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。
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.
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