"Z"型及网状食管支架置入后的病理学比较研究

目的探讨Z型及网状支架置入实验犬食管后局部的形态学变化特点.方法选择成年健康实验犬,均分为Z型组和网状组,采取自体阔筋膜移植固定法置入Z型或网状食管支架,分别于术后1,2,4,8 wk分批处死每组动物,取出置架部位的食管组织,进行大体、光镜、电镜分析,并比较两组的差异.结果自体阔筋膜移植固定法能有效地固定食管支架.支架术后1,2 wk局部食管粘膜炎症反应显著,成纤维细胞处于旺盛的增殖及分泌状态,有广泛肉芽组织形成及部分纤维化,食管组织开始向管腔内生长;术后4,8 wk增生组织已完全覆盖支架结构,并连接成片,管腔明显狭窄,局部大量的纤维结缔组织形成,炎症反应缓解.两组实验标本病理形态基本相似,仅"网状"组于术后1,2 wk炎症反应明显,粘膜广泛出现溃疡.结论支架术后食管组织主要表现为肉芽组织形成及纤维化,术后4,8 wk随着炎性反应的减弱,纤维化过程渐趋稳定.网状及Z型支架术后的病理过程基本一致,网状支架术后局部炎性反应显著加重.

Pathologic study on esophagus after "Z" and "reticular" stenting

AIM To study the morphologic changes of esophagus after placement of " reticular" and " Z" stent in experimental dogs.METHODS Adult and healthy dogs were divided into "Z" and "reticular" groups. "Z" and "reticular" esophageal stents were placed by autogenous broad fascia transplantation and fixation. The animals were killed at week 1, 2, 4 and 8 respectively, and the esophageal tissue was taken and analyzed, by gross observation, light microscopy, electromicroscopy, and the differences were compared between the two groups. RESULTS By the method of "autogenous broad fascia transplantation and fixation" the esophageal stents can be fixed effectively. One and 2 weeks after stenting great inflammatory reaction occurred with the local esophageal mucosa, Fb presented proliferating and secreting status strongly, with much granulation formation and fibrosis and esophageal tissue began to proliferate towards lumen at some stenting places. At week 4 and 8 proliferating tissue covered the stent completely, and inter connected as a body, stenosis occurred with a large amount of fibrotic tissue formed with remittent inflammatory reaction. The pathologic changes were similar between two groups, only "reticular" group had much stronger inflammatory reaction at week 1 and 2, with extensive ulcers formation.CONCLUSION The esophageal tissues presented mainly granulation formation and fibrosis. At week 4 and 8 with the weakening of inflammatory reaction, fibrosis became stable gradually. The pathologic course of esophagus was the same after "Z" and "reticular" stenting.