建立兔颈总动脉旁路移植模型的研究

摘要

Objective To construct the animal model of common carotid artery bypass by three different methods and the experimental results are compared. Methods 36 rabbits were divided into three groups. P1 group:the external jugular vein was inversion and interposed to the ipsilateral common carotid artery using an end-to-side continuous suture technique;P2 group:the common carotid artery bypass was constructed by end-to-end continuous suture technique;C group:the animal model was constructed by cuff technique. The time of surgery and anastomoses,blood loss in operation,the patency of anastomoses,and the proliferation of graft vein were observed and compared between groups. Results No death was found in the three groups. The surgery time was similar between group P1 and P2,but longer than that in group C (P<0.05). Blood loss in operation was similar in three groups (P>0.05). The size of anastomoses constructed by cuff technique was relative fixed,and the stenosis of anastomoses happened infrequently. The suture method needs more techniques,improper suture and tight knots can cause the stenosis of anastomoses directly. The proliferation of vein at anastomoses was more frequent in group P1 and P2 and the rate of anastomotic stenosis was higher,more frequently happened in group P2,compared with cuff group (P<0.05). The proliferation of vein graft body parts were similar in three groups (P>0.05). Conclusion Animal model of common carotid artery bypass by cuff technique was much easier to grasp,and stenosis of anastomoses happens infrequently,which is suitable for the study of pathophysiological change on vein graft. Suture method needs more techniques,and stenosis of anastomoses happens frequently,however,it is important for the study of the anastomotic stenosis.%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(P<0.05).三组手术中出血量相当(P>0.05).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(P<0.05).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(P>0.05).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.