CAJ | 학술논문

目的：从形态学角度观察机械性TMR与激光TMR对心肌管道热损伤、血管生成及纤维化的影响，探讨最佳的TMR方法。方法：采用高速空心钻头和CO2激光在家兔左室壁进行打孔，形成透室壁性心肌管道。动物于术后不同时间处死，利用组织切片染色法，分别观察机械性和激光心肌管道内形态结构及其变化。结果：机械钻孔形成的心肌管道不存在任何热损伤的迹象，而激光形成的心肌管道存在着严重的热损伤；数周后机械管道内新生血管的数量和密度明显高于激光管道，P＜0.01；6～8周后，机械管道残迹的纤维化直径明显小于激光管道，P＜0.0001。结论：①机械性TMR和激光TMR在心肌管道的热损伤、血管生成及纤维化方面均存在着非常显著或极显著性差异；②应用机械钻孔的方式进行TMR明显优于激光心肌打孔。
목적：종형태학각도관찰궤계성TMR여격광TMR대심기관도열손상、혈관생성급섬유화적영향，탐토최가적TMR방법。방법：채용고속공심찬두화CO2격광재가토좌실벽진행타공，형성투실벽성심기관도。동물우술후불동시간처사，이용조직절편염색법，분별관찰궤계성화격광심기관도내형태결구급기변화。결과：궤계찬공형성적심기관도불존재임하열손상적적상，이격광형성적심기관도존재착엄중적열손상；수주후궤계관도내신생혈관적수량화밀도명현고우격광관도，P＜0.01；6～8주후，궤계관도잔적적섬유화직경명현소우격광관도，P＜0.0001。결론：①궤계성TMR화격광TMR재심기관도적열손상、혈관생성급섬유화방면균존재착비상현저혹겁현저성차이；②응용궤계찬공적방식진행TMR명현우우격광심기타공。
Objective:To observe the effects of thermal injury,angiogenesis and fibrosis on the channels after transmyocardial revasculariaztion (TMR) by CO2 laser and by machine drilling from the view of histomorphology,so that the better method of TMR would be selected.Methods:Under direct vision,transmyocardial channels were made by CO2 laser and by machine drilling in vivo on the left ventricular wall of 54 rabbits.The average diameters of both channels were similar (laser,0.8～1.0 mm,drilling 1.0～1.2 mm).The animals were sacrificed at intervals of 1,2,4 and 6～8 weeks after TMR.The effects of thermal injury,angiogenesis and fibrosis were observed under microscope.Results:There was severe thermal injury around the channes made by CO2 laser.The thickness of thermal injury was 0.5～1.0 mm.There wasn't any indication of thermal injury on the wall of the channels made by machine drilling.After several weeks,histology showed all channel remnants composed of granulation tissue,new vessels (NV) and fibrosis.Histological and histochemical analysis confirmed the presence of endothelial cells within NV.The density analysis of the NV within the channel remnants revealed significant difference (after 2 weeks,7.23±0.48NV per 10×4 field in laser versus 8.41±0.59 in drilling,P＜0.01;after 6～8 weeks,2.22±0.33 NV per 10×4 field in laser versus 3.31±0.57 in drilling,P＜0.01);The diameter analysis of fibrosis in both channels demonstrated a high significant difference (laser, 1.73±0.05 mm,drilling, 0.67±0.03 mm.P＜0.001).Conclusions:This study shows that there is significant difference between CO2 TMR and machine drillling TMR in their effects on thermal injury,angiogensesis and fibrosis,therefore the method of machine drilling TMR is better than CO2 TMR on the view of histomorphology.