本文選題：渦靜脈 + 結(jié)扎　； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文

【摘要】：背景渦靜脈是眼球的主要回流靜脈,是脈絡(luò)膜靜脈的唯一回流途徑。渦靜脈回流系統(tǒng)的異�？蓪�(dǎo)致眼前節(jié)和眼底的多種病理生理改變,可引起前節(jié)缺血,虹膜新生血管生成,并與很多眼底疾病,如高度近視、糖尿病視網(wǎng)膜病變、中心性漿液性脈絡(luò)膜視網(wǎng)膜病變、年齡相關(guān)性黃斑變性以及息肉狀脈絡(luò)膜血管病變的發(fā)病機(jī)制相關(guān)。渦靜脈循環(huán)障礙后可能引起脈絡(luò)膜血管結(jié)構(gòu)和功能的改變和脈絡(luò)膜靜脈血流動(dòng)力學(xué)的改變。目的通過(guò)建立渦靜脈結(jié)扎動(dòng)物模型,探究渦靜脈結(jié)扎后造成的急性期和慢性期的眼部改變,評(píng)價(jià)急性期和慢性期脈絡(luò)膜血流動(dòng)力學(xué)的變化,以及評(píng)估脈絡(luò)膜血管結(jié)構(gòu)功能的變化。方法將11只食蟹猴分為A、B、C三組,每組隨機(jī)抽取一只眼為實(shí)驗(yàn)眼,另一只眼為對(duì)照眼。A、B、C組實(shí)驗(yàn)眼分別給予結(jié)扎顳上和顳下象限2條渦靜脈、只結(jié)扎顳下象限渦靜脈,激光誘導(dǎo)脈絡(luò)膜新生血管(CNV)模型后結(jié)扎顳上和顳下2條渦靜脈三種不同的處理方法,建立渦靜脈結(jié)扎動(dòng)物模型。隨訪觀察12周。每只眼分別于術(shù)前及術(shù)后當(dāng)日、術(shù)后前三天、之后每周一次進(jìn)行眼壓測(cè)定及裂隙燈觀察。每只眼分別于術(shù)前、術(shù)后1天、術(shù)后1周、4周、8周、12周進(jìn)行眼底彩照(FP)、熒光素眼底血管造影(FFA)、吲哚菁綠眼底血管造影(ICGA)、相干光斷層掃描(OCT)檢查。對(duì)比分析各時(shí)間點(diǎn)各圖像有無(wú)異常,ICG充盈速度和流空時(shí)間有無(wú)改變。利用Image J軟件在ICGA圖像對(duì)脈絡(luò)膜血管直徑進(jìn)行測(cè)量分析。結(jié)果結(jié)扎渦靜脈動(dòng)物模型成功建立,但激光誘導(dǎo)CNV模型與渦靜脈結(jié)扎術(shù)聯(lián)合的方法建立動(dòng)物模型不理想。實(shí)驗(yàn)組的眼壓在術(shù)后當(dāng)日、術(shù)后1天和術(shù)后2天明顯高于對(duì)照組(P0.05 =。術(shù)后1周內(nèi)出現(xiàn)了前房滲出、前房出血、虹膜淤血等眼前節(jié)缺血的表現(xiàn)。A組一只實(shí)驗(yàn)眼術(shù)后1周內(nèi)FFA和ICGA上出現(xiàn)顳上和顳下大范圍斑片狀熒光滲漏的表現(xiàn),術(shù)后4周發(fā)生熒光充盈遲緩甚至無(wú)熒光充盈,并隨著時(shí)間延長(zhǎng)更加明顯。其他猴無(wú)類(lèi)似表現(xiàn)。術(shù)后1天A、C組實(shí)驗(yàn)眼可見(jiàn)明顯的顳側(cè)脈絡(luò)膜靜脈充盈延遲(100%),術(shù)后1周恢復(fù)正常。術(shù)后4周開(kāi)始A、C組的實(shí)驗(yàn)眼的結(jié)扎象限的脈絡(luò)膜靜脈發(fā)生缺如現(xiàn)象(發(fā)生率:A組87.5%,C組50%)。術(shù)后12周A、C組實(shí)驗(yàn)組的顳上象限的脈絡(luò)膜血管直徑低于對(duì)照組(P0.05),其他時(shí)間點(diǎn)實(shí)驗(yàn)組和對(duì)照組比未見(jiàn)明顯差異。各組ICG排空時(shí)間未見(jiàn)統(tǒng)計(jì)學(xué)差異。OCT檢查可見(jiàn)B組實(shí)驗(yàn)眼術(shù)后1周內(nèi)顳下象限脈絡(luò)膜較顳上象限脈絡(luò)膜厚。結(jié)論渦靜脈結(jié)扎動(dòng)物模型可成功建立,結(jié)扎1-2條渦靜脈可在短期內(nèi)引起脈絡(luò)膜循環(huán)障礙相應(yīng)的表現(xiàn),長(zhǎng)期效應(yīng)為脈絡(luò)膜循環(huán)系統(tǒng)發(fā)生代償性改變。結(jié)扎渦靜脈的動(dòng)物模型更適合于急性期脈絡(luò)膜循環(huán)障礙的研究。
[Abstract]:Background Vortex vein is the main reflux vein of the eyeball and the only way of choroidal vein drainage. Abnormalities in the vortex venous reflux system can lead to multiple pathophysiological changes in the anterior segment and fundus, leading to anterior ganglion ischemia, angiogenesis of the iris, and many fundus diseases such as high myopia, diabetic retinopathy, Central serous chorioretinopathy, age-related macular degeneration and polypoid choroidal vascular disease are associated with the pathogenesis. The structure and function of choroidal vessels and the changes of choroidal venous blood flow dynamics may be caused by the disturbance of vortex vein circulation. Objective to evaluate the changes of choroidal hemodynamics in acute and chronic phase by establishing animal model of vortex vein ligation. And to evaluate the changes of choroidal vascular structure and function. Methods Eleven crab-eating monkeys were divided into three groups. One eye was randomly selected as experimental eye and the other eye as control group. The experimental eyes in group A were treated with ligation of 2 superior temporal quadrant and subtemporal quadrant vortex vein, only inferior temporal quadrant vortex vein was ligated. After laser induced CNV (choroidal neovascularization) model, two superior temporal and two infratemporal vortex veins were ligated to establish the animal model of vortex vein ligation. All patients were followed up for 12 weeks. Intraocular pressure measurement and slit lamp observation were performed on each eye before and after operation, three days before and once a week after operation. Each eye was examined by fundus color radiography (FPN), fluorescein fundus angiography (FFAA), indocyanine green fundus angiography (ICGAA) and coherence tomography (Oct) before operation, 1 day after operation, 1 week and 8 weeks and 12 weeks after operation. The ICG filling velocity and flow time of each image were compared and analyzed. The diameter of choroidal vessels was measured and analyzed by Image J software in ICGA images. Results the animal model of ligation of Vortex vein was successfully established, but the combination of laser induced CNV model and vortex vein ligation was not ideal. The intraocular pressure in the experimental group was significantly higher than that in the control group on the first day, 1 day and 2 day after operation. Anterior chamber exudation, anterior chamber hemorrhage and iris congestion were found in anterior segment ischemia within 1 week after operation. In group A, a large area of spot fluorescence leakage appeared on FFA and ICGA within 1 week after operation. 4 weeks after the operation, delayed or even no fluorescence filling occurred, and it became more obvious as time went on. Other monkeys showed no similar signs. One day after operation, the temporal choroidal vein filling delay was observed in the experimental eyes of group C, and returned to normal 1 week after operation. The absence of choroidal vein in the ligation quadrant of experimental eyes in group A was observed 4 weeks after operation (the incidence was 87.5% in group A and 50% in group C). At 12 weeks after operation, the diameter of choroidal vessels in the superior temporal quadrant of the experimental group was lower than that in the control group (P 0.05), but there was no significant difference between the experimental group and the control group at other time points. There was no statistical difference in the emptying time of ICG in each group. Oct examination showed that the choroid of the subtemporal quadrant was thicker than that of the superior temporal quadrant in group B within 1 week after operation. Conclusion the animal model of vortex vein ligation can be established successfully. Ligation of 1-2 vortex veins can cause choroidal circulatory disturbance in a short period of time. The long-term effect is compensatory change of choroidal circulatory system. The animal model of ligation of Vortex vein is more suitable for the study of choroidal circulatory disorders in acute stage.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R773.4

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