目的 明确交感神经轴突到达外周动脉的确切途径，为新型去动脉交感神经手术策略的研发打下基础。 方法 首先取10只新生SD大鼠股神经血管束，进行全组织免疫荧光染色。接着，取40只成年SD大鼠，分为5组，分别接受假手术、股动脉外膜剥离术、股神经-动脉分离术、神经切断术和腰交感切除术。术后利用激光多普勒血流成像仪测量5组大鼠股动脉的血流灌注和直径，并使用TH、Tuj 1和α-SMA一抗，对5组股动脉外膜交感神经的变化进行检测。最后，取30只大鼠，分成上述5组后，切取以腹壁浅动脉为蒂的跨区皮瓣，7 d后测量皮瓣坏死率。使用单因素方差分析检测上述5组大鼠之间股动脉灌注、直径和皮瓣坏死率的差异。 结果 新生大鼠股神经平均发出（2.8±0.8）根直径为（4.8±1.2） μm的交感支，形成初级和次级交感神经链以支配股动脉及静脉。股神经-动脉分离、股神经切断和腰交感神经切除术可消除动脉外膜的交感神经，分别导致股动脉直径增加约22.5 %、36.7 % 和59.2 %（P<0.05），导致股动脉血流灌注分别增加约51.5%、63.4%和201.3%（P<0.01）。股动脉外膜剥离术对动脉远端外膜的交感神经、直径和灌注没有显著影响（P>0.05）。由于去交感导致股动脉血流灌注显著性增大，股神经-动脉分离、股神经切断和腰交感神经切除术能够显著减少腹部皮瓣的坏死率（P<0.001）。 结论 大鼠股动脉的交感神经支配来源于伴随神经发出的节段性交感支。可能存在3种手术方式可以去除动脉交感神经支配。
Abstract
Objective to clarify the exact route of sympathetic axons reaching the peripheral artery, and pave the way for the development of new surgical strategies for sympathetic denervation. Methods Firstly, femoral neurovascular bundles from 10 neonatal Sprague-Dawley rats were harvested for whole-mount immunostaining to show sympathetic innervation pattern of the artery. Secondly, 40 Sprague-Dawley male rats weighing 350~400 g were assigned to five groups, receiving either sham, perivascular sympathectomy, nerve-artery separation, nerve transection in the femoral neurovascular bundle or lumbar sympathectomy surgery that removes the lumbar sympathetic trunks. Immediately after surgery, the arterial perfusion and diameter were measured using Laser speckling contrast imaging, and one week later the femoral neurovascular bundles were harvested for immunostaining using antibodies against TH, neuron-specific β-tubulin (Tuj 1) , and α-SMA to show the presence or not of the TH immuopositive staining in the adventitia. Finally, 30 rats were divided into the above five groups and underwent corresponding surgery. The abdominal flap was haverstedand the necrotic area of the flap was measured 7 days later. Differences between the five groups were determined using one-way ANOVA. Results For the neonatal rats, an average of (2.8±0.8) branches with a diameter of (4.8±1.2) μm derived from the femoral nerve that morphed into a primary and a scondary sympathetic chains for innervation the femoral artery. Nerve-artery separation, nerve transection, and lumbar sympathectomy could eradicate sympathetic nerves of the artery, resulting, respectively, in a 22.5 %, 36.7 % and 59.2 % increase in diameter (P<0.05), and a 51.5%、63.4% and 201.3% increase in perfusion compared to sham surgery (P<0.01). In contrast, perivascular sympathectomy did not have a significant impact on the sympathetic nerves, the diameter and perfusion of the distal part of the artery (P>0.05). Corresponding to the changes of blood perfusion, nerve-artery separation, nerve transection and lumbar sympathectomy could significantly reduce the necrosis rate of abdominal flap (P<0.001). Conclusions sympathetic innervation of the femoral artery originates from the segmental sympathetic branches emanating from the accompany femoral nerve. There are three potential ways that can eradicate the sympthetic innervation of an artery.
关键词
交感神经 /
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动脉支配 /
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皮瓣 /
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坏死
Key words
Sympathetic nerve /
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Arterial innervation /
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Flap /
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Ischemia
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基金
福建省自然科学资金项目（2020J01625）
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