不同解剖形态猪胸主动脉夹层模型的构建及组织病理学分析  

Histopathological analysis of new porcine thoracic aortic dissection models with different morphologies

作　　者：郭宝磊 符伟国 郭大乔 董智慧 赵子龙 冯西桥[3] Guo Baolei;Fu Weiguo;Guo Daqiao;Dong Zhihui;Zhao Zilong;Feng Xiqiao(Department of Vascular Surgery,Zhongshan Hospital,Fudan University National Clinical Research Center for Interventional Medicine,Shanghai 200032,China;School of Aeronautic Science and Engineering in Beihang University,Beijing 100191,China;School of Aerospace Engineering of Tsinghua University,Beijing 100190,China)

机构地区：[1]复旦大学附属中山医院血管外科,复旦大学血管外科研究所,国家放射与治疗临床医学研究中心,上海200032 [2]北京航天航空大学航空科学与工程学院,100191 [3]清华大学航天航空学院,北京100190

出　　处：《中华实验外科杂志》2022年第5期830-833,共4页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金项目(82000436);上海市科学技术委员会"科技创新行动计划"项目(201409004800、21410710500);上海市卫生健康委员会卫生行业临床研究项目(20214Y0274);上海浦东复旦大学张江科技研究院临床医学创新基金项目(KP7202116)。

摘　　要：目的建立具有不同解剖形态的猪胸主动脉夹层(TAD)模型,并基于该模型对夹层进行组织病理学分析。方法在单发破口猪TAD模型基础上,通过经颈动脉入路联合介入微创的技术在全麻下构建2种具有不同解剖形态的猪TAD模型,分别为TAD假腔扩展模型(6例)和TAD继发破口再塑模型(6例)。建模前后分别通过血管造影对正常或夹层管壁进行评估,术后通过CT血管造影和血管内超声随访夹层进展和继发破口情况,随访3个月时对管壁进行组织病理学分析。计量资料以均数±标准差(±s)或中位数及四分位间距表示,计数资料采用例数和百分数表示。结果假腔扩展模型组建模成功率为83.3%(5/6),手术操作时间为(30.3±8.7)min,术中造影假腔扩展平均长度为(223.2±79.5)mm。TAD继发破口再塑模型组建模成功率为100%,手术操作时间为(36.4±8.8)min,术中造影联合血管内超声测量继发破口平均直径为(7.2±1.1)mm。随访期3个月,两种再塑模型动物均无死亡。组织病理学检测提示滋养血管在升主动脉和主动脉弓更丰富,主要集中于外膜和中膜靠近外膜部分。弹力纤维染色提示TAD撕裂处弹力纤维破碎、断裂,假腔外侧壁(中膜外层及外膜)弹力纤维被过度拉伸,呈线状分布,内侧壁弹力纤维仍呈波浪状排列。TAD未累及分支处可见靠近内膜层弹力纤维逐渐聚集终止,靠近外膜层弹力纤维延伸至分支内。结论本研究提供了一种成功率高、可复制性强、具有不同解剖形态的TAD模型,可作为新型腔内器具临床前实验或有效性验证等研究的动物模型选择。Objective To construct porcine thoracic aortic dissection(TAD)models with different anatomical morphologies,and to analyze the histopathological characteristics based on these models.Methods On the basis of the single tear porcine TAD model,two types of porcine TAD models with different anatomical morphologies were constructed under general anesthesia through the carotid artery approach combined with endovascular technique.A total of 6 cases were created in the TAD false lumen propagation model,and 6 cases in the TAD secondary tear remodeling model.Before and after modeling,the normal and dissecting aortic walls were evaluated by angiography.The dissection progression and secondary tear were followed up by computed tomography angiography(CTA)and intravascular ultrasound(IVUS)after operation.Histopathology of aortic wall was analyzed at 3rd month during the follow-up period.Results In the false lumen propagation model group,the modeling success rate was 83.3%(5/6).The average operation time was(30.3±8.7)min,and the average length of false lumen propagation was(223.2±79.5)mm.The modeling success rate was 100%in secondary tear remodeling model.The average operation time was(36.4±8.8)min,and the average diameter of the secondary tear measured by CTA combined with IVUS was(7.2±1.1)mm.At 3rd month during the follow-up period,there was no death in the two groups.Histopathological examination showed that the vasa vasorum was more abundant in the ascending aorta and aortic arch,mainly in the adventitia and media near the adventitia.EVG staining of elastic fibers(EFs)indicated that the elastic fibers were broken at the dissected tear,and the EFs in the lateral wall of the false lumen(the outer layer of the media and adventitia)were overstretched and distributed linearly.However,the EFs in the inner wall were still arranged in waves.In the uninvolved branch of TAD,the EFs near the intimal layer gradually gathered and terminated,and the EFs near the adventitia layer extended into the branch.Conclusion This study provides

关 键 词：主动脉夹层 猪 病理特征 

分 类 号：R654.3[医药卫生—外科学]