Friedrich R E, Plambeck K, Bartel-Friedrich S, Hellner D, Schmelzle R
Klinik für Mund-, Kiefer- und Gesichtschirurgie, Nordwestdeutsche Kieferklinik, Universitätskrankenhaus Eppendorf, Universität Hamburg.
Unfallchirurgie. 1997 Feb;23(1):1-9.
The objective of our investigation was to study the patency rates of anastomoses in arteries, damaged by a balloon dilatation, in a training model of microvascular surgery. In general anaesthesia, a balloon dilatation was repeated 5 times in 31 left common carotid arteries of female Wistar rats (body weight: 250 to 350 g). A common carotid artery autograft of 4 mm was harvested 1 minute after reflow, turned 180 degrees, and reinserted into the artery. The reflow of the vessels was investigated by micro-Doppler ultrasound equipment. Autografts without balloon dilatation or any other intended damage were performed in further 26 common carotid arteries. In addition, in further 14 common carotid arteries the balloon dilatation was the sole damage. The vessels were harvested and investigated postoperatively after perfusion with 3% glutaraldehyde at 1 day, 7 days, and 1 month. The balloon dilatation in no instance caused an occlusion of the vessel as judged by the micro-Doppler ultrasound. One vessel was found to be occluded after reflow was allowed following insertion of the autograft in the group without balloon dilatation. However, this vessel proved to be patent after explantation (patency rate: 100%). In the group with balloon dilatation preceding the autograft insertion, by micro-Doppler ultrasound, 16 vessels were occluded and 14 were patent. At different times of follow-up, in this group the summarized patency rates were 50%. The patency differences in both groups with autografts proved to be significant, both after micro-Doppler imaging and by histological evaluation (p < 0.001). For clinical use the balloon dilatation is recommended to remove a thrombus or to dilate a spastic vessel segment in anastomized vessels threatening the success of microvascular flaps. In this training model of microvascular surgery we demonstrated the thrombogenic effect of balloon dilatation.
我们研究的目的是在微血管手术训练模型中，研究球囊扩张损伤后动脉吻合口的通畅率。在全身麻醉下，对31只雌性Wistar大鼠（体重：250至350克）的左颈总动脉进行5次球囊扩张。在恢复血流1分钟后，采集4毫米的颈总动脉自体移植物，旋转180度，然后重新插入动脉。通过微型多普勒超声设备研究血管的血流恢复情况。另外26条颈总动脉进行了无球囊扩张或任何其他有意损伤的自体移植。此外，在另外14条颈总动脉中，球囊扩张是唯一的损伤。术后在1天、7天和1个月时用3%戊二醛灌注后采集血管并进行研究。根据微型多普勒超声判断，球囊扩张在任何情况下都未导致血管闭塞。在无球囊扩张组中，有1只血管在植入自体移植物后恢复血流时被发现闭塞。然而，该血管在取出后被证明是通畅的（通畅率：100%）。在自体移植物植入前进行球囊扩张的组中，通过微型多普勒超声检查，16条血管闭塞，14条通畅。在不同的随访时间，该组的总通畅率为50%。通过微型多普勒成像和组织学评估，两组自体移植物的通畅率差异均具有统计学意义（p<0.001）。对于临床应用，建议使用球囊扩张来清除血栓或扩张吻合血管中可能威胁微血管皮瓣成功的痉挛血管段。在这个微血管手术训练模型中，我们证明了球囊扩张的致血栓形成作用。
