穿支皮瓣Choke区动、静脉血流阻力对皮瓣存活的影响

目的　通过在同一组皮瓣中对choke血管的动、静脉阻力进行比较研究，探究血流跨过choke血管的动、静脉阻力大小关系及其对皮瓣存活的影响。 方法　将34只SD大鼠随机分成两组，A组保留右侧肋间后动脉+左侧肋间后静脉，B组保留右侧肋间后动脉+右侧髂腰静脉。测量保留的动、静脉之间的距离。术后7天，统计皮瓣存活率以及血管造影观察皮瓣区微血管形态；choke区取材，H&E染色，计算平均微血管密度；尾静脉采血，检测乳酸含量。 结果　A组保留的动、静脉之间的距离比B组短[(2.5±0.3) cm vs (3.7±0.2) cm，t=14.608，P<0.05）]。术后7 d，A组皮瓣存活率为100%，B组1号血管体区存活率为（67.0±13.1）%，4号血管体区的为100%，整块皮瓣存活率为（88.0±6.8）%；A组比B组血管增生明显[（24.0±3.9）vs (17.6±4.3)，t=2.727，P=0.021]；A组与B组乳酸均接近术前水平，差异无统计学意义[（8.0±0.8）mmol/L vs (8.4±0.4) mmol/L vs (7.5±0.6) mmol/L，P>0.05]。 结论　①血流跨过choke血管的静脉阻力大于动脉阻力；②缩短跨choke区的动、静脉血流单向距离有利于减小跨choke区所受的静脉阻力，提高皮瓣的存活率。

The influence of arterial flow resistance and venous flow resistance of the choke area on the survival of perforator flap

Objective　To investigate the arterial resistance and venous resistance of blood flow across the choke vessels and their effects on the survival of perforator flap, through comparative study of the arterial and venous resistance in the same group of flaps.　Methods　Thirty-four Sprague-Dawley rats were randomly divided into two groups: group A preserved the right intercostal posterior artery and the left intercostal posterior vein, and group B preserved the right intercostal posterior artery and the right iliolumbar vein. The distance between the reserved artery and vein was measured. At day 7 after surgery, the survival rate of the flap was measured and the microvascular morphology was observed through lead oxide-gelatin angiography; Tissues were harvested from the choke area, which then underwent H＆E staining to measure the average microvascular density; Moreover, blood was collected from the tail vein for detection of the contents of lactate.　Results　The distance between the preserved artery and vein in group A was shorter than that in group B, the difference was statistically significant (P<0.05). At day 7 after surgery, the survival rate of group A was 100 percent, while in group B the survival rate of angiosome 1, angiosome 4 and the whole flap was（67.0±13.1）%, 100% and （88.0±6.8）%, respectively; the angiogenesis was more obvious in group A than that in group B, and the difference was statistically significant (P<0.05); the lactate contents in group A and group B were both close to the preoperative level, and the difference was not statistically significant (P>0.05). 　Conclusion　① The venous resistance of blood flow across the choke vessel is greater than that of the arterial resistance; ② It is helpful to reduce the venous resistance of blood flow across the choke vessel and improve the survival rate of the flap by shortening the unilateral distance of the arterial and venous blood flow across the choke area.