建立犬颈总动脉—颈外动脉高流量血管搭桥模型的实验研究

发布时间：2018-10-23 06:44

【摘要】：目的:人类脑组织的血供来自两侧的颈内动脉和中央的基底动脉。这些动脉自身好发动脉瘤,也可因各种先、后天因素形成狭窄或闭塞;颅底肿瘤也常常包绕、压迫甚至侵犯这些重要大血管。对于这些疾病而言,治疗的目的不仅是去除病变,还要保证颅内的血供。颅内外颈内动脉系统血管移植高流量血管搭桥手术是目前解决此问题的一个有效方法。我们希望通过建立大动物颈总动脉—颈外动脉高流量血管搭桥和围手术期观察模型,结合以后建立的人类尸体标本的颈内动脉高流量血管搭桥手术模型,为颅内外高流量血管搭桥手术应用于临床,摸索出一整套完成此项手术所需的临床实践培训模式,为相关神经外科、血管外科、颅底外科医师提供一个模拟训练的平台。方法:健康家犬6只,体重在10Kg～12Kg之间,随机分成3组。术前肌注阿托品0.05mg/Kg,盐酸氯胺酮10mg/Kg,实施基础麻醉,建立静脉通道,以盐酸氯胺酮2mg/kg和异丙酚1～1.5mg/Kg进行麻醉诱导,气管插管后,衔接麻醉机辅助呼吸。异丙酚及安氟醚维持麻醉。经皮下隧道行双侧颈总动脉至对侧颈外动脉高流量血管搭桥手术(n=12)。术后1周(n=4)、4周(n=4)、24周(n=4)行颈总动脉数字减影血管造影及颈部血管彩色超声多普勒检查,测量并记录移植血管的血流量,术后24周麻醉后取移植血管进行病理检查。结果:6只犬(12侧)均在显微镜下行颈总动脉—颈外动脉高流量血管搭桥手术,制成模型。手术顺利,无麻醉意外发生,移植血管通畅,手术时间为5—8小时。术后1周(n=4)、4周(n=4)、24周(n=4)双侧颈总动脉数字减影血管造影显示双侧颈外动脉均由对侧颈总动脉经移植血管供
[Abstract]:Objective: the blood supply of human brain comes from bilateral internal carotid artery and central basilar artery. These arteries themselves tend to cause aneurysms, which can be narrowed or occluded by various prior and acquired factors, and skull base tumors are often wrapped around, oppressing and even invading these important large vessels. For these diseases, the purpose of treatment is not only to remove lesions, but also to ensure intracranial blood supply. High flow vascular bypass grafting with internal carotid artery system is an effective method to solve this problem. We hope to establish a large animal common carotid arterial-external carotid artery bypass graft and perioperative observation model, combined with the subsequent establishment of human cadaveric specimens of the internal carotid artery high flow bypass surgery model. In order to apply the high flow vascular bypass surgery to the clinic, a set of clinical training models needed to complete the operation were found out, and a simulated training platform for neurosurgery, vascular surgery and skull base surgeons was provided for the related neurosurgery, vascular surgery and skull base surgeons. Methods: six healthy domestic dogs with body weight between 10Kg~12Kg were randomly divided into 3 groups. Before operation, atropine 0.05mg / kg and ketamine hydrochloride 10mg / kg were injected intramuscularly. Basic anesthesia was performed, vein passage was established, anesthesia was induced by ketamine hydrochloride 2mg/kg and propofol 1~1.5mg/Kg. After tracheal intubation, the anesthesia machine was connected to assist breathing. Propofol and enflurane maintained anesthesia. High flow artery bypass grafting was performed from bilateral common carotid artery to contralateral external carotid artery via subcutaneous tunnel (nm12). Digital subtraction angiography of common carotid artery and color ultrasound Doppler examination of cervical blood vessels were performed at 1 week, 4 weeks and 24 weeks after operation. The blood flow of grafts was measured and recorded. After 24 weeks of anesthesia, the grafts were taken out for pathological examination. Results: all 6 dogs (12 sides) underwent high flow bypass grafting of common carotid artery and external carotid artery under microscope. The operation was smooth, no anaesthesia accident occurred, the graft was patency, the operative time was 5-8 hours. Digital subtraction angiography of bilateral common carotid artery at 1 week, 4 weeks and 24 weeks after operation showed that bilateral external carotid artery was grafted from contralateral common carotid artery.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R-332;R651

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