颈动脉内膜切除术血管黏合重建的实验研究

目的：在颈动脉内膜切除术（CEA）中，应用黏合的方法进行血管重建，观察术后内膜的愈合过程。方法：采用血管内膜气体干燥损伤结合高脂饲料喂养2月的方法，在新西兰兔颈总动脉上复制粥样硬化性狭窄动物模型，在此模型基础上行颈动脉内膜切除术，运用超声、血管造影、病理等方法从影像学和组织学的角度观察比较CEA术后4h、1d、3d、7d、30d、90d等6个时间点内膜的愈合过程。结果：CEA术后内膜修复过程可以大体上分为血栓形成阶段，发生于术后数小时至3d左右；炎症反应阶段，与血栓形成几乎同时发生；内皮修复阶段，术后3d来自邻近的血管内皮细胞开始蔓延至内膜斑块切除段血管内面；血管平滑肌增值阶段，血管平滑肌细胞增殖开始于术后3d左右，发生在中膜的局部区域；基质形成、堆积阶段。结论：采用新型黏合血管重建的方法为颈动脉内膜切除术的血管重建提供了新的可靠手段。

Experimental study of healing process following sutureless adhesive anastomosis of carotid endarterectomy

Objective:To observe the healing process following sutureless adhesive anastomosis of carotid endarterectomy(CEA).Methods:Using New Zealand rabbits,carotid atherosclerotic stenosis(CASS)model were created by air-drying an isolated seagment of common carotid artery and feeding high cholesterol diet for 2 months.The formation of neointima were observed at 4hours,1,3,7,30,90days by ultrasound and angiography and pathology after CEA.Results:Several stages could be seen in formation of neointima after CEA.The thrombosis could be seen from several hours to 3 days after CEA;the inflammation took place with thrombosis;new endothelium began to grow from the surrounding over the thin thrombus at 3 days after CEA;vascular Smooth muscle cell(VSMC) began to proliferate in local media at 3 days;the formation and stacking of extracellular matrix(ECM) began.Conclusion:New sutureless adhesive anastomosis is a new reliable method for the vessel reconstruction of carotid endarterectomy.