【作者】 孙健鸣；

【导师】 时德；

【作者基本信息】 重庆医科大学 ， 外科学， 2005， 博士

【摘要】 目的:探讨建立实验性兔股动脉瘤、动静脉瘘模型的可行性,提供基本实验条件,模型建成后进行多普勒听诊检查,彩色多谱勒血流成像(CDFI)、CTA、MRA 及 DSA 的检测,进行 tAVF 的血气分析,模型的大体观察、病理检查及电镜组织学的检查,了解模型在不同的检测方法上的表现,同时,对比目前先进的检测手段的各自优点,为临床诊断该类疾病提供可资借鉴的经验和参考。同时该模型的建立也为观察小血管在不同的检测手段上的表现、测试诊断仪器的性能提供了机会。 方法:选用健康新西兰白兔 40 只,随机分组,应用显微外科技术,建立 PA、tAVF 模型。 (1) PA 组:新西兰白兔 20 只,雌雄不拘,体重 2.5～3.5 kg,麻醉:2.5 %戊巴比妥钠,30 mg/ kg 沿耳缘静脉注入。显露股动脉,纵行切开3 mm 切口,相对位置的股内侧肌肌壁上用双极电凝器烧灼成直径 3 mm,深约 5 mm 的圆形肌肉洞穴,显微镜下行股动脉-肌洞洞穴的吻合。动物分为五组,每组四只,每组制作 4 个 PA 模型,共制作 20 个 PA模型。 (2) tAVF 组:动物准备、麻醉部分同(1),行股部切口,显露股动脉、股静脉,股静脉顺行切开 3 mm,股动脉剪成 3 mm×1 mm 的椭圆洞口。显微镜下行股动脉、股静脉的侧-侧吻合,至吻合口无漏血,“四头”充盈良好。动物分为五组,每组四只。每组制作 6 个(单、双侧手术各二只),共 30 个手术部位,成功制作 tAVF 模型 26 个。 多普勒听诊器行模型的血流探测,tAVF 血气分析,CDFI,CTA,MRA,DSA 检测,并行解剖及组织学观察。 结果: 20 只新西兰白兔中成功制作动脉瘤 16 个,成功率 80%,30 个手术部位成功制作 tAVF 模型 26 个,成功率 87%。 PA 组:5～11 天发现搏动性包块出现,大部分(12/16)在 6～9 天出现,模型建成; tAVF 组,见“四头”无扭曲、变形,模型即建成。 (一)CDFI 可提供四肢血管的解剖和功能情况的信息,但在外周的血管疾病诊断上不同于一般的软组织及脏器的操作常规,具有更高的理论要求和技术要求。 ①PA 组:二维声像图,在股部发现圆形团块,直径 0.5～5.5 cm,团块边界清晰,有较厚囊壁;瘤体大者,腔内可见不规则中等回声的血栓,有时内部团块无回声,但适当提高增益,可见密集的细小回声呈漩涡状流动。CDFI,显示团块内呈彩色涡流状,有时可见供血动脉,收缩期彩色血流喷出,色彩明亮,冲入腔内,使腔内彩色血流呈旋转;而舒张期返回动脉内,血流来回往复,呈镶嵌多彩状血流。 多普勒流速曲线,表现为双相血流曲线。可在破口处测及收缩期高速高阻血流。舒张期呈反向低速血流,而腔内旋转血流流速常较低。 ②tAVF 组:二维声像图,由于洞口型动静脉瘘的显示很差,本实更多还原

【Abstract】 Objective To explore the possibility of the establishment femoral pseudoaneurysm (PA) and traumatic arteriovenous fistula(tAVF) models in rabbits. Models were analyzed by blood gas analysis, checked by colour doppler flow imaging(CDFI), examined by computed temography angiography(CTA), magnetic resonance angiography(MRA), digital subtraction angiography(DSA) and histological and transmission electron microscope observation. The experiment show the characteristics in the advanced diagnosising methods including CDFI,CTA, MRA, DSA and so on .At the same time ,It provides a good chance for the diagnosing instruments Methods To establish PA、tAVF models in 40 rabbits by microsurgical technique,male or female are not concerned,their weight are around 2.5 to 3.5 kg and they were divided into two groups in same amount. (1) PA group: Anaesthesia: 2.5% sodium pentobarbital was injected into the vein of ear at 30 mg/kg. Followed by fixation ,skin preparation ,sterilization and other preparation and then a skin incision was made about 4 cm long in femoral region to expose the femoral artery,block the blood flow with Bull dog. made a 3 mm long incision on the femoral artery On the oppositing muscle wall of the incision was made a 3 mm hole in diameter with ,Anastomosis were made with 9-0 Dacron suture by microsope The operation finished until no bleeding in the site and the distal artery pulse could be palpated. The animals were sent to animal center to breed . they were divided into 5 teams in average . (2) tAVF goup: the anaesthesia and preparations were same to the group(1). exposing the femoral artery and vein .blocking the blood flow with Bull dog, made a 3 mm long incision on the femoral vein , on the femoral artery, a 3 mm×1 mm ellipse hole was made and anastomosis can be done with 9-0 dacron suture between the artery and vein,at the end the model was finished. tAVF model was established ,they were divided into 5 teams in average ,30 tAVF operations were made in the group . Models were analyzed by blood gas analysis, checked by color doppler flow imaging(CDFI), examined by computed temography angiography (CTA), magnetic resonance angiography(MRA), digital subtraction angiography(DSA) and histological and transmission electron-microscopy observation. Results It was possible to establish PA and tAVF models with micro-surgical techniques .the surgical skills play an vital important role during the experiment.16 PA models were made in rabbits(16/20,87%). 30 tAVF models were made (100%). The time of Pulsating masses occured in PA group around 5~11 days, and the most appeared around the 7~9 days .In the tAVF group ,there were established at the end of suture. Each testing method has its advantages and disadvantages: I . CDFI It can provide information of anatomy and function in extremities vessels,while in diagnosising of peripheral vessel diseases,much more special theory and technique are needed than regular manipulation . ①PA group :In the two-dimension picture,round masses could de found in the femoral region ,the diameter varied from 0.5 to 5.5 cm.The masses had clear borderline ,and the wall of PA was thick .In big one ,irregular thrombus with moderate echo could be found .Sometimes no echo in the mass ,while increasing the gain moderately , eddied flow in small dense echo could be found . CDFI revealed color mosic in the mass .Sometimes supplying artery could be shown. In the systolic period ,colorful flow ejected into the cavity and whirled in it ; in the diastolic period ,the blood flowed back into the artery. The blood flowed in and out with regular rhythm. In the Dopplar velocity of flow curve ,bidirection blood flow could represent. At thecrevasse ,the blood flow could be measured with high speed and resistance in systolic period ,and reverse low speed and resistance flow in diastolic period .In the cavity ,the whirl flow was very slow . ②tAVF group :the hole between the vessels in tAVFs was not founded in two-dimension picture, but we can guess the site: In the artery , the inner diameter o更多还原