显微外科学习班幻灯课件_1.pptVIP

Management of Vascular Crisis in Microsurgical Operation Shanghai Sixth’s People’s Hospital Cunyi Fan MDPhD  Reasons of vascular crisis 1.Inadequate blood circulation 2.Compression of hamatoma 3.Abnormal position of the limbs 4.Machnical incitation 5.Coldness, low tempreature 6.Chemical incitation ——vascular spasm——thrombosis Survival rate of free tissue transplantationOur hopital: 93％ averageReason of vascular crisis:80％: thrombosisPrevention of thrombosis formation is the key to raise the survival rate of transplanted tissues Foundation of thrombosis 1. Structural changes of vascular wall 2.changes of blood血液动力学的改变 3.Changes of blood ingredient Anatomical tructure of the vessel 1.Internal membrane:endothelia cell,内皮下层、internal elastic membrane 2.Smooth muscle（artery） 3.Epithelium（nutrition vessels, nerves) Functional anatomy of microvesselsInternal membrane：Endothelial cell layer：Ingredients:monolayer of ECCharacter：1.The thinnest layer2. Longitudinal line with the blood flow3.Limited cellular space, incitation─exposure of collgen Function of EC：Powerful negative proton in the surface of EC, correspondent with the negation proton of the blood—排斥each otherInjury of the EC—exposure of the collgen with 正电荷proton—combination with the platelets(negative proton)—thrombosis Functional anatomy of microvessels Function of EC：PGI2合成酶──PGI2──dilation to the blood vessel，inhibit the aggregation of the platelets Functional anatomy of microvessels Functional anatomy of microvessels Function of EC：合成 and release ADPase──ADP分解──inhibit the aggregation of the platelets Functional anatomy of microvessels Function of EC：Store the anti-凝血 en酶第Ⅳ因子（体内主要抗凝因子） 微血管的机能解剖内皮细胞机能：内皮细胞能摄取分解血管收缩物质5—羟色胺、儿茶酚胺等 微血管的机能解剖内皮细胞机能：内皮细胞含血管舒张因子 血管壁的解剖结构内皮下层紧贴内皮细胞层，纤维蛋白具有强大正电荷—强的血栓形成作用 血管壁的解剖结构内弹力层：位置：在内层与中层之间组成：薄层弹力纤维形成的膜特点：环形，膜上有