颈动脉内膜切除术不同方式血管重建后早期再狭窄的实验研究

目的在新西兰兔颈动脉粥样硬化性狭窄动物模型上行颈动脉内膜切除术,应用标准线缝合和胶粘合的方法进行血管重建,观察比较颈动脉内膜切除术后早期再狭窄过程。方法采用血管内膜气体损伤结合高脂饲料喂养的方法建立新西兰兔颈动脉粥样硬化性狭窄动物模型,在此动物模型上行颈动脉内膜切除术,应用标准线缝合和胶粘合的方法分别进行血管重建,观察比较不同重建方式术后动脉早期再狭窄过程。结果颈动脉内膜切除术后早期再狭窄过程可分为数个阶段,而不同的重建方式在每个阶段表现并不相同。在血栓形成阶段,胶粘合组的血栓面积较缝合组明显减小;在炎症反应阶段,胶粘合组动脉外膜的炎症反应较重;在内皮修复阶段,缝合组和胶粘合组内皮膜修复的过程相似;在血管平滑肌增殖阶段,缝合组的平滑肌细胞增殖程度较胶粘合组加重;基质形成、堆积阶段,胶粘合组基质产生较缝合组减少。胶粘合组颈动脉阻断时间较标准缝合组明显缩短。结论颈动脉内膜切除术后早期再狭窄可能是局部血管内膜损伤后的一种修复反应,采用新型粘合血管重建的方法比标准线缝合有一定的优越性。

Early restenosis following different anastomoses of carotid endarterectomy rabbits

Objective To observe and compare the early restenosis after carotid endarterectomy(CEA) with standard sutured anastomoses(group 1) and sutureless adhesive anastomoses(group 2) repectively on the rabbit carotid arteriosclerosis stenosis(CASS) model.Methods Using New Zealand rabbits,CASS model was created by air-drying an isolated seagment of common carotid artery and feeding high cholesterol diet for 2 months.The course of early restenosis after CEA was observed following different anastomoses.Results Several stages could be seen in early restenosis after CEA and difference was showed in each stage following different anastomoses.The area of thrombosis,degree of proliferation of vascular smooth muscle cell(VSMC) and formation of extracellular matrix(ECM) after anastomoses were less and the inflammation was more critical in adventitia in group 2 than that in group 1.The regeneration of endothelium was similar in both groups.The blocking time of carotid was shorter in group2 than that in group1.Conclusion Restenosis after CEA may be repairing response to local intima injury,and the sutureless adhesive anastomosis is more superior than suture anastomsis after CEA.