摘要目的 比较普通球囊扩张和冷冻扩张成形术对犬髂动脉狭窄的治疗效果.方法 采用手术结扎和缝扎方法建立犬髂动脉狭窄模型.将髂动脉狭窄成模犬采用数字表法随机分成冷冻扩张组(冷冻组)和球囊扩张组(球囊组),每组8只.2组犬分别于相应治疗后即刻和2周后进行DSA检查血管狭窄程度,并取出目标血管行HE染色和Masson染色观察血管内膜厚度及胶原纤维增生情况.同一组治疗前后的差异用配对t检验,球囊组及冷冻组间疗效差异采用Fisher确切概率法.结果 采用手术结扎和缝扎方法建立犬髂动脉狭窄模型16只均成功.狭窄血管经普通球囊和冷冻扩张成形后即刻造影显示冷冻组残存狭窄为(45±12)％,球囊组残存狭窄为(39±12)％,差异无统计学意义(t=3.183,P＞0.05)；2周后冷冻组血管狭窄(48±17)％,与术后即刻结果相比,差异无统计学意义(t=-1.271,P＞0.05)；球囊组血管狭窄(67±13)％,与术后即刻相比,差异有统计学意义(t=-6.666,P＜0.01).治疗后2周冷冻组狭窄率＜50％的6只、≥50％的2只,球囊组＜50％的1只、≥50％的7只,疗效差异有统计学意义(P =0.041).治疗后2周,目标血管经HE染色和Masson染色检查,与球囊组相比,冷冻组动脉内膜增生程度轻,新生内膜胶原纤维含量少.结论 联合应用内、中膜损伤的缝扎、结扎的手术方法可制成理想的犬髂动脉狭窄模型.与普通球囊治疗法相比,冷冻扩张成形术可以抑制狭窄血管内膜增生及胶原纤维的合成,从而有助于减轻或预防术后血管再狭窄.

abstractsObjective To evaluate the treatment effect of balloon angioplasty and cryoplasty on iliac artery stenosis in canine model.Methods Canine models of iliac artery stenosis were established with surgical ligation and transfixion.Models were randomly divided into two groups:iliac artery stenosis treated by cryoplasty (n =8) and by balloon angioplasty (n =8).The degree of iliac artery stenosis of two model groups was assessed by digital subtraction angiography (DSA) immediately and two weeks after the angioplasties.Then all the dogs were executed for pathological observation of the target vessels.Results Sixteen canine models of iliac artery stenosis were established by surgical ligation and transfixion method with 100％ success rate.DSA showed there was (45 ± 12)％ of residual artery stenosis in the cryoplasty group immediately after surgery,while it was (39-12)％ in the balloon angioplasty group,and there was no significant difference between them(t =3.183,P ＞ 0.05).The artery stenosis of cryoplasty group was (48 ± 17) ％ after two weeks and not significantly different from that after surgery immediately (t =-1.271,P ＞ 0.05).The artery stenosis of balloon angioplasty group was (67 ± 13)％ after two weeks,and it was significantly higher compared with at after surgery immediately (t =-6.666,P ＜ 0.01).The degree of vascular stenosis in balloon angioplasty group was severer than that in cryoplasty group two weeks after angiography(P =0.041).The pathological examination showed artery intimal hyperplasia in cryoplasty group was milder than that in balloon angioplasty group and neointimal content of collagen in cryoplasty group was less than that in balloon angioplasty group.Conclusions The animal models of iliac artery stenosis were established successfully with surgical ligation and transfixion by damaging the intima and media of arterial wall.Compared with balloon angioplasty,the cryoplasty was able to inhibit proliferation of intimal and reduce collagen synthesis to prevent the iliac artery restenosis.