Guo M K, Zhu J X, Han C M, Bao T, Yang D, Yu P, Duan Y F, Fan F L, Zhang H G, Tian H J
Orthopaedics Surgery, the 260th Hospital of PLA, Shijiazhuang 050041, China.
Zhonghua Yi Xue Za Zhi. 2017 Mar 7;97(9):703-708. doi: 10.3760/cma.j.issn.0376-2491.2017.09.015.
To investigate the effect of preventing perivascular adhesion with topical application of sodium hyaluronate on intimal hyperplasia of the vein grafts in rabbits. Twenty-four male New Zealand white rabbits, aged 5 months, were randomly divided into 2 groups: Group A and B (=12 rabbits per group). Artery defect model was established by cutting about 1 cm artery from the middle part of the dissociated left common carotid artery. A section about 3 cm was cut from the right external jugular vein, and the harvested vein was inverted and end-to-end anastomosed to the artery defect. After anastomosis, the adventitia and two anastomosis of the grafted veins in group A was applied 0.2 ml sodium hyaluronate locally to, and corresponding site in Group B was served as a control, but with the sterile normal saline. The grafted veins were obtained 1, 2 and 4 weeks after operation, HE staining and Masson staining were preformed for histological changes of grafted vein wall, proliferating cell nuclear antigen (PCNA) and platelet-derived growth factor (PDGF) immunohistochemistry staining were conducted for proliferation and expression and distribution of PDGF of the grafted vein. The macroscopic and histological observation showed that the perivascular adhesions in Group A were looser when compared with those in Group B. The thickness of the intima, the degree of intima hyperplasia of 2 groups at different time points were as follows: at 1 week after operation, group A[(25.5±3.9) μm, (1.2±0.1) ]and group B[(26.2±4.2)μm, (1.2±0.1)]; at 2 weeks after operation, group A[(44.3±2.5)μm, (1.2±0.1)]and group B[(51.0±3.8)μm, (1.4±0.0)]; at 4 weeks after operation, group A[(69.9±6.8)μm, (1.5±0.1)] and group B[(84.4±6.4)μm, (1.7±0.1)]. Group A was inferior to group B in terms of the above three parameters 2 and 4weeks after operation (<0.05). Cell proliferation index of intima and that of media were as follows: at 1 week after operation, group A (7.4±2.2), (21.5±3.2) and group B (11.5±2.0), (28.6±4.5); at 2 weeks, group A (20.0±3.2), (35.8±3.4) and group B (26.8±4.1), ( 42.6±4.2); at 4 weeks, group A (11.4±2.0), (22.1±2.7) and group B (15.5±2.4, 28.6±3.9). Group A was inferior to group B in terms of cell proliferation index of intima and media 1, 2 and 4 weeks after operation (<0.05). The percentage of PDGF-positive cells of intima, media and adventitia was as follows: at 1 week after operation, group A (7.7±1.6), (19.6±3.7), (2.5±1.5) and group B (7.6±2.4), (20.6±4.4), (10.3±2.3); at 2 weeks after operation, group A (11.4±2.6), (19.8±3.1), (12.9±3.3) and group B (19.5±3.5), ( 30.6±5.2), (30.5±5.8); at 4 weeks after operation, group A (6.2±1.9), ( 11.1±2.8), (10.2±2.4) and group B (10.5±2.0), (18.6±3.2), (26.5±3.8). Group A was inferior to group B in terms of the percentage of PDGF-positive cells of intima, media and adventitia 2 and 4 weeks after operation (<0.05) and Group A was inferior to group B that of adventitia 1 week after operation (<0.05). Preventing perivascular adhesion with topical application of sodium hyaluronate can inhibit intimal hyperplasia.
探讨局部应用透明质酸钠预防血管周围粘连对兔静脉移植物内膜增生的影响。选取24只5月龄雄性新西兰白兔,随机分为2组:A组和B组(每组12只)。于离断的左颈总动脉中部切断约1 cm动脉建立动脉缺损模型。从右颈外静脉截取约3 cm长的一段静脉,将获取的静脉倒置后与动脉缺损处行端端吻合。吻合后,A组对移植静脉的外膜及两处吻合口局部应用0.2 ml透明质酸钠,B组相应部位用无菌生理盐水作为对照。分别于术后1、2、4周获取移植静脉,行HE染色和Masson染色观察移植静脉壁的组织学变化,行增殖细胞核抗原(PCNA)和血小板源性生长因子(PDGF)免疫组化染色观察移植静脉的增殖情况及PDGF的表达和分布。大体及组织学观察显示,A组血管周围粘连较B组疏松。两组不同时间点内膜厚度、内膜增生程度如下:术后1周,A组[(25.5±3.9)μm,(1.2±0.1)],B组[(26.2±4.2)μm,(1.2±0.1)];术后2周,A组[(44.3±2.5)μm,(1.2±0.1)],B组[(51.0±3.8)μm,(1.4±0.0)];术后4周,A组[(69.9±6.8)μm,(1.5±0.1)],B组[(84.4±6.4)μm,(1.7±0.1)]。术后2周和4周,A组上述三项指标均低于B组(P<0.05)。内膜及中膜细胞增殖指数如下:术后1周,A组(7.4±2.2),(21.5±3.2),B组(11.5±2.0),(28.6±4.5);术后2周,A组(20.0±3.2),(35.8±3.4),B组(26.8±4.1),(42.6±4.2);术后4周,A组(11.4±2.0),(22.1±2.7),B组(15.5±2.4,28.6±3.9)。术后1、2、4周,A组内膜及中膜细胞增殖指数均低于B组(P<0.05)。内膜、中膜及外膜PDGF阳性细胞百分比如下:术后1周,A组(7.7±1.6),(19.6±3.7),(2.5±1.5),B组(7.6±2.4),(20.6±4.4),(10.3±2.3);术后2周,A组(11.4±2.6),(19.8±3.1),(12.9±3.3),B组(19.5±3.5),(30.6±5.2),(30.5±5.8);术后4周,A组(6.2±1.9),(11.1±2.8),(10.2±2.4),B组(10.5±2.0),(18.6±3.2),(26.5±3.8)。术后2周和4周,A组内膜、中膜及外膜PDGF阳性细胞百分比均低于B组(P<0.05),术后1周A组外膜PDGF阳性细胞百分比低于B组(P<0.05)。局部应用透明质酸钠预防血管周围粘连可抑制内膜增生。