时间与缺血程度对皮瓣延迟效果的影响探讨  

Impact of extent of ischemia and length of delay on the efficacy of flap delay surgery

作　　者：陈绍锋 荆幸 方芳[2] 范莹娟[2] 庄跃宏[1] Chen Shaofeng;Jing Xing;Fang Fang;Fan Yingjuan;You Xiuhua;Zhuang Yuehong(Department of Human Anatomy and Institute of Clinical Applied Anatomy,School of Basic Medicine,Fuzhou 350122,China;Experimental Center,School of Pharmacy,Fujian Medical University,Fuzhou 350122,China)

机构地区：[1]福建省高校脑老化与神经变性疾病重点实验室,福建医科大学基础医学院人体解剖学系,临床应用解剖学研究所,福州350122 [2]福建医科大学药学院实验中心,福州350122

出　　处：《中国临床解剖学杂志》2022年第4期447-453,共7页Chinese Journal of Clinical Anatomy

基　　金：福建省自然科学基金(2020J01625,2021J01666)。

摘　　要：目的探讨不同时长及缺血程度的延迟术式对皮瓣存活的影响。方法125只成年ICR小鼠随机等分为5组。对照组切取以髂腰血管为蒂的4.5 cm×1.5 cm皮瓣。4个延迟组按照延迟时间与切断胸背动脉尾侧支与否分为留血管7 d组与14 d组及切血管7 d与14 d组。在延迟结束后,建立与对照组同样的皮瓣模型。之后,计算皮瓣的坏死率,并用激光散斑衬比成像仪测量皮瓣的动脉管径及血流灌注、以及利用CD31抗体标示皮瓣内的血管。利用单因素方差分析对各组数据进行统计学比较。结果术后7 d各延迟组的皮瓣坏死率均小于对照组(P<0.001)。4个延迟组蒂部与choke动脉管径及灌注强度都显著大于对照组(P<0.05)。两切血管组皮瓣存活率、蒂部与choke动脉管径、血流灌注强度均显著大于两留血管组(P<0.05);延迟7 d组之间与延迟14 d组之间各项指标的差异没有统计学意义(P>0.05)。术后0 d,4组延迟皮瓣的血管密度显著大于对照组(P<0.001),但术后7 d各组皮瓣的血管密度没有统计学差异(P=0.883)。结论延迟只需要7 d便能达到最佳效果。此外,延迟期间应尽量使皮瓣处于缺血最严重但不致组织坏死的状态。Objective To investigate the effect of delayed surgery with different length and various degrees of ischemia on flap survival.Methods 125 adult ICR mice were randomly divided into 5 groups.In the control group,flaps based on iliolumbar vessels with a size of 4.5 cm×1.5 cm were established.The four delayed groups were divided into vessels-preserved 1-and 2-week delay groups and vessels-transected 1-and 2-week delay groups.After the delay,the same flap model as the control group was established.Then,the necrosis rate of the flap was calculated,the arterial diameter and blood perfusion of the flap were measured by a laser speckle imaging device,and the blood vessels in the flap were marked by a CD31 antibody.The data of each group were statistically compared by one-way ANOVA.Results 7 days after operation,the flap necrosis rate in each delayed group was lower than that in the control group(P<0.001).The diameter and perfusion intensity of the pedicle and the choke area in the four delayed groups were significantly higher than those in the control group(P<0.05).The survival rate of the flap,the diameter of the pedicle and choke arteries,and the blood perfusion intensity in the two vessels-transected groups were significantly higher than those in the two vessels-preserved groups(P<0.05);There was no significant difference in the various parameters between the 1-week delay group and the 2-week delay group(P>0.05).At 0 days after surgery,the vascular density in the four delayed groups was significantly higher than that in the control group(P<0.001),but there was no significant difference at 7 days after surgery(P=0.883).Conclusion The best efficacy can be achieved by delaying only one week.In addition,during the delay period,the flap should be in the state of the most serious ischemia without tissue necrosis.

关 键 词：延迟皮瓣 choke血管 激光散斑 血流动力学 

分 类 号：R322-33[医药卫生—人体解剖和组织胚胎学] R616.2[医药卫生—基础医学]