联体皮瓣的静脉引流位置对动脉血流导向功能的影响

目的 探讨联体皮瓣的静脉引流位置对动脉血流导向功能的影响。方法 将72只SD大鼠随机分为4组:正常组不做任何处理；对照组仅保留右侧肋间后动、静脉；实验组1仅保留右侧肋间后动脉+左侧肋间后静脉；实验组2仅保留右侧肋间后动脉+左侧髂腰静脉。测量血管体之间距离。术后7 d，统计皮瓣存活率以及明胶氧化铅血管造影观察皮瓣区血管形态；choke 1区取材，HE染色，分析动脉管径扩大倍数；尾静脉采血，检测乳酸含量。结果 血管体Ⅰ离Ⅱ最近，离Ⅲ最远，差异有统计学意义（P<0.05）。术后7 d，对照组皮瓣存活率为（86.5±4.3）%，实验组1和实验组2皮瓣存活率均为100%；血管造影显示，在血管体Ⅲ与Ⅳ区域，对照组血管增生比较少，而实验组1比较明显，实验组2最明显；与正常组相比，实验组2动脉管径扩大最明显，其次为实验组1，差异有统计学意义（P<0.05）；对照组乳酸含量最高，差异有统计学意义（P<0.05）。结论 静脉引流位置的改变可造成动脉灌流与静脉引流效果的改变，进而改变皮瓣区域生理性血管网，提高存活率。

Influence of venous drainage position on arterial blood flow in the conjoined flap

Objective To investigate the influence of venous drainage position on the direction of arterial blood flow in the conjoined flap. Methods Seventy-two Sprague-Dawley rats were randomly divided into four groups: normal group received no treatment; the control group only remained the right intercostal posterior artery and vein; experimental group 1 only remained the right intercostal posterior artery and the left intercostal posterior vein, and experimental group 2 only remained the right intercostal posterior artery and the left iliolumbar vein. The distance among the angiosomes was measured. At day 7 after surgery, the survival rate of the flap was measured and the morphology of vessels by lead oxide-gelatin angiography was observed. Materials from the choke area 1 was drawn, HE staining was used to compare the diameter expansion of the artery. Blood from the tail vein was collected, and the contents of lactate was detected. Results The distance of angiosomeⅠtoⅡ was nearest, Ⅰ to Ⅲ was farthest, the difference was statistically significant (P<0.05). At day 7 after surgery, the survival rate of the control group was (86.5±4.3) percent, while 100 percent in experimental groups 1 and 2. Angiography showed that the number of blood vessels was relatively small in control group, larger in experimental group 1, and the largest in experimental group 2 in regions of angiosome Ⅲ and Ⅳ. Compared to the normal group, the diameter of the artery of the experimental 2 was most obviously expanded, followed by the experimental group 1, the difference was statistically significant (P<0.05). The lactate contents in the control group was the highest, the difference was statistically significant (P<0.05). Conclusion Changes in position of venous drainage can result in the changes of the effect of arterial perfusion and venous drainage, and then alter the vascular rete, improve the flap survival.