实验性静脉撕脱伤的形态变化和闭塞率_医学论文.docVIP

实验性静脉撕脱伤的形态变化和闭塞率_医学论文 实验性静脉撕脱伤的形态变化和闭塞率_医学论文 作者：潘宝华　李荟元　鲁开化　矶贝典孝　上石弘 【关键词】 静脉/损伤 　　关键词: 静脉/损伤血管内膜闭塞率 　　摘 要:目的 观察在牵拉性撕脱损伤时静脉内腔的形态变化和闭塞率. 方法 建立大白鼠静脉牵拉性撕脱伤的模型，分别给予0.6，0.7，0.8和0.9N的牵拉力，灌流后用光镜、扫描电镜观察血管内腔的变化. 结果 静脉被延长到110%，膨隆与狭窄交错发生静脉切断的拉力为（1.093±0.064）N在未被拉断的静脉中，部分静脉广泛性血栓形成、血流停滞，发生血管闭塞.镜下观察发现内皮细胞剥离或缺损，可分为:①内膜隆起裂痕型②散在性内膜剥离型③广泛性内膜缺损等三个类型.牵拉损伤的静脉切断后原位显微吻合的成功率为70%. 结论 损伤静脉有特征性的内膜变化，从内膜隆起、广泛性内膜剥离到内膜缺损，可导致血栓形成，影响血管吻合的成功率. 　　Keywords:veins/injurytunica intimaocclusion rate 　　Abstract:AIM To investigate the morphological changes and occlusion rate of veins in the avulsion injury.METHODS Avulsion injury was induced by applying a vertical traction on rat femoral veins.Following perfusion，the pathological　changes in luminal surface were examined by light microscopy and scanning electron microscopy when applying force was0.6N，0.7N，0.8N and0.9N，respectively.RESULTS All veins were stretched by110%，accompanied by local di-latation and constriction occurred alternately.A complete rupture of the vein was produced when traction force was（1.093±0.064）N.In minority of stretched but unruptured veins，extensive thrombus formation followed by venous oc-clusion was observed.Morphological examination of the lu-minal surface showed that endothelium denudation or missing occurred.According to the extent of endothelium damage，three distinct types could be classified:intima lift off，de-nudation of intima scattered，extensive missing of intima.The success rate of replanted avulsion amputation was70%.CONCLUSION Characteristic appearance presented in inti-ma of avulsion injury vein，which is likely sites of thrombus formation，may lead to failure of replanted avulsion amputa-tion subsequently. 　　0 引言 　　提高血管吻合术后开放率是显微外科领域一个重要问题，特别是直径1mm左右的微小血管需要行显微外科吻合时尤其重要.近年来随着显微外科技术的迅速发展，断指再植的适应范围相应扩大，许多有严重牵拉损伤的病例也救治成功.但比起其他的损伤因素所致的断指来说，有牵拉性撕脱损伤的病例其再植成功率相对要低［1］ .动脉血栓的发生率，在牵拉损伤时明显高于其他损伤机制［2］ .牵拉性撕脱伤对动脉内膜损伤的变化研究报告很多，但关于静脉的形态变化资料较少.为此我们利用血管损伤模型，通过扫描电镜观察损伤静脉的形态变化，为显微外科临床提供理论依据. 　　1 材料和方法 　　1.1 材料 8周龄的Wista