目的 探讨局部应用天然水蛭素对猪随意型皮瓣移植后静脉淤血的影响。 方法 6 ～ 8 月龄广西巴马小型猪3 只，雌雄不限，体重10 ～ 15 kg。于每只猪背两侧制备6 个大小为14 cm × 4 cm 的随意型皮瓣，共18 个皮瓣。根据术后注射药物不同，皮瓣随机分为3 组（n=6）。术后即刻、1、2、3 d，A 组：局部注射3 mL 生理盐水，作为对照组；B 组：局部注射3 mL 天然水蛭素20 ATU；C 组：局部注射3 mL 天然水蛭素40 ATU。术后1、10 d 行大体观察，1、7d 行组织学观察，3、7 d 测定湿重/ 干重比值，5 d 测定皮瓣表面温度，7 d 皮瓣局部血流彩色超声检测，12 d 测定皮瓣成活率。 结 果 术后即刻，3 组皮瓣均出现远端2/3 范围内轻度淤血，差异无统计学意义（P gt; 0.05）；术后1 d，A 组皮瓣淤血长度明显长于B、C 组（P lt; 0.05），B、C 组间比较差异无统计学意义（P gt; 0.05）；术后10 d，A、C 组皮瓣坏死长度明显长于B 组，差异有统计学意义（P lt; 0.05），A、C 组比较差异无统计学意义（P gt; 0.05）。组织学观察：术后1 d，B 组真皮内毛细血管及微静脉红细胞淤滞现象较A 组明显减轻；术后7 d，B 组皮下胶原及肉芽组织增生明显优于A 组。术后3 d，A、B、C 组湿重/ 干重比值分别为3.94 ± 0.14、3.43 ± 0.14、3.60 ± 0.19，A 组与B、C 组比较，差异有统计学意义（P lt; 0.05），B、C 组间比较，差异无统计学意义（P gt; 0.05） ；术后7 d，A、B、C 组湿重/ 干重比值分别为3.61 ± 0.11、3.08 ± 0.13、3.34 ±0.21，A 组与B、C 组比较，差异有统计学意义（P lt; 0.05），B、C 组间比较，差异无统计学意义（P gt; 0.05）。术后5 d，A、B、C 组皮瓣表面温度分别为（36.64 ± 0.70）、（38.61 ± 0.42）和（37.50 ± 0.46）℃，A 组与B、C 组比较差异有统计学意义（P lt;0.05），B、C 组间比较，差异无统计学意义（P gt; 0.05）。术后7 d，皮瓣局部血流彩色超声检测示A 组血流信号稀少，B 组见较完整的动静脉回流信号，可见垂直于皮肤的动脉穿支，C 组可见动脉血流信号。术后12 d，A、B、C 组皮瓣成活率分别为45% ± 7%、67% ± 4%、52% ± 4%，B、C 组与A 组比较，差异有统计学意义（P lt; 0.05），B、C 组间比较差异有统计学意义（P lt; 0.05）。 结论 局部应用天然水蛭素对猪随意型皮瓣移植后静脉淤血有较明显的改善作用。
Objective To investigate the effect of natural hirudin which is appl ied locally on vein congestion of random pattern skin flap in porcine models. Methods Three Guangxi Bama miniature pigs, including male and female aged 6-8 months and weighing 10-15 kg, were employed to establ ish animal model of vein congestive. Six dorsal random pattern skin flaps (three on each side) were prepared on each animal, 14 cm × 4 cm in size. According to the pharmacologic manipulations which were administered immediately and at 1, 2, and 3 days after operation respectively, the eighteen flaps were divided randomly into 3 groups (six in each group). In group A, isotonic Na chloride was locally appl ied as control group. In group B, 3 mL of 20 ATU natural hirudin was locally appl ied at each flap. In group C, 3 mL of 40 ATU natural hirudin was locally appl ied at each flap. Macroscopic observation (at 1 and 10 days postoperatively) and histological observation (at 1 and 7 days postoperatively) were made, the ratio of wet weight to dry weight of the congestive tissue (at 3 and 7 days postoperatively), the temperature of the surface of congestive flap (at 5 days postoperatively) and local blood flow of the flap (by Color Doppler Ultrasound at 7 days postoperatively) were measured. The survival rate of skin flaps was determined at 12 days postoperatively. Results Macroscopic observation showed that congestion of the flaps had no significance among three groups immediately after operation (P gt; 0.05); at 1 day postoperatively, the length of the congestion of the flap in group A (9.68 ± 0.43) cm was significantly longer than that in group B (6.81 ± 0.53) cm and group C (8.51 ± 0.64) cm (P lt; 0.05), while there was no significant difference between group B and group C (P gt; 0.05); at 10 days postoperatively, the necrosis at the distal end of flap in group A and group C were significantly longer than that in group B (P lt; 0.05), while there was no significant difference between group A and group C (P gt; 0.05). The histological observation revealed that the degree of erythrocyte agglutination in dermis capillary and veinule in group A was more serious than that of group B at 1 day postoperatively, and there was l ittle collagen and granulation tissue in group A when compared with group B at 7 days postoperatively. The ratio of wet weight to dry weight: at 3 days postoperatively, the value in group A (3.94 ± 0.14) was significantly higher than that of group B (3.43 ± 0.14) and group C (3.60 ± 0.19) (P lt; 0.05), and there was no significant difference between group B and group C (P gt; 0.05); at 7 days postoperatively, the value in group A (3.61 ± 0.11) was significantly higher than that of group B (3.08 ± 0.13) and group C (3.34 ± 0.21) (P lt; 0.05), and there was no significant difference between group B and group C (P gt; 0.05). The surface temperature of the congestive flap was (36.64 ± 0.70)℃ in group A, (38.61 ± 0.42)℃ in group B and (37.50 ± 0.46)℃ in group C at 5 days postoperatively; showing significant difference between group A and groups B, C (P lt; 0.05), and no significant difference between group B and group C (P gt; 0.05). The Color Doppler Ultrasound showed that the image of blood flow was very l ittle in group A, the image of venous return and perforator artery could be seen in group B and the image of arterial blood flow could be detected in group C. The survival rate of skin flaps was 45% ± 7% in group A, 67% ± 4% in group B and 52% ± 4% in group C at 12 days postoperatively; showing statistically significant difference between groups B, C and group A (P lt; 0.05), but no statistically significant difference between group B and group C (P gt; 0.05). Conclusion Local appl ication of natural hirudin can significantly improve the congestion of random pattern skin flap in a porcine model.
引用本文： 孙智勇,王刚,杨晓楠,健祥,滕晓颦,殷国前. 天然水蛭素对猪随意型皮瓣静脉淤血影响的实验研究. 中国修复重建外科杂志, 2008, 22(11): 1296-1300. doi: 复制