家兔逆行隐动脉皮瓣中静脉干对静脉回流影响的实验研究  

Effect of vein trunks on venous drainage in saphenous reverse-flow island flap:an experimental study of rabbit

作　　者：张申申[1] 王磊[1] 赵维彦[1] 李炳万[1] 李大村[1] 

机构地区：[1]福建医科大学教学医院宁德市闽东医院十五病区,福建福安355000

出　　处：《实用手外科杂志》2008年第1期33-35,F0003,共4页Journal of Practical Hand Surgery

摘　　要：目的通过活体动物实验模型,研究家兔逆行岛状皮瓣中静脉干对皮瓣静脉回流的影响。方法利用家兔隐动静脉模型做成逆行岛状皮瓣的实验模型,实验分为3组:A组静脉干组(皮瓣蒂远端结扎静脉干);B组无静脉干组(皮瓣近端、远端结扎静脉干);C组静脉干+表面渗出组(皮瓣远端结扎静脉),在皮瓣表面作切口引流。观察初始、术后各个时间段静脉干对皮瓣静脉回流的影响。观察指标:皮瓣大体观察;静脉压力测定;血管口径、血流情况观察;组织学检查。结果静脉压测定:A,B,C组皮瓣术后静脉压力均较术前升高(P<0.05);A,B组皮瓣的静脉压在术后各时间点的差异有统计学意义(P<0.05),C组与A组无明显差异。微循环观测:三组皮瓣蒂部静脉干的血管口径在术后均有不同程度扩张,B组管径扩张程度较A,C组明显,A,C组血管管径至术后7d时接近术前水平;但B组仍高于初始水平。A,C组皮瓣蒂部静脉干开始血流方向由皮瓣蒂部向皮瓣远端流动,而后血流速度减慢;自术后2h,皮瓣内血液开始直接通过静脉干向皮瓣蒂部逆流。B组皮瓣蒂部静脉干未见静脉中有血液流动。术后12d观察,B组皮瓣中可见新生小血管,皮瓣成活率最低。结论静脉干对逆行岛状皮瓣的静脉回流起促进作用;静脉瓣膜失效机制在逆行岛状皮瓣静脉回流过程中起主要作用;单纯依靠迷宫式回流不能保证皮瓣静脉充分回流;增加皮瓣表面渗出在皮瓣静脉回流中未见明显作用。Objective To establish living animal experiment model, and to study the effect of vein trunk on venous drainage in reverse-flow island flap on rabbit. Methods The saphenous flap of rabbit was made the test model of reverse-flow island flap.The experiments were divided into three groups.：group A had vein trunk; group B, did not have vein trunk; group C, had vein trunk and made incisions on the surface of flap to drain. Observation index： Generally observation of flap; mensuration of vein pressure; caliber of vas; blood stream status; histology inspection.Results Mensuration of vein pressure： Intravenous tension in group A,B,C increase significantly after operation （P〈0.05）. Postoperative tension of Group A and B have statistical significance （P〈0.05）. Observation of microcirculation：The vessel caliber of vein trunks in flap pedicel distended in differentdegree after operation in three groups. The vessel caliber of vein trunks in A,C groups reach the preoperative level in 7 days. At the beginning, vein trunks in A,C groups flaps pedicel, blood flow direction from flap pedicel to flap distal end, the rate of blood flow step down. 2 hours later, blood flow in flap begine counter-flow directly; in B group flaps pedicel can not see hemokinesis.Conclusion Superficial vein can accelerate venous drainage in reverse-flow island flap.Incompetent values route is the main way in the course of venous reverse flow about vein trunk in reverse-flow island flap; only depend on communicationg and coUaterall by pass route can not ensure the venous return thoroughly.Increase the exsudation on flap surface can not see obviously effect in reverse-flow course.

关 键 词：逆行岛状皮瓣 静脉回流 静脉干 静脉压 血管口径 血流速度 

分 类 号：R622[医药卫生—整形外科]