山羊颈外静脉重建颈总动脉的组织学观察  

Reconstruction of the Common Carotid Artery with Autogenous External Jugular Vein Graft in Goats

作　　者：郑家伟[1] 邱蔚六[1] 张志愿[1] 竺涵光[1] 林国础[1] 

机构地区：[1]上海第二医科大学附属第九人民医院口腔医学院口腔颌面外科,上海200011

出　　处：《上海口腔医学》2001年第1期27-30,共4页Shanghai Journal of Stomatology

基　　金：卫生部科学研究基金!( 96 1 3 4 0 )

摘　　要：目的　观察山羊颈外静脉移植后不同时间的通畅率和组织病理学改变 ,初步了解移植失败的原因 ,为临床应用提供参考。方法　 3只健康成年山羊作为实验对象 ,以 2cm自体颈外静脉修复同等长度的颈总动脉手术缺损。3只动物的 6侧颈部随机分为A、B两组 ,各含 3条动、静脉。A组的近、远心端均为端 -端吻合术 ,B组的近心端为端 -侧吻合术 ,远心端为端 -端吻合术。术后 1周 ,以激光多普勒血流仪监测移植静脉的通畅情况 ,并择期行颈动脉造影术。术后 2周、3月和 6月切取标本 ,观察移植后不同时间的通畅率。标本经处理后 ,分别作光镜、透射电镜和扫描电镜检查。结果　A、B两组自体静脉于术后 2周、3月和 6月的通畅情况分别为 1/1,1/1;0 /1,1/1;0 /1,1/1,两组各有 1条静脉闭锁。χ2 检验表明 ,两组通畅率无显著差别 (χ2 =1.0 ,P =1.0 )。组织病理学检查显示 ,自体静脉移植后 ,呈现静脉动脉化改变。 2周时管壁疏松、水肿 ,内膜及内膜下增殖明显。 3月时 ,宿主动脉中膜平滑肌大量增生、移行 ,静脉壁内平滑肌增厚。 6月时静脉中膜“肌性化”。结论　静脉代替动脉后 ,主要组织病理学变化特征为内膜增殖和静脉动脉化。内膜增殖是宿主动脉平滑肌细胞增殖 ,通过吻合口迁移至静脉内膜并增殖的结果。Objective To establish a method for reconstruction of carotid artery defect with autogenous graft of external jugular vein, to investigate the patency rate and histopathologic changes at different times after implantation. Methods 3 healthy adult goats were used as the experimental models. A segment of 2 cm autogenous external jugular vein was used to bridge a surgical defect of the common carotid artery (2 cm long). The six necks of the three animals were divided into A and B group randomly. In Group A, both cut ends of the artery were anastomosed end to end with the venous graft. In Group B, the proximal end of the artery was anastomosed end to side with the venous graft. The patency rate was recorded at different times. The venous grafts with anastomotic sites were harvested at 2 weeks, 3 months and 6 months after implantation, respectively, for histopathologic examinations. Results The grafts in Group A were patent at 2 weeks and 3 months, but occluded at 6 months. The grafts in Group B were patent at 2 weeks and 6 months, but not patent at 3 months. Chi square test demonstrated insignificant difference in patency rate between Group A and Group B. Histopathologic examinations showed intimal hyperplasia and venous arterialization in venous autografts. The venous wall was loose and edematous, intimal and subintimal hyperplasia was prominent at 2 weeks. Proliferation and migration of smooth muscle cell was found at 3 months after implantation. At 6 months, the venous media was predominantly composed of smooth muscle. Intimal hyperplasia was most prominent adjacent to the anastomosis. Conclusions Reconstruction of the common carotid artery with autogenous graft of external jugular vein had a higher patency rate. The main histopathologic changes after implantation is intimal hyperplasia and venous arterialization. Intimal hyperplasia is the result of proliferation and migration of host arterial smooth muscle cell, which passes through the anastomosis to the intima of the vein graft. [

关 键 词：羊 颈总动脉 自体静脉移植物 重建 实验研究 

分 类 号：R654.4[医药卫生—外科学]