肺组织瓣内衬壳聚糖支架对食管部分缺损的修补

目的: 探讨肺组织瓣内衬壳聚糖管修补食管缺损的可行性.方法: 取50只日本大耳白兔, 随机分为2组, 实验组25只, 行自体肺组织瓣修补中段食管部分缺损(内衬壳聚糖管支架); 对照组25只, 无内衬支架, 术后第2、4、8周时, 大体及组织学观察缺损修补处肺组织瓣愈合情况, 并于术后10wk对存活兔行钡餐透视观察食管通畅情况.随访观察剩余兔长期存活时间及死因.结果: 45只实验动物存活超过2 wk以上, 围手术期死亡5只, 死亡率10%, 肺组织瓣与食管缺损处牢固愈合, 肺组织瓣表面有鳞状上皮化生. 术后10 wk: 食管钡餐检查见实验组食管钡剂通过顺利, 无明显狭窄及反流, 蠕动尚可, 对照组轻度狭窄, 无明显梗阻及反流. 随访实验动物存活6-8 mo,死亡原因与手术无关.结论: 肺组织瓣修补食管缺损是一种可行的方法, 壳聚糖管可以作为内衬支架防止狭窄.     

自体小肠黏膜置换食管的实验研究

目的 探讨自体小肠黏膜替代部分食管缺损的可行性.方法 选择10只成年杂种犬,截取其小肠10cm,剥除其浆肌层,保持黏膜的完整性;颈、胸段食管切除5 cm,小肠黏膜内衬食管支架替代缺损段食管,外覆大网膜包裹移植物.观察实验犬的术后进食情况.分期处死实验犬,并行病理组织学检查.结果 实验犬均可经口进食.大网膜对移植物包裹严密,移植物血运良好,无吻合口瘘发生.术后6周移植物表面由鳞状上皮完全覆盖.结论 应用小肠黏膜替代部分食管是可行的.     

内镜下高频电切联合激光治疗颈段食管癌支架置入术后再发狭窄15例

目的: 探讨内镜下高频电切联合激光治疗颈段食管癌支架置入术后再发狭窄的疗效及安全性.方法: 本组15例患者经胃镜检查, 病理细胞学证实为食管恶性肿瘤, 颈段食管癌支架置入术后再发狭窄, 癌肿上段距门齿16-20 cm; 隆起型病变采用内镜下高频圈套电切清除, 管状浸润性狭窄病变或不能圈套病变联合激光治疗, 并观察治疗前后食管直径大小、狭窄程度改善.结果: 15例患者均成功, 术后12 h顺利进食, 无1例发生食管大出血、穿孔并发症, 治疗术前狭窄管腔直径约4±2 mm, 术后约13.5±2mm, 1 mo后完全有效11例, 显著效应3例, 有效应1例, 无效应0例, 有效率100%.结论: 内镜下高频电切联合激光治疗食管上段癌支架置入术后再发狭窄, 是目前治疗食管狭窄安全、有效的方法之一.     

三种食管支架覆膜对支架置入术后再狭窄影响的研究

目的探讨3种覆膜支架置入后引起的食管黏膜局部形态学及病理学变化特点。方法将16只新西兰大白兔分为4组,每组4只。A组置入硅橡胶覆膜镍钛合金支架,B组置入有裙边的硅橡胶覆膜镍钛合金支架（作为对照组）,C组置入有裙边的聚四氟乙烯覆膜镍钛合金支架,D组置入有裙边的聚氨酯覆膜镍钛合金支架。X线辅助下置入支架后,各组分别于术后2、4、6、8周处死1只动物,取出置架部位的食管组织分别行肉眼形态、光学显微镜、电子显微镜观察及免疫组化法检测。结果随着支架置入时间的延长,同一组内食管壁厚度相应增加,支架两端增生严重,局部肉芽组织形成及纤维化,管腔狭窄。以B组作为对照,C组相应部位同一观察时点食管壁的厚度较薄（P〈0．05）。术后2、4、6、8周光镜下观察食管黏膜炎症变化,发现A组重于B组,C组轻于B组,D组与B组相似。A组术后2周少量PCNA阳性表达,术后4周明显表达,术后6周少量表达;B、C、D组术后4、6周明显表达,术后8周少量表达。结论再狭窄主要表现为肉芽组织形成和纤维化,发生于支架两端,下端炎性反应重于上端。不同覆膜食管支架置入后引起的食管黏膜炎症变化有所不同,其中聚四氟乙烯组支架引起的黏膜炎症反应最轻,对局部食管壁的损伤出现的最晚。     

小口径镍钛合金支架治疗食管上段癌术后狭窄2例

目的观察用小口径镍钛合金支架治疗食管上段癌术后狭窄的疗效.方法食管上段癌术后或术后放疗引起吻合口狭窄是临床上十分棘手的问题.单纯采用扩张术很难维持长期效果,常规支架放置后患者疼痛难忍.本文报告2例应用小口径治疗的患者.例1,患者2a前因食管上段癌行手术切除,术后2次直线加速器放疗.术后1a出现进行性吞咽困难,X线检查发现吻合口有6cm长狭窄段,直径约0.3cm.先行萨氏扩张器扩张到1.2cm,连续3次,疗效不好.即在X线条件下放置2.0cm×6cm镍钛合金支架,术后患者进食困难无明显改善,内镜检查发现支架上口因挤压变形,失去支撑作用.经内镜取出后重新放置小口径(直径1.4cmm)支架.例2,女,45岁.5a前因食管上段癌切除术,术后放疗,3a后出现进行性吞咽困难,X线检查狭窄长约5cm,直径约0.5cm.内镜检查食管上段扩约肌以下严重狭窄,用萨氏扩张器扩张到0.9cm时,患者极度吸气性呼吸困难,考虑可能有气管狭窄,支气管镜检查见相当于第六颈椎水平气管严重狭窄,直径约0.4cm,气管内腔失去正常环状结构,当即放置1.6cm×6cm网状气管支架,患者呼吸困难立即缓解,于d2放置1.4cm×8cm网状食管支架.结果第1例患者术后有轻微疼痛,对症处理后缓解,能进半流质,随访3mo病情稳定.第2例患者术后能进半流质饮食,呼吸困难较轻.随访6mo病情无变化.结论小口径支架治疗食管高位狭窄安全有效,但需更多的病例总结经验.     

氩离子凝固术的输出功率治疗Barrett食管致食管瘢痕狭窄的影响

[目的]探讨氩离子凝固术(APC)的输出功率对治疗Barrett’s食管致食管狭窄的影响。[方法]经胃镜检查、病理证实的Barrett’s食管(全周型)患者44例,随机分成A组(22例)、B组(22例)。在氩气流量(2L/min)和作用时间(3s)固定的情况下,A组、B组分别以60 W输出功率、70 W输出功率,在内镜下行氩离子一次性全周喷凝,术后给以质子泵抑制剂辅助治疗,于治疗后4周复查胃镜及超声内镜,观察2组食管修复情况及管壁厚度及管腔有无狭窄。[结果]患者均完成治疗,4周后复查胃镜,A组表现黏膜光滑,部分可见少许白色瘢痕,蠕动正常,未见明显的管腔狭窄;B组表现黏膜色泽灰白色,APC治疗部位有大量瘢痕组织,部分黏膜充血、糜烂,食管管腔明显狭窄;A组:第4周与处理前管壁最大厚度相比较无明显变化(P0.05);B组:第4周管壁较处理前明显增厚(P0.05),有统计学意义。[结论]当氩气流量为2L/min、持续时间为3s时功率控制在≤60 W可以避免并发食管瘢痕狭窄。     

镍钛金属支架治疗高位食管梗阻15例

目的探讨高位食管内金属支架置入的可行性,为传统方法不能疏通的高位食管梗阻患者恢复自主饮食提供微创的姑息性治疗机会.方法高位颈段食管梗阻病例15例,均为男性.年龄28岁～76岁,中位年龄62岁.梗阻部位位于食管环咽段至以下12mm区间(约相当于第5颈椎下缘至胸锁关节上缘水平之间).梗阻原因分别为颈段食管癌直接浸润(4例)、颈部恶性肿瘤压迫(5例)、高位食管癌术后吻合口复发(4例)和吻合口疤痕挛缩(2例).所有病例均被判无外科手术条件,其中3例已经化学治疗,5例已经放射治疗、4例已同时接受化疗和放疗.15例中有8例已完全禁食禁水,4例尚能微量进食流质,3例微量进水,但均需静脉营养维持生命,有7例已出现低钠、低氯等电解质失衡,5例同时有气管狭窄已出现气急或呼吸不畅.在X线监视下经递送导管将超滑导丝送过阻塞段,经导丝由细及粗引入PVC扩张管进行耐受性扩张试验;经反复扩张试验后引入管径为2cm的球囊导管,根据患者耐受情况由稀释后的造影剂扩张球囊显示狭窄段并摄片留影;测量狭窄段球囊管径,根据所测管径用0.20mm镍钛合金丝以单丝编制网管状支架;再次经口插入导丝,由导丝引入附定型制作之支架的套管式输送器自膨式释放支架,或用鞘管推送器将支架送、放至狭窄段.所用支架直径11mm～15mm,长度35mm～45mm,一端或二端带喇叭口,喇叭口直径较支架主体直径增加3mm～5mm.结果15例病例共放置19个颈段食管支架,6个气管支架.支架放置后所有病例均恢复进食流质或细渣半流质.除轻微疼痛及可耐受性不适外未产生其他副作用.结论高位颈段食管并非内支架治疗禁区,对已无外科手术指征或预计外科手术影响进食功能的高位食管梗阻患者,可作为改善生活质量的姑息性治疗方法予以应用.     

回结肠代食管治疗小儿食管良性狭窄

目的采用附有回盲瓣的回结肠肠段替代食管术治疗小儿食管化学灼伤性狭窄,并对该术式的应用解剖研究和术后早期对代谢的影响作出评价.方法1992/1999采用顺蠕动回结肠肠段经胸骨后途径替代食管术式共12例,另以50具尸体观察、测量回结肠肠段的血管配布状况及20只仔猪的动物模型检测手术前后与手术组及对照组间的代谢指标的变化.结果临床12例获平均3 a随访,无手术死亡,2例发生颈部吻合口瘘;回结肠肠段的静脉配布较动脉恒定,动脉配布分7个类型,边缘动脉未见吻合中断;整段切除仔猪50 cm末端回肠、盲肠和50 cm的升结肠后,短期内影响胆汁酸(胆盐)的肠-肝循环,进而可影响脂肪代谢;因缩短了水分在肠道内吸收的时间和面积,引起粪便变稀以及失去回盲瓣的"细菌栅栏"作用导致结肠内细菌迁入回肠并大量繁殖.结论利用回盲瓣的抗反流功能施行回结肠代食管术临床已获满意疗效,掌握回结肠肠段的血管配布特点和手术后对代谢的影响将有助于指导手术操作和术后处理,减少术后并发症的发生.     

预防良性再狭窄食管支架的动物实验研究

目的于普通食管支架上口捆绑^125I粒子,通过动物实验探索其预防食管良性再狭窄的可行性及效果。方法于普通食管支架上口均匀捆绑8颗^125I粒子,制成预防食管良性再狭窄支架并进行动物实验。取32只比格犬,分为对照组、实验组,其中对照组（16只）置人捆绑空粒子的支架;实验组（16只）置入捆绑^125I粒子（33．3MBq×8）的支架。术后1、2、4、8周分别取各组犬4只,处死前行相关影像学检查及胃镜检查;处死后取各组支架上端2cm范围内的食管组织行病理学等检查。结果所有食管支架均释放到位,ECT复查未发现放射源泄漏。测量支架上口管腔内径,结果显示随着时间延长管腔逐渐变窄,4、8周时对照组较实验组更为狭窄,差异有统计学意义（P〈0．05）;免疫组化结果示平均光密度值4周时实验组较对照组减低,差异有统计学意义（P〈0．05）;羟脯氨酸及总氨基酸含量随时间延长逐渐上升并且术后4、8周时实验组较对照组含量减低,差异有统计学意义（P〈0．05）。实验观察期间内实验组支架周围的气管与大血管等与对照组肉眼、光镜所见基本一致。结论该新型支架用于食管良性狭窄的预防是可行的、安全的,并具有一定的预防和减轻支架术后良性再狭窄的效果。     

保留膈食管裂孔、管状胃成形重建食管在胸段食管癌手术中的应用

目的评价保留膈食管裂孔并行管状胃成形重建食管在胸段食管癌切除术中的应用价值。方法对55例胸段食管癌患者行根治性切除术,术中不行膈食管裂孔切开游离食管及胃,并行管状胃成形重建食管。观察手术并发症发生情况。结果 55例术后近期均恢复良好,康复出院。术后随访6～13个月,无吻合口瘘及狭窄、胸胃综合征、膈疝、反流性食管炎等并发症发生,无肿瘤复发。结论在胸段食管癌根治性切除术中不切开膈食管裂孔游离食管及胃,并用管状胃重建食管更符合人生理解剖要求,可有效预防术后并发症发生,有实用价值。     

Lung tissue flap repairs esophagus defection with an inner chitosan tube stent

AIM： TO repair the partial esophagus defect with a chitosan stent, a new esophageal prosthesis made of pulmonary tissue with vascular pedicie.
METHODS： Fifteen Japanese big ear white rabbits were divided into experimental group （n = 10） and control group （n = 5）. Esophagus defect in rabbits of experimental group was repaired using lung tissue flap with a chitosan tube stent, gross and histological appearance was observed at week 2, 4 and 8 after operation, and barium sulphate X-ray screen was performed at week 10 after operation. Esophagus defect of rabbits in control group was repaired using lung tissue flap with no chitosan tube stent, gross and histological appearance was observed at week 2, 4 and 8 after operation, and barium sulphate X-ray screen was performed at week 10 after operation.
RESULTS： In the experimental group, 6 rabbits survived for over two weeks, the lung tissue flap healed esophageal defection, and squamous metaplasia occurred on the surface of lung tissue flap. At week 10 after operation, barium sulphate examination found that barium was fluent through the esophagus with no stricture or back stream, the creeping was good. In the control group, 4 rabbits survived for two weeks, the lung tissue flap healed esophageal defection with fibrous tissue hyperplasia, barium sulphate examination found that barium was fluent through the esophagus with a slight stricture or back stream, and the creeping was not good at week 10 after operation.
CONCLUSION： Esophagus defect can be repaired using lung tissue flap with an inner chitosan tube stent.     

Postpneumonectomy esophageal fistula: a combined radiological-endoscopic technique

We report a case of a 70-year-old man who presented with a long-standing esophagocutaneous fistula following a pneumonectomy for aspergilloma. Major surgical procedures, including a pectoralis major flap reconstruction, a pedicled omental transposition and a radial forearm flap transposition, failed to obliterate the fistula. Seven years after initial surgery the esophagocutaneous fistula was successfully treated by means of a minimally invasive joint endoscopic and radiological technique. A radiographic catheter was passed through the fistula. The catheter and the guide wire were manipulated into the esophageal defect and into the upper esophagus. Under endoscopic vision, the catheter was then advanced over the guide wire and out of the patient's mouth. A T-tube was sutured to the catheter outside the mouth, pulled down through the esophagus, and into the esophageal defect and out through the chest wall, leaving the T-part of the tube within the esophagus. The patient made a good recovery and was discharged 7 days later. He was able to resume oral intake 3 weeks after the procedure.     

成膜法制作壳聚糖管状支架及支架的理化生物特性研究

目的 探讨成膜法自制壳聚糖管状支架的方法及支架的理化学生物特性.方法 利用乙酸溶液制备浓度为8％的壳聚糖乙酸水溶胶,采用成膜方法制管后用NaOH脱下壳聚糖导管,扫描电镜下观察壳聚糖管表面超微结构;并进行溶胀性实验、pH值测定、细胞毒性试验、体外及体内降解实验.结果 壳聚糖管光滑,韧性好,具有三维多孔立体结构,孔径大小不同.壳聚糖管具有膨胀性,中性,无毒,随时间被组织吸收降解,体外降解慢于体内.结论 成膜法自制壳聚糖管状支架可行,其理化生物学特性表明可用作生物可吸收支架.     

Experimental reconstruction of cervical esophageal defect with artificial esophagus made of polyurethane in a dog model

The defect of esophagus after surgical excision in patients is usually replaced by autologous stomach, jejunum, or colon. The operation brings severe trauma and complications. Using artificial esophagus to replace the defect in situ can reduce the operative trauma, simplify the operative procedures, and decrease the influence to digestive function. A variety of experiments have been designed for developing a practical artificial esophagus. Nevertheless, a safe and reliable artificial esophagus is not yet available. The objective is to evaluate the possibility of the artificial esophagus made of non‐degradable polyurethane materials being used in reconstruction of the segmental defect of cervical esophagus in beagles, observe the regeneration of esophageal tissue, and gather experience for future study. The cervical esophageal defects in 13 beagles were designed to 2‐cm long and were constructed by the artificial esophagus made of non‐degradable polyurethane materials. Nutrition supports were given after the operation. The operative mortality, anastomotic leakage, migration of artificial esophagus, and dysphagia were followed up. The regeneration of the esophageal tissues was evaluated by histopathology and immunohistochemical labeled streptavidin‐biotin method. The surgical procedures were successfully completed in all beagles, and 12‐month follow‐ups were done. Only one beagle died of severe infection, and all others survived until being killed. The anastomotic leakage occurred in nine beagles, most of them (8/9) were cured after supportive therapy. The migration of artificial esophagus occurred in all 12 surviving beagles, and one artificial esophagus stayed in situ after migration. All 12 surviving beagles showed dysphagia with taking only fluid or soft food. No beagle died of malnutrition. The neo‐esophagus was composed of granulation tissue, and the inner surface was covered by epithelium in 2–3 months completely. But the inner surface of neo‐esophagus with artificial esophagus staying in situ after migration was not covered by epithelium, and the granulation tissue was infiltrated by a great deal of inflammatory cells. Antibodies against cytokeratin were positively expressed in epithelium of neo‐esophagus. Up to 12 months after operation, antibodies against smooth muscle actin and desmin were both negatively expressed in neo‐esophagus. The artificial esophagus made of non‐degradable polyurethane reconstructing cervical esophageal defect is practicable. Although there are some problems, including anastomotic leakage, migration, and dysphagia, they are not lethal following good supportive therapy. The esophageal epithelium can regenerate with the supporting role of artificial esophagus. In the future, deformable artificial esophagus should be improved, and a much longer follow‐up will be performed to evaluate whether the esophageal gland and skeletal muscle can regenerate.     

Reconstruction techniques for hypopharyngeal and cervical esophageal carcinoma

Objective

To investigate the incidence of perioperative complications in patients with hypopharyngeal and cervical esophageal carcinoma who underwent three types of esophageal defect reconstruction procedures.

Methods

Clinical data from 105 patients with hypopharyngeal and cervical esophageal carcinoma who were treated at SUN YAT-SEN Memorial Hospital from January 2003 to February 2013 were retrospectively analyzed. Among these patients, 45 underwent a pectoral major muscle skin flap reconstruction following carcinoma resection (group A); 32 patients were treated with stomach replacement of the esophagus (group B), and 28 patients were treated with tube stomach replacement of the esophagus (group C). The incidences of perioperative complications were compared among these three groups.

Results

The incidences of anastomotic leakage, neck swelling, and incision infection were significantly lower in group C than in group A (P<0.05). The incidences of anastomotic leakage, reflux esophagitis, and thoracic stomach syndrome were significantly lower in group C than in group B (P<0.05).

Conclusions

Tube stomach replacement of the esophagus in the setting of hypopharyngeal and cervical esophageal carcinoma reduced the incidence of complications; therefore, it is a reasonable procedure for the management of esophageal defects.     

Effect of peristaltic dysfunction on esophageal volume clearance

Prolonged esophageal acid clearance, found in some patients with esophagitis, can be attributed in part to the peristaltic dysfunction observed in this population. In this study, we undertook to define the effect of commonly observed peristaltic dysfunction on volume clearance by obtaining concurrent videofluoroscopic and manometric recordings in patients with nonobstructive dysphagia or heartburn. Excellent correlation existed between the findings from the two studies. A single normal peristaltic wave resulted in 100% clearance of a barium bolus from the esophagus. At each recording site, luminal closure, as demonstrated by videofluoroscopy, coincided with the upstroke of the peristaltic pressure complex. Absent or incomplete peristaltic contractions invariably resulted in little or no volume clearance from the involved segment. Regional hypotensive peristalsis was associated with incomplete volume clearance by the mechanism of retrograde escape of barium through the region of hypotensive contraction. The regional peristaltic amplitude required to prevent retrograde escape of barium was greater in the distal compared with the proximal esophagus. The mean peristaltic amplitude associated with instances of retrograde escape was 25 mmHg in the distal esophagus compared with 12 mmHg in the proximal esophageal segments. Thus, the peristaltic dysfunction commonly seen in patients with esophagitis (failed and hypotensive peristalsis) likely leads to impaired volume clearance.     

Esophageal tissue engineering: A new approach for esophageal replacement

A number of congenital and acquired disorders require esophageal tissue replacement. Various surgical techniques, such as gastric and colonic interposition, are standards of treatment, but frequently complicated by stenosis and other problems. Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function. We review the literature of esophageal tissue engineering, discuss its implications, compare the methodologies that have been employed and suggest possible directions for the future. Medline, Embase, the Cochrane Library, National Research Register and ClinicalTrials.gov databases were searched with the following search terms: stem cell and esophagus, esophageal replacement, esophageal tissue engineering, esophageal substitution. Reference lists of papers identified were also examined and experts in this field contacted for further information. All full-text articles in English of all potentially relevant abstracts were reviewed. Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation. When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality. Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration, whilst omental wrapping to induce vascularization of the construct has an uncertain benefit. Decellularized matrices have been recently suggested as the optimal choice for scaffolds, but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution. Results in animal models that have used seeded scaffolds strongly sug- gest that seeding of both muscle and epithelial cells on scaffolds prior to implantation is a prerequisite for complete esophageal replacement. Novel approaches need to be designed to allow for peristalsis and vascularization in the engineered esophagus. Although esophageal tissue engineering potentially offers a real alternative to conventional treatments for severe esophageal disease, important barriers remain that need to be addressed.     

CASE OF A SEVERE AND LONG BENIGN STRICTURE OF THE ESOPHAGUS

A unique case of a severe and long benign stricture of the esophagus was experienced by the authors. A 50‐year‐old alcoholic man was admitted to our hospital complaining of dysphagia as well as severe and continuous retrosternal burning pain of acute onset after abrupt vomiting. His previous medical history included alcoholic liver dysfunction, renal dysfunction, Klinefelter’s syndrome and a surgically treated duodenal ulcer. Ingestion of foreign body or acid/alkali substances was excluded. Although histopathologic examination of the endoscopic biopsy specimen was reported to be an esophageal squamous cell carcinoma, endoscopic findings and a barium esophagogram were not typical for a malignant disease. Since this study demonstrated a smooth surface of the lumen in spite of it being approximately 10 cm long, severe stricture of the esophagus was diagnosed. Because the stricture was very long and severe, and was not conservatively treatable, it was decided, after obtaining informed consent, that surgical resection of the esophagus would be performed. Subtotal esophagectomy with lymph node dissection and colonic interposition was carried out. During surgery, the patient was diagnosed as having liver cirrhosis. Histopathologic examination of the surgically resected specimen revealed a 10 cm‐long narrowing of the middle and lower thoracic esophagus with thick walls, particularly in the inner circular muscle layer, without malignancy. Unfortunately, the patient’s postoperative course was followed by cervical leakage. He subsequently died of multiple organ failure on the sixteenth postoperative day. It is worth keeping in mind that esophageal benign stricture with longitudinal ulceration can be induced by esophageal submucosal dissection, as seen in the present case.     

Recurrent cervical esophageal stenosis after colon conduit failure:Use of myocutaneous flap

A 53-year-old male developed cervical esophageal stenosis after esophageal bypass surgery using a right colon conduit.The esophageal bypass surgery was performed to treat multiple esophageal strictures resulting from corrosive ingestion three years prior to presentation.Although the patient underwent several endoscopic stricture dilatations after surgery,he continued to suffer from recurrent esophageal stenosis.We planned cervical patch esophagoplasty with a pedicled skin flap of sternocleidomastoid(SCM) muscle.Postoperative recovery was successful,and the patient could eat a solid meal without difficulty and has been well for 18 mo.SCM flap esophagoplasty is an easier and safer method of managing complicated and recurrent cervical esophageal strictures than other operations.     

Poly‐ε‐caprolactone mesh as a scaffold for in vivo tissue engineering in rabbit esophagus

Repair of long‐gap esophageal atresia is associated with a high degree of complications. Tissue engineering on a scaffold of a bioresorbable material could be a solution. The aim of the present study was to investigate the in vivo tissue engineering of smooth muscle cells and epithelium on a poly‐ε‐caprolactone mesh in rabbit esophagus. Twenty female rabbits had a window of 0.6 × 1 cm cut in the abdominal part of the esophagus. The defect was covered with a poly‐ε‐caprolactone mesh. The rabbits were killed on postoperative day 28–30, and mesh with surrounding esophagus was removed for histological examination. Fifteen rabbits survived the trial period. Six had no complications and had the mesh in situ. They all had ingrowth of epithelial and smooth muscle cells and an almost completely degraded mesh. Nine rabbits developed pseudo‐diverticula. It proved possible to engineer both epithelial and smooth muscle cells on the poly‐ε‐caprolactone mesh in spite of a fast mesh degradation. The latter may be the explanation to the development of pseudo‐diverticula; this is a problem that needs attention in future experimental trials.