国产覆膜支架主动脉瘤实验研究和支架OVERSIZE对腹主动脉的影响

发布时间：2018-06-15 22:32

本文选题：主动脉 + 主动脉瘤　；参考：《中国人民解放军医学院》2016年博士论文

【摘要】：目的：1、应用腹直肌后鞘建立犬胸主动脉和腹主动脉瘤模型,探讨国产覆膜支架治疗主动脉瘤的可行性,并观察治疗后的病理变化2、通过对实验犬按照不同oversize标准植入腹主动脉覆膜支架,通过病理检查了解实验犬腹主动脉的病理学变化,揭示oversize对于主动脉的影响。方法：1.国产支架的设计与制作,支架由PET超薄覆膜与超弹性镍钛合金支架通过不可吸收缝线缝合而成。用于实验动物的支架设计制作,支架型血管由威海维心医疗设备有限公司按照临床标准制作完成。2.进行动脉瘤造模并植入国产覆膜支架,12条犬分为4组,每组3只实验狗。A组：降主动脉不进行造瘤直接植入国产覆膜支架,B组：腹主动脉不进行造瘤直接植入国产覆膜支架,C组：降主动脉造瘤后植入国产覆膜支架,D组：腹主动脉造瘤后植入国产覆膜支架。植入支架型血管后实验犬饲养30、60和90天,处死并取标本进行病理学检查。3.15条犬分为3组,每组5只实验用犬。第一组：oversize 10-20%,第二组：oversize20-30%,第三组：oversize30%.在实验犬腹主动脉植入支架型血管后饲养观察30天,处死并取标本进行病理学检查和数据统计分析。结果：1.动脉瘤建模并行覆膜支架植入实验情况：共对12只实验动物进行手术,12例实验动物均成活至预订取标本时间。术中手术顺利,主动脉造瘤成功,支架放置顺利,支架植入后造影提示：支架与血管壁贴附良好,动脉瘤不显影,无明显内漏发生。实验标本检查大体肉眼观察未见镍钛合金金属丝断裂、PET覆膜破损等不良事件。2.Oversize实验情况：所有15只实验动物术中麻醉满意,顺利完成手术,所有病例均存活,并成功饲养至30天。实验标本检查大体肉眼观察未见镍钛合金金属丝断裂、PET覆膜破损等不良事件。结论：1、应用腹直肌后鞘作为补片制作胸主动脉瘤和腹主动脉瘤,是一种简单,有效、快捷的动脉瘤建模方式,威海维心主动脉覆膜支架产品疗效显著,导入及释放系统操作简便可靠,覆膜支架具有优良的组织及生物相容性。2、自膨式支架会导致血管壁变薄,引起血管中层平滑肌纤维数量减少,其结果是导致血管弹性降低而发生扩张,而这种趋势与ocersize呈正相关。
[Abstract]:Objective to establish a canine model of thoracic aortic and abdominal aortic aneurysms with rectus abdominis posterior sheath, and to explore the feasibility of domestic covered stent in the treatment of aortic aneurysms. The pathological changes of abdominal aorta were observed after treatment. The experimental dogs were implanted with abdominal aortic stent according to different oversize standards. The pathological changes of abdominal aorta of experimental dogs were studied by pathological examination, and the influence of oversize on aorta was revealed. Method 1: 1. The design and fabrication of domestic scaffold, which is made of PET thin film and super elastic nickel titanium alloy stent, are sutured by non-absorbable suture. Stent design for experimental animals, stent vessels by Weihai Weixin Medical equipment Co., Ltd. in accordance with clinical standards. 2. 2. Twelve dogs were divided into 4 groups. Each group of 3 experimental dogs. Group A: descending aorta was not directly implanted with domestic coated stents. Group B: abdominal aorta were not directly implanted with domestic stents. Group C: after descending aortic aneurysm, domestic coated stents were implanted. Group A: after abdominal aortic aneurysm, domestic covered stent was implanted. The experimental dogs were raised for 30 days and 90 days after stenting. The dogs were killed and taken for pathological examination. 3.15 dogs were divided into 3 groups with 5 dogs in each group. The first group: 10-20, the second group: 20-30, the third group: oversize 30. The abdominal aorta of experimental dogs were fed and observed for 30 days after stenting. The specimens were sacrificed for pathological examination and statistical analysis. The result is 1: 1. Model of aneurysm and stent implantation: 12 experimental animals were operated on and all survived until the scheduled time. The operation was successful, the aortic aneurysm was successful, the stent was placed smoothly, and the angiogram showed that the stent attached well to the vascular wall, the aneurysm did not develop, and no obvious internal leakage occurred. There were no adverse events such as breakage of Nickel-Titanium alloy wire, PET film covering and breakage. 2. Oversize experiment: all 15 experimental animals were anesthetized satisfactorily during operation, and all the cases survived successfully. And successfully raised to 30 days. No adverse events such as breakage of Ni-Ti alloy wire and PET film were observed. Conclusion: using rectus abdominis posterior sheath as a patch to make thoracic aortic aneurysm and abdominal aortic aneurysm is a simple, effective and fast way to model aneurysm. The introduction and release system is simple and reliable. The stent has good tissue and biocompatibility. The self-expandable stent will lead to the thinning of vascular wall and the decrease of the number of smooth muscle fibers in vascular media. As a result, vascular elasticity decreases and dilates, a trend that is positively correlated with ocersize.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R654.3

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