本文選題：主動脈 + 主動脈瘤��； 參考：《中國人民解放軍醫(yī)學(xué)院》2016年博士論文

【摘要】：目的：1、應(yīng)用腹直肌后鞘建立犬胸主動脈和腹主動脈瘤模型,探討國產(chǎn)覆膜支架治療主動脈瘤的可行性,并觀察治療后的病理變化2、通過對實(shí)驗(yàn)犬按照不同oversize標(biāo)準(zhǔn)植入腹主動脈覆膜支架,通過病理檢查了解實(shí)驗(yàn)犬腹主動脈的病理學(xué)變化,揭示oversize對于主動脈的影響。方法：1.國產(chǎn)支架的設(shè)計(jì)與制作,支架由PET超薄覆膜與超彈性鎳鈦合金支架通過不可吸收縫線縫合而成。用于實(shí)驗(yàn)動物的支架設(shè)計(jì)制作,支架型血管由威海維心醫(yī)療設(shè)備有限公司按照臨床標(biāo)準(zhǔn)制作完成。2.進(jìn)行動脈瘤造模并植入國產(chǎn)覆膜支架,12條犬分為4組,每組3只實(shí)驗(yàn)狗。A組：降主動脈不進(jìn)行造瘤直接植入國產(chǎn)覆膜支架,B組：腹主動脈不進(jìn)行造瘤直接植入國產(chǎn)覆膜支架,C組：降主動脈造瘤后植入國產(chǎn)覆膜支架,D組：腹主動脈造瘤后植入國產(chǎn)覆膜支架。植入支架型血管后實(shí)驗(yàn)犬飼養(yǎng)30、60和90天,處死并取標(biāo)本進(jìn)行病理學(xué)檢查。3.15條犬分為3組,每組5只實(shí)驗(yàn)用犬。第一組：oversize 10-20%,第二組：oversize20-30%,第三組：oversize30%.在實(shí)驗(yàn)犬腹主動脈植入支架型血管后飼養(yǎng)觀察30天,處死并取標(biāo)本進(jìn)行病理學(xué)檢查和數(shù)據(jù)統(tǒng)計(jì)分析。結(jié)果：1.動脈瘤建模并行覆膜支架植入實(shí)驗(yàn)情況：共對12只實(shí)驗(yàn)動物進(jìn)行手術(shù),12例實(shí)驗(yàn)動物均成活至預(yù)訂取標(biāo)本時(shí)間。術(shù)中手術(shù)順利,主動脈造瘤成功,支架放置順利,支架植入后造影提示：支架與血管壁貼附良好,動脈瘤不顯影,無明顯內(nèi)漏發(fā)生。實(shí)驗(yàn)標(biāo)本檢查大體肉眼觀察未見鎳鈦合金金屬絲斷裂、PET覆膜破損等不良事件。2.Oversize實(shí)驗(yàn)情況：所有15只實(shí)驗(yàn)動物術(shù)中麻醉滿意,順利完成手術(shù),所有病例均存活,并成功飼養(yǎng)至30天。實(shí)驗(yàn)標(biāo)本檢查大體肉眼觀察未見鎳鈦合金金屬絲斷裂、PET覆膜破損等不良事件。結(jié)論：1、應(yīng)用腹直肌后鞘作為補(bǔ)片制作胸主動脈瘤和腹主動脈瘤,是一種簡單,有效、快捷的動脈瘤建模方式,威海維心主動脈覆膜支架產(chǎn)品療效顯著,導(dǎo)入及釋放系統(tǒng)操作簡便可靠,覆膜支架具有優(yōu)良的組織及生物相容性。2、自膨式支架會導(dǎo)致血管壁變薄,引起血管中層平滑肌纖維數(shù)量減少,其結(jié)果是導(dǎo)致血管彈性降低而發(fā)生擴(kuò)張,而這種趨勢與ocersize呈正相關(guān)。
[Abstract]:Objective to establish a canine model of thoracic aortic and abdominal aortic aneurysms with rectus abdominis posterior sheath, and to explore the feasibility of domestic covered stent in the treatment of aortic aneurysms. The pathological changes of abdominal aorta were observed after treatment. The experimental dogs were implanted with abdominal aortic stent according to different oversize standards. The pathological changes of abdominal aorta of experimental dogs were studied by pathological examination, and the influence of oversize on aorta was revealed. Method 1: 1. The design and fabrication of domestic scaffold, which is made of PET thin film and super elastic nickel titanium alloy stent, are sutured by non-absorbable suture. Stent design for experimental animals, stent vessels by Weihai Weixin Medical equipment Co., Ltd. in accordance with clinical standards. 2. 2. Twelve dogs were divided into 4 groups. Each group of 3 experimental dogs. Group A: descending aorta was not directly implanted with domestic coated stents. Group B: abdominal aorta were not directly implanted with domestic stents. Group C: after descending aortic aneurysm, domestic coated stents were implanted. Group A: after abdominal aortic aneurysm, domestic covered stent was implanted. The experimental dogs were raised for 30 days and 90 days after stenting. The dogs were killed and taken for pathological examination. 3.15 dogs were divided into 3 groups with 5 dogs in each group. The first group: 10-20, the second group: 20-30, the third group: oversize 30. The abdominal aorta of experimental dogs were fed and observed for 30 days after stenting. The specimens were sacrificed for pathological examination and statistical analysis. The result is 1: 1. Model of aneurysm and stent implantation: 12 experimental animals were operated on and all survived until the scheduled time. The operation was successful, the aortic aneurysm was successful, the stent was placed smoothly, and the angiogram showed that the stent attached well to the vascular wall, the aneurysm did not develop, and no obvious internal leakage occurred. There were no adverse events such as breakage of Nickel-Titanium alloy wire, PET film covering and breakage. 2. Oversize experiment: all 15 experimental animals were anesthetized satisfactorily during operation, and all the cases survived successfully. And successfully raised to 30 days. No adverse events such as breakage of Ni-Ti alloy wire and PET film were observed. Conclusion: using rectus abdominis posterior sheath as a patch to make thoracic aortic aneurysm and abdominal aortic aneurysm is a simple, effective and fast way to model aneurysm. The introduction and release system is simple and reliable. The stent has good tissue and biocompatibility. The self-expandable stent will lead to the thinning of vascular wall and the decrease of the number of smooth muscle fibers in vascular media. As a result, vascular elasticity decreases and dilates, a trend that is positively correlated with ocersize.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R654.3

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