【摘要】 目的:比较生物膜与膨体聚四氟乙烯在动脉瘤包裹的远期治疗效果。方法:实验于2004-12/2006-10年在南方医院神经外科实验室与广东冠昊动物实验中心进行。取成年健康杂种犬10只,采用显微外科技术,将双侧的颈外静脉1.5cm嫁接双侧颈总动脉缺损1.5cm制作梭形动脉瘤模型20枚。左侧10枚应用生物膜(广东冠昊生物科技有限公司产品)包裹治疗,右侧10枚应用膨体聚四氟乙烯(美国戈尔公司周围血管补片)包裹治疗。术后第1,3,6,9,12个月行彩色多普勒超声血动态观察血流动力学变化,第12个月进行数字减影血管造影检测及解剖组织学观察。结果:10只犬全部进入结果分析。①血流动力学观察:生物膜包裹侧瘤腔消失、形态上趋于正常的颈总动脉,管腔均通畅,造影剂快速通过无滞留;血流恢复为层流,频谱特征与颈总动脉一致;1个月时生物膜与瘤壁存在微小间隙,3个月后间隙完全消失,12个月时血管顺应性、弹性与颈总动脉基本相匹配。膨体聚四氟乙烯包裹侧瘤腔消失、管腔通畅6枚,腔内为层流,频谱特征与颈总动脉相似,但速度明显高于远近端颈总动脉;瘤腔轻度缩窄,内壁出现轻度波状充盈缺损,包裹片长度轻度缩短;1个月和3个月各出现2枚血栓性闭塞,经主动脉弓照影不显像。6个月内膨体聚四氟乙烯与瘤壁存在清晰微小间隙,6个月后间隙消失。②组织学观察:生物膜包裹侧外表柔软类似颈总动脉,有较多毛细血管长入但维持原形,瘤腔内膜光滑无增厚,内皮细胞无增生、脱落,未见附壁血栓;生物膜与瘤壁融合、多层次降解,降解间隙内较多新生血管、组织长入,未见炎症细胞。膨体聚四氟乙烯外表僵硬、未见周围组织长入;内膜增厚、不光滑,内皮细胞核密集、部分脱落,薄层血栓附壁;4例见胶冻状长圆柱形杂色血栓。膨体聚四氟乙烯与瘤壁嵌入无降解,未看到明显的毛细血管长入;有极少的成纤维细胞伸入,散在的淋巴细胞浸润及少量巨噬细胞。结论:生物膜具有良好的理化性能与生物相容性,其效果优于膨体聚四氟乙烯,是动脉瘤包裹治疗的理想再生医学工程材料。更多还原

【Abstract】 AIM:To compare the long-term therapeutic effectiveness of aneurysm wrapping with biomembrane and GORE expanded polytetrafluoroethylene(e-PTFE) .METHODS:The experiment was conducted in the laboratory of Department of Neurosurgery,Nanfang Hospital and the Animal Experiment Center of Summit(GD) Biotech Co.,Ltd.between December 2004 and October 2006.Ten healthy adult hybrid dogs were selected,and the bilateral segment of 1.5 cm autogenous external jugular vein were anastomosed to bridge a 1.5 cm surgical defect of the common carotid artery to construct 20 fusiform aneurysm models by microsurgical techniques;the left models were wrapped with biomembrane(manufactures of Summit(GD) Biotech Co.,Ltd.) and the right models with GORE e-PTFE,(GORE-TEX ACUSEAL CARDIOVASCULAR PATCH,products of W.L.Gore & Associates Inc.) .The hemodynamic alteration of these two types were compared with color Doppler in 1,3,6,9,and 12 months after operation,and observed with digital subtraction angiography and histomorphology at the 12th month after operation.RESULTS:All the 10 dogs were involved in the result analysis.①Hemodynamic alteration:In the lumens of wrapping with biomembrane,the shape of aneurysm was resemble to common carotid artery,the blood flow could pass the lumens easily and smoothly as laminar flow and the constrast medium without detained,with the same spectra features to common carotid artery;there was a tiny interstitium between the biomembrane and the wall of lumens at 1 month,which disappeared 3 months after the operation;at 12 month,the complaisance and elasticity of lumens were similar to common carotid artery.On the other side wrapped with e-PTFE,the aneurysm disappeared,and blood flow could pass the lumens easily and smoothly as laminar flow only in 6 cases,with the similar spectra features as the common carotid artery,but the velocity of blood flow was significantly higher than the common carotid artery;the lumens constricted lightly with slight wave filling defect in inner wall,and the length of patch was shortened gently;thrombosis was found in 2 cases respectively in 1 month and 3 month after operation and without video picture in digital subtraction angiography by aortic arch.The tiny interstitial between the e-PTFE and the wall of lumens was observed clearly until 6 month after operation.②Histomorphological observation:The biomembrane wrapped side had a soft shape similar to that of common carotid artery,ingrowths of micrangium;the tunica interna was smooth and glossy without thickening and mural thrombosis;endothelial cell without hyperplasia or exfoliation;the biomembrane was fused with wall of aneurysm with multistrata degradation,and many tiny interspaces emerged in the internal which induced the ingrowth of new vessels and tissues;no inflammatory cells were found.The surface of e-PTFE was stiff with no ingrowth of tissues;the tunica interna was thickening and rough leading to lumens coarctation;endothelial cell nucleolus was concentrate and partly exfoliation,which induced lamellar mural thrombosis;long and cylinder variegation thrombus was observed 4 cases.There was no degradation between the e-PTFE and wall of lumens,and no growth of micrangium was found besides scanty fibroblast;scattered lymphocytes infiltraion and small amounts of macrophages were observed.CONCLUSION:Biomembrane with excellent biocompatibility and physical and chemical performance,is an ideal biomaterial for wrapping aneurysm which is superior to e-PTFE to e-PTFE.更多还原