深低温保存同种异体血管移植建立游离皮瓣血供的实验研究

发布时间：2018-05-27 12:32

本文选题：深低温保存 + 同种异体　；参考：《南华大学》2015年硕士论文

【摘要】：目的:本实验利用经深低温保存的同种异体血管移植,建立游离皮瓣血供。通过观测移植后皮瓣存活率,推断同种异体血管移植后血管通畅率,并与新鲜自体、新鲜同种异体血管移植进行比较。探讨同种异体血管移植可行性,为临床上应用同种异体血管移植建立皮瓣血运提供实验研究基础。方法:将60只体重约2.5kg,雌雄不限的成年新西兰兔按照随机分配原则,平均分成3组,每组20只。以动物兔腹壁浅动脉为血管蒂设计一面积约5×4cm2椭圆形腹部皮瓣,并在股动脉近心端与腹壁浅动脉发出处之间截取约15mm长的股动脉,造成股动脉缺损模型。在显微镜下,A组用新鲜被截取的长15mm自体股动脉原位回植;B组用新鲜的长15mm同种异体股动脉移植;C组用经深低温保存后的长15mm同种异体股动脉移植。术后予青霉素抗炎、肝素钠抗凝、罂粟碱抗血管痉挛。术后对各组动物兔腹部皮瓣颜色、温度、毛细血管反应等指标进行观察,判断皮瓣是否存活,推断出各组移植后股动脉是否通畅。统计术后1d、2d、3d、5d、7d、14d、21d各时间点各组血管通畅率,将各组动物血管通畅率进行两两比较,检验标准以P0.05有统计学意义。结果:各组血管移植后要求即刻通畅率为100%(因操作不当至失血死亡或吻合失败等,不计入最后结果)。移植完成后,对每组实验动物皮瓣进行各项指标观测,各组动物未见明显感染迹象,皮瓣存活率随时间推移逐渐下降。A组在第1d、2d、3d、5d各有2例、2例、1例、1例皮瓣出现坏死;B组在第1d、2d、3d、5d、7d各有8例、4例、2例、2例、1例皮瓣出现坏死;C组在第1d、2d、3d、7d各有3例、2例、2例、1例皮瓣出现坏死。血管移植术后3周,根据皮瓣存活率推断出血管通畅率分别为:A组为70.0%,B组为15.0%,C组为60.0%。A、B、C三组进行两两比较,A、C组比较,P0.05,无统计学差异,B组与A、C两组比较,P0.05,有统计学差异。结论:经深低温保存后的同种异体血管移植建立血运的游离皮瓣有较好的存活率,要远高于用新鲜同种异体血管移植组,与新鲜自体血管移植组比较无统计学差异。经深低温保存的同种异体血管移植建立游离皮瓣血供在临床上具有一定的可行性。
[Abstract]:Objective: to establish the blood supply of free flap by deep cryopreserved allograft. By observing the survival rate of skin flap after transplantation, the patency rate of blood vessel after allograft was inferred and compared with that of fresh autograft and fresh allograft. To explore the feasibility of allograft vascular transplantation, and to provide experimental research basis for clinical application of allograft vascular transplantation to establish flap blood circulation. Methods: 60 adult New Zealand rabbits weighing about 2.5 kg were randomly divided into 3 groups with 20 rabbits in each group. A 5 脳 4cm2 elliptical abdominal flap was designed with the superficial abdominal artery of the rabbit as the vascular pedicle. The femoral artery was cut off between the proximal heart end of the femoral artery and the superficial artery of the abdominal wall, and the femoral artery was cut off from the proximal end of the femoral artery and the superficial artery of the abdominal wall. The model of femoral artery defect was established. In group A, fresh long 15mm autogenous femoral artery was replanted in situ under microscope. Group B was transplanted with fresh long 15mm allogeneic femoral artery. Group C was transplanted with long 15mm allograft after cryopreservation. Postoperative penicillin anti-inflammatory, heparin sodium anti-coagulation, papaverine anti-vasospasm. After operation, the color, temperature and capillary reaction of the abdominal flap were observed, the survival of the flap was judged, and the patency of femoral artery after transplantation was inferred. The blood vessel patency rate of each group was counted at 1 day, 2 days, 3 days, 5 days, 7 days, 14 days and 21 days. The vascular patency rate of each group was compared in two groups. The test standard was P0.05. Results: the rate of immediate patency required after vascular transplantation in each group was 100% (due to improper operation, death of blood loss or failure of anastomosis, etc.) After the transplantation, the indexes of each group of experimental animal flaps were observed, and there were no obvious signs of infection in each group. The survival rate of flap decreased gradually with the passage of time. In group A, there were 2 cases of flap necrosis in 2 cases and 1 case of skin flap necrosis on day 1, 2 d and 3 d / 5 d respectively. In group B, there were 8 cases of flap necrosis on day 1, 2 cases and 2 cases, and 1 case of flap necrosis. In group C, there were 3 cases of flap necrosis on day 1, 2 cases on day 2 and 2 cases on day 2 on day 7. In group B, there were 2 cases of flap necrosis on day 1, 2 cases on day 2 and 2 cases on day 2 at day 1. Necrosis of flap occurred in 1 case. At 3 weeks after vascular transplantation, the vascular patency rate of group B was 70. 0 and that of group B was 15. 0. The rate of patency of flap was 60. 0. 0. 05 in group C and 60. 0. 05 in group C, respectively. There was no statistical difference between group B and group A (P 0. 05). Conclusion: the free flap of blood vessel transplantation after cryopreservation has a better survival rate than that of fresh blood vessel transplantation group, and there is no statistical difference between the two groups. It is feasible to establish free flap blood supply by cryopreservation of allograft.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.3

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