带孔钛环外支撑游离皮片重建气管缺损的动物实验

目的探讨带孔钛环外支撑游离皮片重建颈段气管缺损的可行性。方法12只成年杂种犬随机均分为两组。实验组切除颈段气管前壁、侧壁约2／3周径，长约25mm（4个气管环），制作人工气管缺损模型，取腹部全厚游离皮片修复气管缺损，皮片外部由带孔钛环悬吊支撑。对照组手术模型及缺损修复与实验组相同，但未放置钛环。术后1个月及6个月行X线及纤维支气管镜检查，观察钛环固定情况及管腔情况。术后6个月处死动物，病理检查移植物组织学变化。结果实验组动物1只术后第5天出现伤口感染裂开，皮片坏死，钛环脱落排出，予以处死；其余5只存活，无呼吸困难；X线摄片示气管腔通畅，钛环固定良好，无移位、变形；纤维支气管镜检查见管腔通畅，管壁光滑，未见狭窄、挛缩及坏死，其中1只在远心端吻合口有少量肉芽，不影响呼吸。存活动物术后6个月处死后病理检查示移植皮片表面大部分覆盖假复层柱状上皮，但上皮覆盖不连续；未见到毛囊，毛发等皮肤附件结构。3只对照组动物术后24h内死于窒息，尸检发现管腔塌陷皮片水肿；另外3只术后出现不同程度的呼吸困难，最长存活16d，术后14d纤维支气管镜检查示管腔塌陷狭窄。结论带孔钛环可重建气管支架，游离皮片可作为气管黏膜替代物，是气管重建的简便方法之一。     

记忆合金支架与游离空肠移植联合重建长段气管动物实验研究

目的探索形状记忆镍钛合金(shape-memory titanium-nickelalloy,SMA)支架与游离空肠联合修复6．0cm以上袖状气管缺损的新方法,初步评价游离空肠肠液分泌对实验犬呼吸系统的影响程度。方法建立犬游离空肠分泌模型,10只犬均分为A、B组,分别内置未覆膜和覆膜SMA内支架,研究观测去外源神经游离空肠的分泌情况。采用单独SMA裸支架置于游离空肠内(C组,6只杂种犬)和SMA硅胶管临时扩张支架内置、类“C”型支架外置于游离空肠浆膜面(D组,6只比格犬 6只杂种犬)两种方法进行长段(6．5cm)气管替代。术后分别于第7、15天和1、3、6、8个月,在麻醉下对实验犬行纤维支气管镜检查后,无痛处死2只犬并切取移植肠黏膜、吻合口组织进行光镜观察。结果两组去外源神经游离空肠肠腺分泌高峰期均位于术后7天内,7天以后肠腺分泌逐渐减少,2个月后分泌量趋于稳定。气管重建实验中,C组重建气管吻合口和中段黏膜均有肉芽组织增生,4只分别于术后7天-2个月死亡。D组除1只术后3个月因肠梗阻致死外,其余全部存活到预定观察期。两组中大部分实验犬(13／15)术后1～2个月胸部X线摄片有轻度肺炎,未发现因肠液分泌过量所致肺部感染致死者。结论采用SMA硅胶管临时扩张支架内置和类“C”型支架外置联合游离空肠移植重建长段气管,可一期解决重建气管的血管化、上皮覆盖和管腔通畅性三大难题,是比较理想和实用的长段气管替代实验方法,有进一步临床实验价值;游离空肠替代气管后,未发现因肠液分泌扰乱肺功能致死的情况。     

聚丙烯网状材料与颈前皮瓣联合重建气管的实验研究

目的 通过构建犬颈段气管缺损与重建的实验动物模型,寻找一种通过一期手术即能与自体气管完全愈合为一体的人工气管材料和手术方法.方法 将8只犬一期手术切除3.5～4.0 cm长的颈部气管,采用可以永久保留在体内的聚丙烯网状材料与颈前皮瓣联合行气管重建,术后初期管腔内置入Z型金属覆膜气管支架,观察犬的生存期、生存质量,通过纤维气管镜、X线片及组织切片观察吻合口愈合情况及病理变化.结果 8只犬中1只犬因继发呼吸衰竭于术后2 d死亡,1只犬因吻合口感染术后10 d死亡.存活的6只犬中除1只并发轻度气管狭窄,其余5只犬生活质量好,术后第2 d即可正常饮水及进食,无呼吸困难等并发症.术后2、4、8周及6个月处死动物取出重建气管标本,见2周时有软组织长入聚丙烯网孔,使其硬度增加并具有一定的支撑度;4周时长入网孔的软组织增多;8周及6个月时软组织将聚丙烯网完全覆盖,并发生纤维化使网的支撑度明显增加.病理检查显示,术后2、4、8周时可见吻合口肉芽生长,术后6个月时肉芽组织较前缩小,皮瓣的鳞状上皮与黏膜的柱状上皮愈合良好.结论 具有良好的组织相容性的聚丙烯网状材料与颈前皮瓣联合一期成形重建气管可与自体气管融为一体,成为自体气管的一部分,此种重建气管方法有望应用到临床.     

气管食管科学

20020469经墓磷灰石气管重建的实验研究/秦永…//中华耳鼻咽喉科杂志一2001,36(4)一281~284 目的:探讨富含微孔的管状轻基磷灰石(HA)人工气管用于长段气管环形缺损修复的可行性。方法:采用实验动物为健康家犬,共12只。切除环状软骨弓、部分软骨板以及颈段10个气管环,将长约scm管型HA人工气管分别与环甲膜、残存的环状软骨板和气管断端吻合固定,6个月后处死存活的实验动物8只,取出植入的HA管及其周围组织,进行组织病理学和扫描电镜检查。结果:HA管植入6个月后,植入位置无明显改变。显微镜下见纤维结缔组织、新生血管及组织细胞长入HA管微…     

丝素蛋白涂覆的钛网在家兔气管缺损重建中的应用

目的探讨丝素蛋白涂覆的钛网在促进气管黏膜愈合及减少术后并发症方面的作用。方法采用随机数字表法将25只新西兰雄性白兔随机分为丝素蛋白涂覆的钛网组(12只),单纯钛网组(12只),正常对照家兔(1只)。将丝素蛋白涂覆的钛网和单纯钛网分别埋植于家兔气管7~12环前,2周后全层切除7~12环气管前面及两侧面,大小为8MM×6MM,并用预先埋植的丝素蛋白涂覆的钛网和单纯钛网修复气管缺损;于术后4周、8周、12周分批处死家兔,并行气管CT、内镜、病理及扫描电镜检查。1只正常家兔切取7~12环气管作为对照。结果两实验组各有1只家兔死于腹泻。丝素蛋白涂覆的钛网组术后3只家兔并发颈部皮下气肿(25·0%),无窒息家兔;术后4周、8周、12周气管CT检查、内镜检查基本无管腔狭窄;组织病理学检查无明显肉芽及瘢痕增生,黏膜组织及纤毛生长良好,重建12周后丝素未完全吸收,残余丝素生物相容性好;扫描电镜检查显示黏膜纤毛恢复快于单纯钛网重建组,术后12周纤毛基本恢复正常;气管管腔狭窄处增生组织的截面积为(X-±S,下同)为(3·15±1·58)MM2。单纯钛网重建组全部家兔术后并发颈部及全身皮下气肿(100·0%),5只(5/12,41·7%)家兔分别于术后4~60D因窒息死亡;气管CT检查、内镜及组织病理学检查,7只有肉芽及瘢痕增生,气管狭窄;气管管腔狭窄处增生组织的截面积为(18·15±7·85)MM2。两组的术后窒息死亡率、皮下气肿发生率、管腔狭窄处增生组织截面积比较,差异均有统计学意义(P值均<0·05)。结论丝素及丝素蛋白涂覆的钛网具有良好的生物相容性,用于家兔气管重建,可以促进气管黏膜的修复愈合,减少术后皮下气肿、气管狭窄,有望用于临床环行气管组织缺损的重建。     

羟基磷灰石气管重建的实验研究

目的探讨富含微孔的管状羟基磷灰石(hydroxyapatite,HA)人工气管用于长段气管环形缺损修复的可行性.方法采用实验动物为健康家犬,共12只.切除环状软骨弓、部分软骨板以及颈段10个气管环,将长约5cm管型HA人工气管分别与环甲膜、残存的环状软骨板和气管断端吻合固定,6个月后处死存活的实验动物8只,取出植入的HA管及其周围组织,进行组织病理学和扫描电镜检查.结果HA管植入6个月后,植入位置无明显改变.显微镜下见纤维结缔组织、新生血管及组织细胞长入HA管微孔,占据HA管微孔壁的外2/3,HA内管壁未见上皮覆盖.吻合口周围出现不同程度肉芽组织增生和瘢痕形成,但气管管腔无明显狭窄,实验动物均未出现呼吸困难和窒息.结论通过确切地手术吻合固定,喉气管的正常活动不影响自体组织长入HA管,气管粘膜上皮未见移行于HA管内壁表面.单纯采用HA管型材料修复较长的环形气管缺损能维持实验动物正常的呼吸功能,吻合口附近纤维结缔组织增生和瘢痕形成等问题有待于进一步解决.     

聚丙烯网状材料与颈前皮瓣联合重建气管的实验研究

目的通过构建犬颈段气管缺损与重建的实验动物模型，寻找一种通过一期手术即能与自体气管完全愈合为一体的人工气管材料和手术方法。方法将8只犬一期手术切除3．5—4．0cm长的颈部气管，采用可以永久保留在体内的聚丙烯网状材料与颈前皮瓣联合行气管重建，术后初期管腔内置入z型金属覆膜气管支架，观察犬的生存期、生存质量，通过纤维气管镜、x线片及组织切片观察吻合口愈合情况及病理变化。结果8只犬中1只犬因继发呼吸衰竭于术后2d死亡，1只犬因吻合口感染术后10d死亡。存活的6只犬中除1只并发轻度气管狭窄，其余5只犬生活质量好，术后第2d即可正常饮水及进食，无呼吸困难等并发症。术后2、4、8周及6个月处死动物取出重建气管标本，见2周时有软组织长入聚丙烯网孔，使其硬度增加并具有一定的支撑度；4周时长入网孔的软组织增多；8周及6个月时软组织将聚丙烯网完全覆盖，并发生纤维化使网的支撑度明显增加。病理检查显示，术后2、4、8周时可见吻合口肉芽生长，术后6个月时肉芽组织较前缩小，皮瓣的鳞状上皮与黏膜的柱状上皮愈合良好。结论具有良好的组织相容性的聚丙烯网状材料与颈前皮瓣联合一期成形重建气管可与自体气管融为一体，成为自体气管的一部分，此种重建气管方法有望应用到临床。     

记忆合金支架与游离空肠移植联合重建长段气管动物实验研究

目的 探索形状记忆镍钛合金(shape-memory titanium-nickel alloy,SMA)支架与游离空肠联合修复6.0 cm以上袖状气管缺损的新方法,初步评价游离空肠肠液分泌对实验犬呼吸系统的影响程度。方法 建立犬游离空肠分泌模型,10只犬均分为A、B组,分别内置未覆膜和覆膜SMA内支架,研究观测去外源神经游离空肠的分泌情况。采用单独SMA裸支架置于游离空肠内(C组,6只杂种犬)和SMA硅胶管临时扩张支架内置、类“C”型支架外置于游离空肠浆膜面(D组,6只比格犬 6只杂种犬)两种方法进行长段(6.5 cm)气管替代。术后分别于第7、15天和1、3、6、8个月,在麻醉下对实验犬行纤维支气管镜检查后,无痛处死2只犬并切取移植肠黏膜、吻合口组织进行光镜观察。结果 两组去外源神经游离空肠肠腺分泌高峰期均位于术后7天内,7天以后肠腺分泌逐渐减少,2个月后分泌量趋于稳定。气管重建实验中,C组重建气管吻合口和中段黏膜均有肉芽组织增生,4只分别于术后7天～2个月死亡。D组除1只术后3个月因肠梗阻致死外,其余全部存活到预定观察期。两组中大部分实验犬(13/15)术后1～2个月胸部X线摄片有轻度肺炎,未发现因肠液分泌过量所致肺部感染致死者。结论 采用SMA硅胶管临时扩张支架内置和类“C”型支架外置联合游离空肠移植重建长段气管,可一期解决重     

羟基磷灰石气管重建的实验研究

目的 探讨富含微孔的管状羟基磷灰石（hydroxyapatite,HA）人工气管用于长段气管环形缺损修复的可行性。方法 采用实验动物为健康家 犬，共12只。切除环状软骨弓、部分软骨板以及颈段10个气管环，将长约5cm管型HA人工气管分别与环甲膜、残存的环状软骨板和气管断端吻合固定，6个月后处死存活有实验动物8只，取出植入的HA管及其周围组织,进行病理组织学和扫描电镜检查。结果 HA管植入6个月后，植入位置无明显改变。显微镜下见纤维结缔组织、新生血管及组织细胞长入HA管微孔，占据HA管微孔壁的2／3，HA内管壁未见上皮覆盖。吻合口周围出现不同程度肉芽组织增生和瘢痕形成，但气管管腔无明显狭窄，实验动物均未出现呼吸困难和窒息。结论 通过确切地手术吻合固定，喉气管的正常活动不影响自体组织长入HA管，气管粘膜上皮未见移行于HA管内壁表面。单纯采用HA管型材料修复较长的环形气管缺损能维持实验动物正常的呼吸功能，吻合口附近纤维结缔组织增生和瘢痕形成等问题有待于进一步解决。     

镍钛记忆合金网修复气管缺损的实验研究

目的：探讨应用“C”形镍钛记忆合金网进行气管缺损修复的可行性。方法：以皮肤代替气管黏膜上皮,以镍钛记忆合金网代替气管软骨构建成气管样结构,修复犬气管缺损。结果：5只犬除1只因感染失败外,其余4只顺利拔管。CT和纤维气管镜检查均显示镍钛记忆合金网位置良好,管腔宽敞。结论：应用皮管和镍钛记忆合金网二期重建可修复大段气管缺损,是一有良好前景的修复气管缺损的方法。     

聚丙烯网状材料与颈前皮瓣联合重建气管的实验研究

OBJECTIVE: Canine model established for tracheal defect reconstruction, to investigate the outcome of tracheal reconstruction with combination of polypropynene and flap. METHODS: About 3.5 to 4 centimeter cervical trachea was resected and replaced with artificial trachea made from monofilament knitted polypropylene and surgical flap. Covered stent was implanted postoperatively. Survival period and quality of life were recorded, bronchofibroscopy, X-ray films and HE sections were perfomed. RESULTS: Six dogs survived well and another two died. The causes of death were respiratory failure in 1 and infection in another. Stenosis of anastomosis in 1 was recorded during survival period. The dogs started drinking and eating on the second postoperative day, no dyspnea was found. The animals were sacrificed at 2, 4, 8 weeks and 6 months after surgery. Soft tissue growth was found in polypropynene net 2 weeks after surgery and more at 4 weeks. The polypropynene net was covered completely with soft tissue at 8 weeks and 6 months postoperatively, the hardness and sustentation degree were enhanced following the growth and fibrosis of soft tissue. The squamous epithelium and columnar epithelium were observed healing well by HE staining method. CONCLUSIONS: One-stage operative artificial trachea made from monofilament knitted polypropylene which has good histocompatibility and surgical flap is the closer artificial trachea to native trachea. It has a promising prospect in clinical use.     

Viability of a 12-ring complete tracheal segment transferred in the form of a compound flap: an experimental study in dogs

INTRODUCTION: There is a lack of an ideal substitute for the injured tracheal tissues. Autologous or homologous grafts and prostheses are inadequate because of their unreliable and nonviable nature for the reconstruction of a complete tracheal segment (CTS). OBJECTIVE: We studied the viability of a 12-ring CTS transferred in the form of a compound flap from the sternohyoid muscle (SM) for tracheal reconstruction. METHODS: Sixteen mongrel dogs of both sexes were divided into two groups of eight dogs each. In group I (control), a 12-ring CTS was removed and then reimplanted as an autograft. In group II, an SM flap was used to envelop four rings of the CTS to produce a compound CTS flap neovascularized by the SM (CTSNV). After 21 days, a 12-ring CTSNV, consisting of the four rings previously covered with SM, four rings above, and four rings below (without muscle covering), was sectioned and completely separated from the trachea. The CTS was then reimplanted at its original site, with the SM being the only vascular supply pedicle for the flap. RESULTS: The results were evaluated clinically and by macroscopic and microscopic examination of the surgical specimens. All the animals in group I (control) died or were killed by the first or second week because of necrosis and stenosis of the CTS graft. In group II, all animals were killed after 77 days of follow-up without showing any alteration in the CTSNV. CONCLUSIONS: We conclude that a compound 12-ring CTSNV flap remains viable and can be mobilized from the trachea without the risk of necrosis or stenosis.     

Effect of the hyaluronic acid on tracheal healing. A canine experimental mode

Several drugs have been used to modulate of the tracheal healing process in order to prevent tracheal stenosis. Hyaluronic acid (HA) is a modulator of the fibrogenesis. In this work we evaluate the effect in order the application of hyaluronic acid has on tracheal healing, after cervical tracheoplasty in dogs. A cervical tracheal resection and tracheoplasty was performed in 12 dogs and they were treated following surgery as follows: Group I (n = 6) Topical application of normal saline solution (0.9%) on the anastomosis site. Group II Topical application of hyaluronic acid on the trachea anastomosed. The animals were evaluated clinical, radiological and tracheoscopically during 4 weeks and were submitted to euthanasia. Macroscopic and microscopic examinations of the tracheal anastomotic healing were evaluated. Biochemical collagen quantification by the Woessner method was performed to evaluate the collagen development at the anastomotic site. All the animals survived the surgical procedure and the study time. No animal presented differences in clinical evaluation. Radiological and endoscopical findings both two showed more development of the tracheal stenosis in-group than in group II. The tracheoscopy and macroscopic studies showed major inflammation and development of fibrotic tissue with a firm consistency in the healing of the group I than in group II. Microscopic examination in group I showed severe fibrosis and inflammatory reaction. The group II presented deposits of a thin and organized collagen fibers and minimal inflammatory reaction. Biochemical collagen concentration was larger in-group I, however significantly. We conclude that the hyaluronic acid applied after cervical tracheoplasty in dogs reduces postsurgical tracheal stenosis and inflammation, as well as improve the quality of the tracheal healing.     

部分去黏膜游离空肠重建长段气管后肠黏膜组织学研究

目的：通过建立部分去除黏膜层的带蒂游离空肠段重建6．5cm袖状气管缺损动物模型,研究部分去黏膜空肠重建气管后空肠黏膜层的组织学变化。方法：比革犬8只,在制作好带蒂部分去黏膜游离空肠段后,肠腔内放置硅胶管内支架,空肠外面放置形状记忆镍钛合金外支架,切除犬的6．5cm长袖状气管后,将肠系膜动静脉分别与右侧颈总动脉、颈内静脉相吻合,重建气管缺损。术后分别于1、2、3、4个月各处死2只犬,于吻合口和移植空肠肠腔中部取活检,标本行光镜及电镜观察。结果：8只犬术后全部生存到预期时间,移植游离空肠全部成活。组织学观察术后1个月时空肠段重建气管的上皮层大量缩短的小肠绒毛,绒毛间有大量的纤维素性渗出和炎性细胞。术后2个月时小肠的绒毛明显稀疏减少、长度明显缩短,腺体萎缩,腺腔缩小,肠黏膜上皮层明显变薄。术后3个月时移植空肠腔上皮基本化生为鳞状上皮,4个月时移植空肠内腔部分鳞状上皮化生为假复层纤毛柱状上皮。结论：部分去黏膜游离空肠重建长段气管后可以加速肠腔黏膜层的萎缩及化生过程,3个月可见肠腔黏膜层化生为鳞状上皮、4个月时有部分鳞状上皮化生为假复层纤毛柱状上皮。     

Further experience with tracheojejunal shunt speech after pharyngolaryngoesophagectomy

Over the past 10 years, 16 patients have undergone the tracheojejunal shunt operation for voice reconstruction after undergoing pharyngolaryngoesophagectomy with free jejunum reconstruction for advanced hypopharyngeal cancer. For the purpose of voice reconstruction, a 2-cm inferiorly based tracheal flap is obtained from the membranous part of the trachea by removing 4 cartilaginous tracheal rings. After the establishment of digestive continuity with the jejunal graft, a side-to-side anastomosis is created by approximating the incised margin of the jejunal mucosa to that of the tracheal flap. The tracheal flap is tubed to construct the tracheojejunal shunt. In addition, the incised margin of the jejunal serosa is sutured to the lateral wall of the shunt to reinforce the approximation of the shunt to the jejunal graft. Thirteen of the 16 patients (81%) were initially capable of voice production. The length of time during which tracheojejunal speech has been used ranges from 18 to 122 months, with a mean of 55 months. During follow-up, 12 of the 13 patients (92%) have been able to swallow without aspiration.     

胸锁乳突肌肌骨膜瓣修复颈段气管缺损

目的:探讨利用胸锁乳突肌肌骨膜瓣修复颈段气管缺损的方法。方法:对13例恶性肿瘤侵犯颈段气管及原发性气管肿瘤患者,切除肿瘤及受累气管壁后利用胸锁乳突肌肌骨膜瓣修复气管壁缺损。结果:13例患者中,气管切开患者为10例,9例分别于术后1~5个月拔除气管套管,1例因声门区狭窄,戴管呼吸,3例未行气管切开患者术后呼吸通畅。结论:带蒂胸锁乳突肌肌骨膜瓣是较好的气管修复材料。     

Tracheal regeneration after partial resection: a tissue engineering approach

OBJECTIVES: The aims of this study are to investigate the efficiency of a tissue engineering approach to partial tracheal reconstruction and to improve epithelialization of the reconstructed trachea. The trachea must be resected in some cases of cancer or trauma. Various restructuring techniques are used, with no consensus on the best approach. Two problems that arise when treating tracheal defects by conventional techniques are an inability to regenerate ciliated epithelium at the reconstructed site and having to perform multiple procedures to achieve the desired repair. This study is designed to address these problems. STUDY DESIGN: Preliminary, an animal experiment. METHODS: Surgery was performed on five adult beagles under anesthesia. After the making of a longitudinal cervical skin incision, the trachea was exposed and a circular defect created. A polypropylene and collagen scaffold preclotted with peripheral blood was inserted to the defect site. Postoperatively, the site was evaluated fiberscopically, histologically, and radiographically. RESULTS: All dogs did well postoperatively. Fiberscopic examination showed that the implanted scaffolds were completely covered with regenerated mucosa with capillaries in all cases. Histologic data showed ciliated epithelium regenerated at the operated site from 1 month postoperatively. Newly formed cartilage was detected in the specimens from 8 to 12 postoperative months. Computed tomography images revealed the fine luminal contour of the regenerated site. CONCLUSIONS: Good epithelial regeneration was observed after repair of a round tracheal resection using a simple tissue engineering technique, making the technique a good substitute for conventional approaches to tracheal reconstruction in patients with cancer or trauma.