백서 대퇴동맥에서의 혈관함입문합술과 혈관단단문합술의 주사전자현미경적 비교연구

A SCANNING ELECTRON MICROSCOPIC STUDY OF END-IN-END AND END-TO-END MICROVASCULAR ANASTOMOSIS IN THE RAT FEMORAL ARTERY

미세혈관봉합술에서의 가장 큰 문제점은 봉합부에서의 내피손상과 혈전형성이라고 볼 수 있다. 이 연구의 목적은 봉합시 일어날 수 있는 내피손상부에서의 치유과정을 관찰코져 각각 다른 문합술인 혈관함입문합술과 혈관단단문합술을 백서 대퇴부동맥에 적용하여 개존율및 전자현미경적 관찰을 통하여 비교하였고 아울러 임상에의 적용 가능성을 검토코져 하였다. 저자는 미세현미경시야에서 혈관함입문합술 20례와 단단문합술 20례를 시행한후 1일, 3일, 1주, 2주, 3주에 각각 4마리씩 희생후 문합혈관부를 육안관찰후 주사전자현미경으로 조직변화를 관찰하여 다음의 결과를 얻었다. 1. 혈관 함입문합술 시술시 문합후 개존율은 90%였고 혈관 단단문합술은 85%였다. 2. 혈관 함입문합시 술후 3일째는 문합부에서의 혈소판 응집물이 기질화되었으며 함입으로 좁아져 있던 혈관내경이 약 1주째 혈관 합입부의 중막 위축현상으로 다소 넓어졌다. 3. 혈관 내피재생과정을 혈관 함입문합술에서는 7일에서 14일경에, 혈관 단단문합술에서는 14일에서 21일째 완성되었다.

The occurrence of thrombotic occlusion & endothelial injuries at the site of anastomosis have been considered as major problems in microvascular surgery. The purpose of this study was to ascertain whether a end-in-end(sleeve, telescope) anastomosis compared favorably with end-to-end anastomosis in healing procedures on the endothelium and to study the possibility of clinical application in end-in-end method. The microvascular anastomoses have been performed with end-in-end method in the femoral arteries of 20 rats group, also with end-to-end method on the same arteries of another 20 rats group, and then the four anastomosed vessels in subdivided groups on each group were taken after period of 1, 3, 7, 14, 21 days following by anastomoses for scanning electron microscope observation. The results were as following: 1. The patency rate was 90% in the end-in-end group and 85%in the end-to-end group and late thrombus occurred at 7, 14 days on both groups, which suggested -consistent monitoring of patency was required for two weeks at least. 2. Platelet aggregates at the site of anastomosis began to organize on post-operation 3 days and in the end-in-end group, the initially decreased lumen of inserted vessel was gradually increasing on 7 days due to atrophy of the medial layers. 3. Re-endothelialization was completed between 7 and 14 days in end-in-end group, whereas between 14 and 21 days in end-to-end group.