吻合方法、抗凝治疗对犬下腔静脉吻合口血栓形成的影响

目的 观察吻合方法、抗凝治疗对犬下腔静脉吻合口血栓形成的影响,探讨血管吻合术后血栓形成的相关危险因素.方法 成年健康杂种犬30条,随机分6组,即空白对照组、假手术组、连续吻合抗凝组、连续吻合不抗凝组、间断吻合抗凝组、间断吻合不抗凝组.采用不同的吻合方法制造犬下腔静脉吻合模型,术后抗凝组给予抗凝治疗,其余各组等量生理盐水对照.术前、术后第1天、术后第3天测定各组实验犬血清血栓前体蛋白(TpP)的含量,术后1周各实验犬行彩色多普勒超声检查及经股静脉行下腔静脉造影观察下腔静脉通畅情况,造影后切取吻合处及两端少许正常血管,进行形态学观察.结果 血管造影、彩超、TpP的含量测定及形态学检查结果均显示,连续吻合不抗凝组和间断吻合不抗凝组血栓形成指标与其他组之间差异有统计学意义(P＜0.05),两组血栓阳性率分别为80%(4/5)、100%(5/5).结论 静脉血管吻合术后缺乏有效的抗凝治疗,是术后血栓形成的危险因素,及时有效的抗凝治疗有助于减少术后血栓的形成.不同的血管吻合方法不是血管吻合术后血栓形成的危险因素.

Correlation between thrombosis of anastomotic stoma and the different anastomosis methods, anticoagulation treatment in dogs

Objective To observe the effects of different methods of vascular anastomosis and anti-coagulation on thrombosis after vascular anastomosis and analyze the risk factors of thrombosis after vascular anastomosis. Methods Thirty adult healthy dogs were randomly divided into six groups equally:control group, sham-operated group, continuous anastomosis and anti-coagulation group, continuous anastomosis and no anti-coagulation group, interrupted anastomosis and anti-coagulation group, interrupted anastomosis and no anti-coagulation group. The anastomosis model of inferior vena cava was established by using different methods. Postoperatively, anti-coagulation treatment was performed in anti-coagulation groups, and the remaining groups were given normal saline. Thrombus precursor protein (TpP) level was mesured before and 1,3 days after operation. One week after operation, all animals were subjected to color Doppler ultrasound examination and inferior vena cavography, and the blood vessels around the anastomotic stoma were cut for microscopic examination. Results Inferior vena cavography, Color doppler ultrasound,TpP changes and morphologic examination revealed there was significant difference in the parameters for thrombosis between no anti-coagulation groups ( including continuous anastomosis and no anti-coagulation group, and the interrupted anastomosis and no anti-coagulation group) and other groups (P <0. 05 ). The positive rate of thrombosis in continuous anastomosis and no anti-coagulation group, and the interrupted anastomosis and no anti-coagulation group was 80% (4/5), and 100% (5/5), respectively. Conclusion Lack of effective anti-coagulant treatment is the risk factor of thrombosis after vascular anastomosis. Timely and effective anti-coagnlant therapy after vascular anastomosis can reduce thrombosis. Methods of vascular anastomosis are not the risk factor of thrombosis after vascular anastomosis.