Wang Chuan, Xin Yi, Li Na, Li Diankun, Li Jingxing, Gu Chengxiong
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China.
Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, P.R. China.
Exp Ther Med. 2017 Jul;14(1):317-323. doi: 10.3892/etm.2017.4460. Epub 2017 May 17.
Effective therapies for preventing perioperative complications such as thrombosis and inflammation after coronary endarterectomy (CE) are lacking. Electrocoagulation electrotomes have been routinely used in surgery for their cutting, clotting, and hemostatic properties. As strong flattening tools, their electrocautery function may prevent mechanical intimal-adventitial injury to arterial circulation and attenuate stenosis. The present study investigated the effects of intravascular application of electrocautery on ameliorating inflammation and thrombosis in a rabbit model of abdominal aortic endarterectomy. New Zealand rabbits were randomly divided into the sham, control (endarterectomy), and study (endarterectomy + electrocautery) groups with 10 in each group. Abdominal aortas were partially blocked and intima was removed. Electrocautery was performed with an electrocoagulation electrotome through the entire blocked vessel lumen. Vascular ultrasound parameters, molecular biological and histological characteristics of the abdominal aorta including vascular diameter, blood flow velocity, serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels, and apoptosis rate of vascular endothelial cells (ECs) were evaluated postoperatively by vascular Doppler ultrasound, ELISA, real-time RT-PCR, flow cytometry, and immunofluorescence at various time points. Compared with the endarterectomy + electrocautery group, the isolated endarterectomy group had significantly increased levels and gene expression of TNF-α and IL-6 (P<0.05), and rates of apoptosis of vascular ECs (P<0.05), with gradual vascular stenosis and decreased blood flow velocity. In conclusion, intravascular application of electrocautery has favorable short-term effects on the abdominal aorta and can reduce inflammation in a rabbit model of abdominal aorta endarterectomy. Long-term anti-inflammatory and anti-thrombotic effects on arterial remodeling and the clinical value of electrocautery in CE remain to be determined.
目前缺乏有效的疗法来预防冠状动脉内膜切除术（CE）后诸如血栓形成和炎症等围手术期并发症。电凝手术刀因其切割、凝血和止血特性而在手术中被常规使用。作为强力的扁平工具，其电灼功能可能会防止对动脉循环造成机械性内膜-外膜损伤并减轻狭窄。本研究在兔腹主动脉内膜切除术模型中研究了血管内应用电灼对改善炎症和血栓形成的影响。将新西兰兔随机分为假手术组、对照组（内膜切除术）和研究组（内膜切除术+电灼），每组10只。对腹主动脉进行部分阻断并去除内膜。使用电凝手术刀对整个阻塞的血管腔进行电灼。术后在不同时间点通过血管多普勒超声、酶联免疫吸附测定（ELISA）、实时逆转录-聚合酶链反应（RT-PCR）、流式细胞术和免疫荧光评估腹主动脉的血管超声参数、分子生物学和组织学特征，包括血管直径、血流速度、血清白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平以及血管内皮细胞（EC）的凋亡率。与内膜切除术+电灼组相比，单纯内膜切除术组的TNF-α和IL-6水平及基因表达显著升高（P<0.05），血管EC的凋亡率显著升高（P<0.05），伴有血管逐渐狭窄和血流速度降低。总之，血管内应用电灼对兔腹主动脉具有良好的短期影响，并且可以在兔腹主动脉内膜切除术模型中减轻炎症。电灼对动脉重塑的长期抗炎和抗血栓作用以及在CE中的临床价值仍有待确定。
