from the experimental dogs was made into axtificial conduits. Bypass between the aortic roof and the main right coronary artery (RCA) was performed on the beating heart off pump. The change of blood flow was measured using electromagnetic flowmeter. Survival in early period of dogs was recorded after oparation. Dogs were pastured postoperatively. Peritoneal graft specimens by HE staining were taken to examined under microscopy. Results The early mortality of the dogs was 10% postoperatively. After finishing the anastomosis, there was no significant difference in the coronary blood flow of RCA (126±13) ml/min vs (117±14) ml/min, P>0.05]. The pathological changes of the graft under microscopy showed that the patency of the grafts was satisfactory. By microacope,there was no tumor like distension of peritoneal conduit and obvious fiber cicatrisation. Elastic fibers structure of peritoneal conduit was complete, no fragmentation. Vascular endothelial cell derivatized from close to stoma between peritoneal conduit and blood vessel. Conclusion In off pump peritoneal conduit used as substitute for traditional transplantated blood vessel is little wound. Survive rate of experimental dogs is high and the effect of blood supply in coronary artery is satisfactory. Under the condition of the shortage of autologous vessels, the selection of the peritoneal substitute for CABG is feasible.