血栓消融联合股动-静脉瘘治疗犬深静脉血栓的实验研究

目的: 观察和比较Amplatz血栓消融术(amplatz thrombectomy device,ATD)、股动-静脉瘘术(arteriovenous fistula,AVF)以及血栓消融联合股动-静脉瘘术(ATD+AVF)治疗犬急性下肢深静脉血栓形成后的静脉通畅程度和血管内皮细胞的形态及功能的变化。方法: 取成年杂种犬,下肢深静脉血栓模型建立成功后分为ATD组(n=8)、AVF组(n=8)和ATD+AVF组(n=8);对照(C)组(n=5)不做任何手术。结果: 血栓调节蛋白(TM)于术后7天内表达进行性升高,但ATD+AVF组TM表达峰值下降,术后4周恢复至正常水平(P>0.05)。静脉通畅程度ATD+AVF组均高于其它组(P<0.005),电镜检查内皮损伤多为Ⅰ、Ⅱ级,均高于AVF组和C组(P<0.005)。结论: 下肢深静脉血栓形成后,血栓及时清除和临时性动-静脉瘘的建立,对于减轻内皮细胞的损伤和维持静脉血流通畅有重要意义。

Amplatz thrombectomy device combined with arteriovenous fistula treating deep venous thrombosis in dogs

Objective: To compare the effects of Amplatz thrombectomy device(ATD),arteriovenous fistula(AVF),ATD+AVF and no-operation(C)in treatment of deep venous thrombosis in dogs.Methods: The right femoral veins of 29 adult mongrel dogs were ligated proximally and were clamped distally by hemostatic forceps.After 48 hours,the thrombosis model was established.The thrombosed veins were treated with ATD(n=8),AVF(n=8),and ATD+AVF(n=8),C(n=5),respectively.Results: In each group,the expression of thrombomodulin(TM)gradually increased,but the climax in ATD+AVF group was less than other groups on 7th day.The expression of TM decreased to be normal at the time of 4th week(P>0.05).The transmission electron microscopy results showed that the endothelium injury degree of ATD+AVF group were mostly Ⅰ,Ⅱ grade(ATD+AVF vs AVF,C,P<0.005).Conclusions: The restored blood stream dynamics in time and temporary AVF are important to decrease the injury and maintain the potency of thrombosed veins.