CAJ | 학술논문

目的探讨组织型纤溶酶原激活物及其抑制剂-1(t-PA和PAI-1)在游离穿支皮瓣移植术后静脉危象早期不同时间点的变化规律与意义. 方法将30只体质量为2.5 ～3.0 kg、4个月龄健康新西兰大耳白兔随机分为实验组(n=15)和对照组(n=15).两组均建立腹壁浅动脉穿支皮瓣游离移植模型.构建成功后,实验组采用体外留线结扎以阻断静脉回流来构建穿支皮瓣静脉危象模型而对照组体外留线不结扎.观察两组皮瓣血运变化,于静脉危象发生的不同时间点采血,采用Elisa法检测血浆t-PA和PAI-I浓度,切取部分皮瓣组织行组织形态学检查.利用SPSS 17.0统计学软件行统计分析,P＜0.05为差异有统计学意义. 结果实验组除1例发生麻醉意外、对照组1例发生静脉危象外,其余均成功构建穿支皮瓣游离移植和静脉危象模型.皮瓣在静脉结扎1h之内颜色无明显改变,在静脉结扎2h以后出现典型静脉危象表现.t-PA和PAI-1在皮瓣移植前、通血即刻、静脉结扎即刻、结扎后15 min、30 min、1h差异无统计学意义(P＞0.05),t-PA在静脉结扎后2、4、6、8h浓度显著降低(P＜0.05),PAI-1在静脉结扎后2、4、6、8h浓度显著升高(P＜0.05).病理结果显示:随着穿支皮瓣发生静脉危象时间的延长,管腔内红细胞逐渐黏附聚集,最后导致血管堵塞. 结论 t-PA、PAI-1对穿支皮瓣移植术后静脉危象的早期(2h以内)无明显变化,不能应用于诊断早期静脉危象.
목적 탐토조직형섬용매원격활물급기억제제-1(t-PA화PAI-1)재유리천지피판이식술후정맥위상조기불동시간점적변화규률여의의. 방법 장30지체질량위2.5 ～3.0 kg、4개월령건강신서란대이백토수궤분위실험조(n=15)화대조조(n=15).량조균건립복벽천동맥천지피판유리이식모형.구건성공후,실험조채용체외류선결찰이조단정맥회류래구건천지피판정맥위상모형이대조조체외류선불결찰.관찰량조피판혈운변화,우정맥위상발생적불동시간점채혈,채용Elisa법검측혈장t-PA화PAI-I농도,절취부분피판조직행조직형태학검사.이용SPSS 17.0통계학연건행통계분석,P＜0.05위차이유통계학의의. 결과 실험조제1례발생마취의외、대조조1례발생정맥위상외,기여균성공구건천지피판유리이식화정맥위상모형.피판재정맥결찰1h지내안색무명현개변,재정맥결찰2h이후출현전형정맥위상표현.t-PA화PAI-1재피판이식전、통혈즉각、정맥결찰즉각、결찰후15 min、30 min、1h차이무통계학의의(P＞0.05),t-PA재정맥결찰후2、4、6、8h농도현저강저(P＜0.05),PAI-1재정맥결찰후2、4、6、8h농도현저승고(P＜0.05).병리결과현시:수착천지피판발생정맥위상시간적연장,관강내홍세포축점점부취집,최후도치혈관도새. 결론 t-PA、PAI-1대천지피판이식술후정맥위상적조기(2h이내)무명현변화,불능응용우진단조기정맥위상.
Objective To investigate the change of dynamic expression of t-PA and PAI-1 during early venous crisis after free perforator flap transplantation.Methods Thirty healthy New Zealand white rabbits weighed 2.5-3.0 kg were chosen and randomly divided into experimental group (n =15) and control group (n =15).Free transplantation of superficial epigastric artery perforator flap (SEAPF) was implemented in all rabbits firstly.Then the model of venous crisis was established by ligating the anastomosis vein in order to interrupt venous blood outflow in experimental group.The blood supply of all flaps was monitored by observing their color,swelling degree and the filling reaction of the capillaries after operation.Peripheral blood was drawn from femoral artery at different time point for measuring the concentration of t-PA and PAI-1 by Elisa.Partial flap tissue was harvested for pathological examination at corresponding time point.Data analysis was performed by using SPSS 17.0 statistical software.P ＜ 0.05 was considered statistically significant.Results One rabbit died of anesthesia,and the venous congestion was observed in 1 rabbit in control group.The models of free transplantation of SEAPF and venous crisis were established successfully in the remaining rabbits.No significant appearance change was observed within 1 h after the outflow vein being ligated,while typical appearance of venous crisis could be observed 2 hours after the outflow vein being ligated.Compared with the control group,the concentration of t-PA was lower,but the concentration of PAI-1 was higher in experimental group at 2 hours,4 hours,6 hours,8 hours after the outflow vein being ligated(P ＜ 0.05).However,there was no obvious differences between two groups at other time points (P ＞ 0.05).The pathological examination showed the red cells gradually got together and adhered to the venous wall,eventually the microcirculation had been blocked completely and theflap became necrosis after venous crisis being occurred.Conclusion t-PA and PAI-1 can't be used to diagnose early venous crisis of perforator flap transplantation.