Chignier E, Eloy R
Surg Gynecol Obstet. 1986 Oct;163(4):327-34.
While adventitial resection is a part of the preparation of microvessels for operation, the procedure may provoke damage to the vessel wall. The histologic and ultrastructural endothelial lesions associated with adventitial resection, the interface of the blood vessel and the course of endothelial repair are discussed herein. The adventitia of the abdominal aorta of rats was stripped under microscopic magnification (32X) around the whole circumference of infrarenal segment of 1 centimeter in length. The rats were sequentially sacrificed. Fixation and silver staining were carried out in vivo. The specimens were collected at six, 12 and 24 hours, at seven, 15, 30 and 90 days, and at six, nine and 12 months after injury. These specimens were studied by en face light microscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The results of en face light microscopy and SEM investigations showed: an initial severe trauma of the endothelial surface leading to complete de-endothelial areas as early as six hours after injury, the lesions were limited to the adventitial resected areas; at seven days the polygonal cells were recognized in silver stain preparation; at 30 days the endothelial surface was partially reconstituted but cells had large protoplasmic areas, TEM in the same time period confirm the absence of the endothelial cells up to 30 days; at 90 days the reconstitution of the endothelial layer was almost complete, and intimal hyperplasia was observed already at one month and appeared to have stabilized at six months postoperatively with three to four cell layers. These results suggest that: adventitial resection immediately provokes endothelial desquamation; endothelialization is a slow process when large areas are involved, and intimal hyperplasia may develop even on an autologous arterial segment, thus providing new insight to the etiopathogeny of vascular graft initial hyperplastic reactions.
虽然外膜切除术是微血管手术准备工作的一部分，但该手术可能会对血管壁造成损伤。本文讨论了与外膜切除术相关的组织学和超微结构内皮损伤、血管界面以及内皮修复过程。在显微镜放大（32倍）下，将大鼠腹主动脉肾下段1厘米长的整个圆周外膜剥离。依次处死大鼠，在体内进行固定和银染色。在损伤后6小时、12小时和24小时、7天、15天、30天和90天以及6个月、9个月和12个月采集标本。通过表面光镜、扫描电子显微镜（SEM）和透射电子显微镜（TEM）对这些标本进行研究。表面光镜和SEM研究结果显示：内皮表面最初受到严重创伤，损伤后6小时最早出现完全内皮剥脱区域，病变局限于外膜切除区域；7天时在银染色标本中可识别出多边形细胞；30天时内皮表面部分重建，但细胞有大的原生质区域，同一时期的TEM证实直至30天内皮细胞均不存在；90天时内皮层重建几乎完成，内膜增生在术后1个月已观察到，术后6个月似乎已稳定，有三到四层细胞。这些结果表明：外膜切除术立即引发内皮剥脱；当涉及大面积时，内皮化是一个缓慢的过程，即使在自体动脉段也可能发生内膜增生，从而为血管移植物初始增生反应的病因学提供了新的见解。
