激光心肌血运重建联合大网膜移植的研究  

Research study of transmyocardial laser revascularization combined with omental graft

作　　者：蔡俊锋[1] 袁忠祥[2] 肖明第[2] 林雷[2] 张闻瑞[3] 于红[4] 

机构地区：[1]复旦大学附属中山医院心外科,上海200032 [2]上海交通大学附属第一人民医院心外科 [3]上海交通大学附属第一人民医院同位素室 [4]上海交通大学附属第一人民医院病理科

出　　处：《上海医学》2006年第6期342-344,共3页Shanghai Medical Journal

基　　金：上海市卫生局基金(024014)

摘　　要：目的采用激光心肌血运重建术（TMLR）联合大网膜移植作用于犬的缺血心脏，观察缺血心肌血供的变化和新生毛细血管的增生情况。方法将24条实验犬随机分为缺血组（I组）、激光打孔组（L组）、大网膜移植组（O组）、激光打孔联合大网膜移植组（L＋O组）。3个月后再行^99m锝（Tc）心肌同位素灌注显像。然后处死，取心肌组织，观察各组新生毛细血管的增生情况。结果①L＋O组干预后同位素图像上感兴趣区（region of interest，ROI）比值（ROI比值=干预区ROI同位素计数／正常区ROI同位素计数）明显提高（P〈0．01），其增幅明显高于其他3组（P值均〈0．05）。L组干预后ROI比值明显高于干预前（P〈0．001），但其增幅与I组、O组的差异无显著性（P值均〉0．05）。I组、O组干预前、后ROI比值的差异无显著性（P值均〉0．05）。②高倍镜下，L＋O组和L组孔道区（孔道为中心0．5mm范围）的新生毛细血管数明显多于孔道周围区（离开孔道1个低倍视野以上，P〈0．01、0．05）。L＋O组与L组孔道区的差异无显著性（P〉0．05）。结论以TMLR联合大网膜移植较单一使用这两种方法能够更明显改善缺血心肌的灌注。Objective Transmyocardial laser revascularization combined with omentum graft was used for treatment of ischemic dog＇s myocardium and to observe the change of per＇fusion and hyperplasia of newly formed capillaries in the ischemic area was studied so as to explore a new method of treatment. Motheds Ischemic heart model was set up in 24 dogs, confirmed by 99mTc ECT examination. The experimental animals were divided into ischemic group （group I）, TMLR group （group L）, omentum graft group （group O）, TMLR＋omentum graft group （group L＋O） ; and were given different management. After 3 months, ^99mTc ECT was repeated in the Region of Interest （ROI）, and the isotope perfusion changes of the above groups were compared. After excution of the experimental animals, samples were taken for observation on hyperplasia of capillaries de vo. Results ①The ischemic area in group L＋O reduced obviously after the treatment （P 〈 0. 01）, the radioactivity count rate （RCR） of its ROI improved more than that in the other groups. L group＇s RCR after treatment improved only a little （P 〈 0. 001 ）, there was no difference between those of group I and O （P 〉 0.05, P 〉 0.05）. The RCRs in group I and O showed no difference before and after the treatment. ②Under low power microscopy, there were various degrees of hyperplasia of capillaries in the ischemic area of each group. Under high power microscopy（40 fold enlargement）, there were more hyperplastic capillaries in the central portion of the hole-area（a rounded area within a radius of 0.5 mm around the laser hole） than those in the peripheral portion in group L＋ O and group L （P 〈 0.01, 0.05） but with no statistical significance （P 〉0.05 ）. Conelnsion Transmyocardial laser revascularization combined with omentum graft can improve the myocardium perfusion in the ischemic heart more effectively than using either method alone.

关 键 词：激光心肌血运重建术 大网膜移植 感兴趣区 新生毛细血管 

分 类 号：R654.2[医药卫生—外科学] R651.2[医药卫生—临床医学]