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目的探讨糖尿病状态下血管吻合口愈合规律的特点。方法将8周病程的糖尿病组和对照组SD大鼠各20只双侧颈总动脉切断后行端端吻合,于术后1、3、7、14d分别取材观察其通畅情况,并对血管吻合口行组织学、超微结构观察和图像分析。结果对照组吻合口血管内膜损伤小,管壁各层次结构清晰,炎症反应轻;糖尿病组血管内膜损伤重,管壁各层次结构紊乱,有断裂痕,管壁周围肉芽织织增生明显。吻合术后7d糖尿病组吻合口血管内膜平均再内皮化明显延迟[(3745±1045)μm2与(1298±225)μm2,P<0.01];吻合术后14d,糖尿病组血管吻合口内膜增生明显,内膜/中膜厚度比值(I/M值)达0.41±0.22。结论糖尿病改变了血管吻合口正常的愈合规律,使一个正常的吻合口愈合过程转变为一个慢性炎性、纤维增殖过程,血管吻合口部位的重塑变为病理性,上述病理改变可能是造成糖尿病血管危象易于发生的因素之一。
Objective To investigate the characteristics of vascular anastomotic healing under diabetic conditions. Methods 20-week-old bilateral common carotid arteries of 8-week-old diabetic rats and control rats were cut off and end-to-end anastomosed. At 1, 3, 7 and 14 days after operation, Oral histology, ultrastructure observation and image analysis. Results In the control group, the intima of the anastomosis had less vascular intimal injury, clear structure and clear inflammatory response. The intima-media thickness of the diabetic group was heavy, the structure of the vascular wall was disorganized, the rupture marks were observed, and the proliferation of granulation tissue around the wall was obvious. At 7 days after anastomosis, the mean re-endothelialization of vascular intima in the anastomotic group was significantly delayed [(3745 ± 1045) μm2 vs (1298 ± 225) μm2, P <0.01] Obviously, intima / media thickness ratio (I / M value) of 0.41 ± 0.22. Conclusion Diabetes mellitus can change the normal healing pattern of vascular anastomosis and convert a normal process of anastomotic healing into a chronic inflammation and fibrogenesis process. The remodeling of vascular anastomotic sites becomes pathological. The above pathological changes may be caused by diabetes Vascular crisis prone to one of the factors.