中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (09): 701-705.doi: 10.3969/j.issn.1671-4091.2023.09.015

• 血管通路 • 上一篇    下一篇

应用No-touch技术分离静脉构建家兔动静脉内瘘对手术后早期近吻合口静脉炎症反应及内膜增生的影响

张春华   焦自钊   安传国   汲 宁   丁乐欣   袁雅丽   陈萍萍   李凤楼   

  1. 276826 日照，济宁医学院附属日照市人民医院1门诊手术室 2血液净化科 3普通外科 4病理科
  • 收稿日期:2023-02-07 修回日期:2023-07-09 出版日期:2023-09-12 发布日期:2023-09-12
  • 通讯作者: 焦自钊 E-mail:jiaozzrz@sina.com
  • 基金资助:
    济宁医学院教师科研扶持基金项目(JYFC2019FKJ221)；日照市重点研发计划项目(2021ZDYF020208)

Effects on the early postoperative juxta-anastomotic venous inflammatory response and intimal hyperplasia in arteriovenous fistula in rabbits constructed with the no⁃touch technique to dissect the veins

ZHANG Chun-hua, JIAO Zi-zhao, AN Chuan-guo, JI Ning, DING Le-xin, YUAN Ya-li, CHEN Ping-ping, LI Feng-lou   

  1. Department of Outpatient Operation Division, 2Department of Blood Purification, 3Department of General Surgery, and 4Department of Pathology, the People’s Hospital of Ri’zhao Affiliated to Jining Medical College, Ri’zhao 276826, China
  • Received:2023-02-07 Revised:2023-07-09 Online:2023-09-12 Published:2023-09-12
  • Contact: 276826 日照，济宁医学院附属日照市人民医院2血液净化科 E-mail:jiaozzrz@sina.com

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摘要： 目的 探讨应用No-touch技术(no-touch technique,NTT)分离静脉构建家兔颈总动静脉内瘘(arteriovenous fistula,AVF)对手术后早期近吻合口静脉炎症反应及内膜增生的影响。方法  24只雄性家兔随机分为常规技术(conventional technique,CT)组和NTT组分别构建家兔颈总AVF，每组12只。手术后第7天每组各随机取6只家兔AVF近吻合口静脉，定量逆转录聚合酶链式反应检测其Toll样受体4(toll-like receptor 4,TLR4)、核因子-κB p65(nuclear factor-κB p65,NF-κB p65)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)mRNA表达；手术后第21天每组各取剩余6只家兔AVF近吻合口静脉，苏木精-伊红染色测量其血管内膜厚度、内中膜厚度比值，免疫组化法检测其内膜增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)的表达。 结果  CT组AVF近吻合口静脉内膜厚度、内中膜厚度比值较NTT组均明显增加(t=2.726、3.145,P=0.021、0.010)；CT组AVF近吻合口静脉内膜细胞PCNA的阳性表达率明显高于NTT组(t=4.242,P=0.002)，CT组AVF近吻合口静脉TLR4、NF-κB p65、TNF-α、IL-1β mRNA的相对表达量均明显高于NTT组(t=13.457、12.116、9.693、9.678,均P＜0.001)。 结论 比较常规技术，应用No-touch技术分离静脉构建家兔颈总AVF能够减轻手术后早期近吻合口静脉炎症反应及内膜增生。

关键词: No-touch技术, 动静脉内瘘, 近吻合口静脉, 炎症反应, 内膜增生

Abstract: Objective To investigate the effects on the early postoperative juxta-anastomotic venous inflammatory response and intimal hyperplasia of arteriovenous fistula (AVF) in rabbits constructed with the no⁃touch technique (NTT) to dissect veins.  Methods  Twenty-four male rabbits were randomly divided into conventional technique (CT) group and NTT group, with 12 rabbits in each group. AVFs were constructed with CT to dissect the veins in CT group, and with NTT to dissect veins in NTT group. At the 7th day after the operation, the juxta-anastomotic veins of AVFs were randomly collected in 6 rabbits from each group. The mRNA expressions of toll-like receptor 4 (TLR4), nuclear factor⁃κB p65 (NF⁃κB p65), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in the juxta-anastomotic veins were measured by quantitative reverse transcription PCR. At the 21st day after the operation, juxta-anastomotic veins of AVFs were collected in the remaining 6 rabbits from each group, the intimal thickness and the ratio of intima-media thickness were measured after hematoxylin-eosin staining, and the expression of proliferating cell nuclear antigen (PCNA) in the intima was detected by immunohistochemistry.  Results  The intimal thickness and intima-media thickness ratio of juxta-anastomotic veins were 23.7±3.1μm and 26.5±2.3% respectively in the CT group, significantly higher than those of（19.5±2.2）μm and 22.7±1.9% in the NTT group  (t=2.726 and 3.145 respectively; P=0.021 and 0.010 respectively). The positive expression rate of PCNA in the intimal cells of juxta-anastomotic veins was 20.2±2.3% in the CT group, significantly higher than that of 15.2±1.8% in the NTT group (t=4.242, P=0.002). The relative mRNA expressions of TLR4, NF⁃κB p65, TNF-α and IL-1β of juxta-anastomotic veins in the CT group were also significantly higher than those in the NTT group (t=13.457, 12.116, 9.693 and 9.678 respectively; P＜0.001).  Conclusions   Compared with CT, dissection of veins using NTT for the construction AVF in rabbits could attenuate the early postoperative juxta-anastomotic venous inflammatory response and intimal hyperplasia.

Key words: No?touch technique, Arteriovenous fistula, Juxta-anastomotic vein, Inflammatory response, Intimal hyperplasia

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