微型血管夹吻合口内膜再生及生物力学研究

Microvascular anastomosis is crucial to free tissue transfer and replantation. The conventional microvascular anastomosis method is suturing, also being named "gold standard" microvascular anastomosis method. However, the suturing anastomosis has some defects. For example, the procedure is technically difficult and time_consumed; it leads to serious damage to vessel wall, especially to the intima; suture material exposes into the vessel lumen, which would cause thrombocyte gathering and thrombogenesis. We attempt to seek an ideal microvascular anastomosis method. Arteries and veins were anastomosed with anastomosis microclips in animal models (160 rabbits and 30 dogs). For comparative experimental study, one side of the vessel was anastomosed with clips, the other side was anastomosed with suturing. TA(time for anastomosis) and patency rate were statistically studied. By using light microscopy, scanning electron microscopy, biodynamic method and Ultrasonic Doppler technique, the endothelial cells regeneration, biodynamic changes and hemodynamic indexes of the anastonosed vessels were studied. The results shows:⑴ The patency of microclip method is better than that with suturing. ⑵TA of the microvascular anastomosis with microclips is less than that with suturing. ⑶ The histological results indicate that vessel wall healing of the anastomosis with microclips is better than that with suturing. The endothelial cells regenerate earlier, and the intima is smoother.⑷ The average maximal stretch breading force with microclips is stronger than that with suturing. ⑸ The hemodynamic consequences with microclips are better than that with suturing. Conclusion: The advance nonpenetrating technique with microclips is rapid, safe and reliable microvascular anastomosis method. Our study supplied an experimental method for improving microvascular anastomosis. This method has practical value clinically.

与传统针线吻合法相关比，微型血管夹的吻合作用点在血管外膜，方法简单迅速，血管内膜无损伤，管腔内异物，减少了吻合口血栓形成因素。课题将利用动物模型，对血管吻合口的内皮细胞再生、生物力学及血流动力变化行研究，从而阐明微型血管吻合夹提高血流通畅率的作用机理，为显微外科提供更加理想的血管吻合方法及其理论依据。