并行带瓣双静脉自体移植的实验研究
摘要
目的：探索并行带瓣双静脉自体移植动物模型的建立方法，并对并行带瓣双静脉自体移植进行可行性研究，为下肢慢性静脉功能不全的患者的深静脉瓣膜重建寻求新的手术方法，并为其奠定实验和理论基础。
方法：新西兰兔24只，体重2.0－2.5公斤，雌雄各半。随机分实验组和对照组。将实验组兔的单侧带有静脉瓣膜的颈内、外静脉连同颈总静脉的“Y”字形血管切取下来，在体外将其远心端对侧缘剖开并吻合成“岛状”的并行带瓣双静脉，然后将其移植到自体的下腔静脉肾下段。对照组在体外将颈内、外静脉的对侧缘完全剖开并吻合成具有共同通道的1条血管，其余手术操作同实验组。术后观察4周，术后第1天、第1、2、4周行动态彩色多谱勒检测，若术后1天内血管阻塞，考虑系手术操作所致，不记入统计处理。术后4周行股静脉插管造影检查，并解剖标本，行病理及超微结构研究。
结果：实验组和对照组24只新西兰兔手术模型一次性成功建立，手术1天后，兔后肢功能全部恢复正常。术后1天、1、2周彩色多谱勒检查显示，通畅率100％，术后4周，彩色多谱勒及股静脉插管静脉造影检查显示，实验组和对照组组各有一例移植段血管阻塞，解剖证
实系腹膜粘连压迫所致，无血栓形成。实验组和对照组术后4周通常率无显著差别（P＞0.05）。动态彩色多谱勒检查显示，手术1天以后，血管管径及血流状态基本保持正常和恒定。病理及超微结构研究显示，移植段静脉内膜完整，无损伤及附壁血栓的形成。静脉壁弹力纤维染色图像分析显示，两分支血管管壁厚度和颈总静脉段及下腔静脉段管壁厚度有显著差别（P＜0.01），但表现为各层成比例增加，考虑系两分支静脉的横截面积之和大于下腔静脉的横截面积，导致分支静脉收缩所致。
结论：本实验发现兔颈内、外静脉各存在一对恒定的瓣膜，并成功建立了并行带瓣双静脉自体移植的动物模型，初步证实了并行带瓣双静脉自体移植的可行性，使之可能成为临床上慢性下肢深静脉功能不全中静脉瓣膜重建的一种可行且很有希望的一种手术方法。
Objective To establish the animal model of autogeneic graft of parallel bi-vein with valves and study the feasibility of the transplantation and seek a new surgical method for venous valve reconstruction in patients with chronic venous insufficiency. To search for the experimental and theoretical foundation for the clinical application of the new technique.
Methods 24 New Zealand rabbits were divided into experiment group and control group randomly. The parallel bi-vein with valves autogeneic graft animal model was established in experiment group and the vein which was incorporated with external and internal jugular vein autogeneic graft in control group by microsurgery. The hemorheologic and hemodynamic changes were examined by real time Color-duplex scanning and phlebography. The transplanted vascular segments were perfusion-fixed in situ and dissected, then observed by light microscope
and scanning electron microscope 4 weeks postoperatively.
Results The animal models of autogeneic graft was established successfully in all the 24 rabbits. One was died of intraabdominal hemorrhage in control group 12 hours postoperatively because of the over dose of heparin during operation. Only 1 rabbit per group was obstructed in the 4 weeks because of the compression of the adhering zone of peritoneum, which was confirmed by anatomy. And the rest remained patency which kept favorable configuration and steady blood stream with laminar flow and the results observed by light microscope and scanning electron microscope revealed that there was no injury of endomembrane and no thrombosis in the transplanted fragment.
Conclusion The autogeneic graft of parallel bi-vein with valves by microsurgery may be a feasible and promising technique of deep venous reconstruction for patients with chronic venous insufficiency.
方法：新西兰兔24只，体重2.0－2.5公斤，雌雄各半。随机分实验组和对照组。将实验组兔的单侧带有静脉瓣膜的颈内、外静脉连同颈总静脉的“Y”字形血管切取下来，在体外将其远心端对侧缘剖开并吻合成“岛状”的并行带瓣双静脉，然后将其移植到自体的下腔静脉肾下段。对照组在体外将颈内、外静脉的对侧缘完全剖开并吻合成具有共同通道的1条血管，其余手术操作同实验组。术后观察4周，术后第1天、第1、2、4周行动态彩色多谱勒检测，若术后1天内血管阻塞，考虑系手术操作所致，不记入统计处理。术后4周行股静脉插管造影检查，并解剖标本，行病理及超微结构研究。
结果：实验组和对照组24只新西兰兔手术模型一次性成功建立，手术1天后，兔后肢功能全部恢复正常。术后1天、1、2周彩色多谱勒检查显示，通畅率100％，术后4周，彩色多谱勒及股静脉插管静脉造影检查显示，实验组和对照组组各有一例移植段血管阻塞，解剖证
实系腹膜粘连压迫所致，无血栓形成。实验组和对照组术后4周通常率无显著差别（P＞0.05）。动态彩色多谱勒检查显示，手术1天以后，血管管径及血流状态基本保持正常和恒定。病理及超微结构研究显示，移植段静脉内膜完整，无损伤及附壁血栓的形成。静脉壁弹力纤维染色图像分析显示，两分支血管管壁厚度和颈总静脉段及下腔静脉段管壁厚度有显著差别（P＜0.01），但表现为各层成比例增加，考虑系两分支静脉的横截面积之和大于下腔静脉的横截面积，导致分支静脉收缩所致。
结论：本实验发现兔颈内、外静脉各存在一对恒定的瓣膜，并成功建立了并行带瓣双静脉自体移植的动物模型，初步证实了并行带瓣双静脉自体移植的可行性，使之可能成为临床上慢性下肢深静脉功能不全中静脉瓣膜重建的一种可行且很有希望的一种手术方法。
Objective To establish the animal model of autogeneic graft of parallel bi-vein with valves and study the feasibility of the transplantation and seek a new surgical method for venous valve reconstruction in patients with chronic venous insufficiency. To search for the experimental and theoretical foundation for the clinical application of the new technique.
Methods 24 New Zealand rabbits were divided into experiment group and control group randomly. The parallel bi-vein with valves autogeneic graft animal model was established in experiment group and the vein which was incorporated with external and internal jugular vein autogeneic graft in control group by microsurgery. The hemorheologic and hemodynamic changes were examined by real time Color-duplex scanning and phlebography. The transplanted vascular segments were perfusion-fixed in situ and dissected, then observed by light microscope
and scanning electron microscope 4 weeks postoperatively.
Results The animal models of autogeneic graft was established successfully in all the 24 rabbits. One was died of intraabdominal hemorrhage in control group 12 hours postoperatively because of the over dose of heparin during operation. Only 1 rabbit per group was obstructed in the 4 weeks because of the compression of the adhering zone of peritoneum, which was confirmed by anatomy. And the rest remained patency which kept favorable configuration and steady blood stream with laminar flow and the results observed by light microscope and scanning electron microscope revealed that there was no injury of endomembrane and no thrombosis in the transplanted fragment.
Conclusion The autogeneic graft of parallel bi-vein with valves by microsurgery may be a feasible and promising technique of deep venous reconstruction for patients with chronic venous insufficiency.
引文
Mayberry JC, Moneta GL, Taylor LM, et al. Fifteen-year results of ambulatory compression therapy for chronic venous ulcers. 1991, 109(5): 575-81.
Tawes RL, Barron ML, Coello AA, et al. Optimal therapy for advanced chronic venous insufficiency. Vasc Surg, 2003, 38(2): 411.
Kistner RL. Surgical repair of the incompetent femoral vein valve. Arch Surg, 1975, 110(11): 1336-42.
Taheri SA, Lazar L, Elias SM, et al. Vein valve transplant. Surgery, 1982, 91(1): 28-33.
Becker CD. Haemogregarina baueri nom. n., a replacement for H. cotti Bauer, 1948 (Coccidia: Adeleina), preoccupied. J Parasitol, 1968, 54(1): 167.
Kistner RL. Primary venous valve incompetence of the leg. Am J Surg, 1980, 140(8): 218.
Kistner RL, Sparleuhl MD. Surgery in acute and chronic venous diseases. Surgery, 1979, 85(1): 31.
Raju S, Fredericks R: Valve reconstruction procedures for nonobstructive venous insufficiency: Rationale, techniques, and results in 107 procedures with two- to eight-year follow-up. Vasc Surg, 1988, 7: 301-310.
Tawes RL, Barron ML, Coello AA, et al. Optimal therapy for advanced chronic venous insufficiency. Vasc Surg, 2003, 2:411.
Iafrati M, O'Donnell TF. Surgical reconstruction for deep venous insufficiency. Mal Vasc, 1997, 22(3):193-7.
10 Carrel A, Guthrie CC. Anastomosis of blood vessels by the patching method and transplantation of the kidney. 1906 [classical article]. Yale J Biol Med, 2001, 74(4): 243-7.
11 Eiseman B, Malette W. An operative technique for the construction of venous
valves. Surg Gynecol Obstet, 1953, 97(6): 731-4.
Kistner RL. Surgical repair of the incompetence of femoral vein valve. Arch Surg, 1975, 110(6): 1336.
Psathakis N. A new rational operative treatment for the insufficiency syndrome of the deep of the lower extremity. Vasc Dis, 1964, 84: 261-6.
Gloviczki P, Merrell SW, Bower TC. Femoral vein valve repair under direct vision without venotomy: a modified technique with use of angioscopy. J Vasc Surg, 1991, 14(5): 645-8.
Queral LA, Whitehouse WM Jr, Flinn WR, et al. Surgical correction of chronic deep venous insufficiency by valvular transposition. Surgery, 1980, 87(6): 688-95.
Psathakis N. Has the "substitute valve" at the popliteal vein solved the problem of venous insufficiency of the lower extremity. J Cardiovasc Surg (Torino), 1968 , 9(1): 64-70.
Raju S, Hardy JD. Technical options in venous valve reconstruction. Am J Surg, 1997, 173:301.
Gruss JD. Reconstructive venous valve surgery. Zentralbl Chir, 2001 Jun, 126(6): 461-5.
孙建明. 下肢深静脉瓣膜的解剖和组织学观察及临床意义. 中华实验外科杂志，1989，6（1）：1.
孙建民. 自体带瓣静脉段股浅静脉移植的实验研究与临床应用. 中华外科杂志，1988，10：628－630.
张柏根，张纪蔚，邝耀麟等. 静脉壁环缝缩窄术治疗股静脉瓣膜关闭不全. 中华外科杂志，1986，24（10）：600.
Belcaro G, Nicolaides AN, Ricci A, et al. External femoral vein valvuloplasty with limited anterior placation (LAP). Angiology, 1999, 50(7): 531.
Bush HL Jr、Nabseth DC. Autogenous venous valve transplantation in the dog. J Surg Res, 1982, 32(4): 313-21.
Rosenbloom M S, Schuler J J, chief editor. Journal of vascular surgery - official
publication, the Society for Vascular Surgery and International Society for Cardiovascular Surgery. United States, North American Chapter, 1988 . 7(5): 642-6.
Hasaniya NW. Phlebology, United Kingdom. 2002 , 16/4: 142-144.
Tawes RL, Barron ML, Coello AA, et al. Optimal therapy for advanced chronic venous insufficiency. Vasc Surg, 2003, 38(2): 411.
Kistner RL. Surgical repair of the incompetent femoral vein valve. Arch Surg, 1975, 110(11): 1336-42.
Taheri SA, Lazar L, Elias SM, et al. Vein valve transplant. Surgery, 1982, 91(1): 28-33.
Becker CD. Haemogregarina baueri nom. n., a replacement for H. cotti Bauer, 1948 (Coccidia: Adeleina), preoccupied. J Parasitol, 1968, 54(1): 167.
Kistner RL. Primary venous valve incompetence of the leg. Am J Surg, 1980, 140(8): 218.
Kistner RL, Sparleuhl MD. Surgery in acute and chronic venous diseases. Surgery, 1979, 85(1): 31.
Raju S, Fredericks R: Valve reconstruction procedures for nonobstructive venous insufficiency: Rationale, techniques, and results in 107 procedures with two- to eight-year follow-up. Vasc Surg, 1988, 7: 301-310.
Tawes RL, Barron ML, Coello AA, et al. Optimal therapy for advanced chronic venous insufficiency. Vasc Surg, 2003, 2:411.
Iafrati M, O'Donnell TF. Surgical reconstruction for deep venous insufficiency. Mal Vasc, 1997, 22(3):193-7.
10 Carrel A, Guthrie CC. Anastomosis of blood vessels by the patching method and transplantation of the kidney. 1906 [classical article]. Yale J Biol Med, 2001, 74(4): 243-7.
11 Eiseman B, Malette W. An operative technique for the construction of venous
valves. Surg Gynecol Obstet, 1953, 97(6): 731-4.
Kistner RL. Surgical repair of the incompetence of femoral vein valve. Arch Surg, 1975, 110(6): 1336.
Psathakis N. A new rational operative treatment for the insufficiency syndrome of the deep of the lower extremity. Vasc Dis, 1964, 84: 261-6.
Gloviczki P, Merrell SW, Bower TC. Femoral vein valve repair under direct vision without venotomy: a modified technique with use of angioscopy. J Vasc Surg, 1991, 14(5): 645-8.
Queral LA, Whitehouse WM Jr, Flinn WR, et al. Surgical correction of chronic deep venous insufficiency by valvular transposition. Surgery, 1980, 87(6): 688-95.
Psathakis N. Has the "substitute valve" at the popliteal vein solved the problem of venous insufficiency of the lower extremity. J Cardiovasc Surg (Torino), 1968 , 9(1): 64-70.
Raju S, Hardy JD. Technical options in venous valve reconstruction. Am J Surg, 1997, 173:301.
Gruss JD. Reconstructive venous valve surgery. Zentralbl Chir, 2001 Jun, 126(6): 461-5.
孙建明. 下肢深静脉瓣膜的解剖和组织学观察及临床意义. 中华实验外科杂志，1989，6（1）：1.
孙建民. 自体带瓣静脉段股浅静脉移植的实验研究与临床应用. 中华外科杂志，1988，10：628－630.
张柏根，张纪蔚，邝耀麟等. 静脉壁环缝缩窄术治疗股静脉瓣膜关闭不全. 中华外科杂志，1986，24（10）：600.
Belcaro G, Nicolaides AN, Ricci A, et al. External femoral vein valvuloplasty with limited anterior placation (LAP). Angiology, 1999, 50(7): 531.
Bush HL Jr、Nabseth DC. Autogenous venous valve transplantation in the dog. J Surg Res, 1982, 32(4): 313-21.
Rosenbloom M S, Schuler J J, chief editor. Journal of vascular surgery - official
publication, the Society for Vascular Surgery and International Society for Cardiovascular Surgery. United States, North American Chapter, 1988 . 7(5): 642-6.
Hasaniya NW. Phlebology, United Kingdom. 2002 , 16/4: 142-144.