消化道重建三种吻合方法的微循环研究

目的比较研究常用的三种肠吻合术的吻合口微循环及愈合情况。方法杂种犬18只,每只犬小肠的近端、中段及远端分别进行A lbert单层吻合、A lbert-Lembert双层吻合及吻合器吻合,每种吻合均有6只犬在相同部位进行同一种吻合。分别于术后3、5、7 d行二次开腹手术,对比观察吻合口的微循环、愈合情况、病理形态学、肠组织匀浆的SOD活性和MDA含量。结果单层吻合与吻合器吻合术后,吻合口区域的微区血流量、微循环流态、微血管的面密度和数密度均优于双层吻合术,且前两者的过氧化损伤、炎症反应和吻合口内翻较轻,手术用时较短。结论肠单层吻合与吻合器吻合术后,吻合口的微循环重建和愈合情况优于双层吻合术。     

两种缝线在模拟胰十二指肠切除术胆肠吻合重建动物实验中的应用

目的通过模拟胰十二指肠切除术胆肠吻合重建,寻找适宜的胆肠吻合术缝线。方法选择健康犬6只,随机分成Prolene组(使用prolene线缝合吻合口)和PDS组(使用PDS线缝合吻合口),每组3只。完成术前准备后行模拟胰十二指肠切除重建术,选择不同的吻合缝线,观察实验犬胆总管内壁直径及肝功能变化。结果 2组实验犬术后生存率均为100%,感染率为33. 3%。PDS组术中与术后30 d胆总管内壁直径比较,差异有统计学意义(P 0. 05)。Prolene组术中与术后30 d胆总管内壁直径比较,差异无统计学意义(P0. 05)。2组术中胆总管内壁直径与术后30 d胆总管内壁直径差值、平均胆管扩张度比较,差异均无统计学意义(P0. 05)。2组术后发生恶心呕吐与肝功能异常并发症比较,差异无统计学意义(P0. 05)。2组术前、术后7 d、14 d、30 d的ALT、AST、TBIL、ALKP比较,差异均无统计学意义(P 0. 05)。术后7 d,Prolene组的ALT、AST、TBIL、ALKP值最大。结论在早期预后方面,应用Prolene线缝合胆肠吻合口对吻合口的影响小于PDS线。     

几丁糖对大鼠股动脉吻合口通畅率的影响

背景：几丁糖在预防术后组织粘连方面疗效确切,但在断指再植术后能否应用,其对血管吻合口的愈合是否有影响,国内外文献较少提及。 目的：观察医用几丁糖对成年大鼠股动脉吻合口通畅率的影响。 方法：离断SD大鼠双侧股动脉,左侧为实验组,右侧为对照组,显微镜下吻合双侧股动脉,所有吻合动脉即时通畅率达100%,且为同一人操作,吻合后,实验组吻合口周围均匀涂布医用几丁糖1滴,对照组不涂。分别观察术后7,14,21,28 d大鼠吻合口的通畅情况,吻合口口径、吻合口周围有无感染、周围粘连情况及病理切片观察吻合口内皮细胞覆盖情况。 结果与结论：术前、术后吻合口管径无明显变化,实验组和对照组吻合口周围均无明显感染,实验组吻合口周围粘连较对照组轻,吻合口总体通畅率实验组为96%,对照组为89%,差异无显著性意义。术后各个时间段实验组、对照组内皮细胞覆盖情况差异无显著性意义。提示医用几丁糖的放置不影响大鼠股动脉吻合口的总体通畅率。     

新型可降解吻合夹吻合血管的生物力学特点

背景:目前国内外应用于临床的血管吻合器均可以克服传统血管吻合方法操作复杂、吻合时间长和内膜损伤等严重缺陷。但其不可吸收的针环影响了吻合口处血管正常收缩与舒张的生理功能,从而限制血管的生长,不适宜未成年患者。目的:分析新型可降解的吻合夹吻合血管的生物力学特点。方法:剪断新西兰大白兔双侧颈静脉,一侧应用新型可完全降解的吻合夹吻合,另一侧行针线吻合对照,测定术后当天,第7,14,30天时离体血管吻合口的平均破裂压。结果与结论:吻合夹组吻合时间短于针线吻合法(P0.05),吻合夹组平均破裂压与针线吻合法组比较差异无显著性意义(P0.05)。生物力学表明新型可降解的吻合夹安全可靠。     

直肠癌低位前切除术吻合口漏的防治

目的：探讨直肠癌低位前切除术吻合口漏的原因、预防及处理方法。方法：采用双吻合技术施行直肠癌低位前切除术39例,术后引流管放置到病人进食排便后5天酌情拔除,每日扩肛。对发生吻合口漏者改进无渣或少渣饮食,局部冲洗,漏口处周围腔隙明显减小后及时将引流管拔至漏口以下水平。结果：39例中发生吻合口漏3例。原因分别为吻合不确切、吻合口存在感染因素及吻合口存在潜在缺血区域,均经非手术治疗愈合。其中明显漏1例术后半年内吻合口狭窄,1年后恢复正常,微小漏2例无吻合口狭窄。结论：掌握直肠癌低位前切除术要点并注重操作细节是预防吻合口漏的关键。恰当调整引流管放置时间和位置对吻合口漏的及时发现及预后具有重要意义。     

人工气管材料的研究

气管是呼吸系统重要的通道,但有时往往会因肿瘤、理化等原因需要行切除,而当切除长度超过6cm,则需借气管假体等代用品来重建气管。迄今为止,对气管假体的研究包括以下几类：
　　1.1涤纶一硅胶制品涤纶、硅胶材料组织相容性良好、排异反应小,在医学领域应用范围广。虽有报道用于患者术后恢复良好,但Dodge等使用硅胶材料在兔体内的实验中观察到吻合口外层被纤维细胞包盖,内腔存留大量的坏死细胞,并缺乏可再生的气管内皮细胞,故认为此类产品仅能作为临时通道,而非长久使用[1]。     

改良胃食管吻合在食管癌切除术中的应用

目的探讨改良胃食管吻合术应用于食管癌切除术中预防吻合口狭窄的临床效果。方法将接受食管癌切除术98例病人分为两组,实验组49例施行改良胃食管吻合,对照组采用传统的方法,胃食管单纯吻合法,比较两组病人术后吻合口狭窄发生率。结果实验组49例病人术后随访3～30个月,通过食道吞钡或胃镜检查,提示无吻合口狭窄。对照组49例术后随访3～30个月,通过胃镜或食道吞钡摄片证实12例有不同程度的吻合口狭窄,其中吻合口宽度在0.5～0.7 cm之间8例,吻合口宽度在0.3～0.5 cm之间3例,吻合口宽度<0.3 cm有1例,吻合口狭窄发生率达24%。两组比较差异均有显著性(P<0.05),实验组发生吻合口狭窄明显低于对照组。结论改良胃食管吻合术有降低食管癌切除术后吻合口狭窄发生率的优点,有效减轻病员术后的痛苦,提高生存质量,值得临床上推广应用。     

新型复合型人工气管移植实验研究

以聚四氟乙烯人造血管为主体,两端压制钛金属支撑环集成构建一种新型复合型人工气管。制作犬颈段气管缺如模型,用复合人工气管重建呼吸道。通过犬体内移植动物实验观察复合型人工气管初步效果和影响长期生存的因素。直接移植复合人工气管作为对照组(n=8),复合人工气管移植后加生长因子等改善组织环境作为实验组(n=8)。术后定期气管镜检查以及处死后组织检查评价复合型人工气管移植效果。16只实验动物复合型人工气管均顺利完成移植,无手术死亡。一月后各组吻合口处有肉芽增生。对照组4只犬因移植后呼吸困难死亡,实验组有2只死亡。死亡犬经解剖标本显示吻合口感染、裂开,气道狭窄,人工气管移位脱落。其余犬按计划14月后处死。实验组平均生存时间长于实验组(558.6dvs 401.8d,P0.05);实验组吻合口感染、裂开、重度狭窄以及意外死亡的发生率均低于对照组(P0.05)。犬处死后解剖显示复合人工气管已被纤维组织包裹,人工气管腔内未见内膜生长。以聚四氟乙烯为主体连接支撑钛环的新型复合型人工气管替代自体气管重建气道,恢复气道通畅性,能保持移植物不变形。人工气管的复合设计减轻了吻合口狭窄,而感染和裂开仍是复合型人工气管移植的主要并发症,影响动物长期生存。应用生长因子改善局部环境可促进组织愈合。     

悬吊造瘘在新生儿小肠闭锁手术中的应用

目的探讨减少新生儿小肠闭锁术后吻合口瘘发生率的措施和方法。方法总结近期采用新措施治疗的8例新生儿小肠闭锁，分析可能引发吻合口瘘的相关因素。结果8例两盲端肠管口径相差悬殊的新生儿小肠闭锁采用Ⅰ期吻合加悬吊造瘘的手术方法，无一例发生吻合口瘘。结论悬吊造瘘能有效减低吻合口处的压力，利于吻合口的生长愈合，显著提高新生儿肠闭锁的手术治愈率，降低因为发生吻合口瘘而导致的死亡率。     

食管贲门癌术后吻合口瘘50例临床分析

目的总结50例食管贲门癌切除术后吻口瘘的治疗体会,探讨食管癌、贲门癌术后吻合口瘘发生的原因及防治方法。方法总结我院50例食管贲门癌切除术后吻口瘘的临床资料,12例二次手术治疗,38例保守治疗。结果保守治疗死亡3例,手术治疗死亡4例,死亡总数7例,总死亡率14%。结论手术切口的选择,保证吻合口的血液供应,大网膜包绕吻合口,营养支持是预防吻合口瘘的有效措施。早期吻合口瘘,如无明显的手术禁忌证,则选择采用二次手术予以治疗。中晚期吻合口瘘患者,保守治疗为首选。     

Use of concentrated fibrinogen in experimental tracheal repair

Tracheal stenosis is a devastating complication of tracheal resection that may be related to improper suture selection and technique, as well as extensive surgical devascularization. This study evaluated Fibrin Sealant (FS) (Immuno AG, Vienna, Austria), a two-component biologic adhesive, as a method for reducing the need for sutures in tracheal surgery. This adhesive has been found to be effective in face-to-face sealing of tissues, wound healing, and in establishing hemostasis. Six adult mongrel dogs underwent tracheal repair with FS. Three had tracheal hemitransections (approximately three quarters of the circumference) and were repaired using one absorbable suture and FS, and three had complete transections (with resection of two tracheal rings each) repaired using five absorbable sutures and FS. The animals were killed at varying intervals ranging from 6 h to 6 weeks. No animal had gross evidence of significant tracheal stenosis, and the endotracheal mucosa appeared well healed. We conclude that the use of FS in tracheal reconstruction results in a stable, leakless trachea, and that it significantly reduces the number of sutures needed; this may lead to a decreased potential for anastomotic ischemia and tracheal stenosis.     

人工气管及气管支架材料的应用

背景：以往对中心气道狭窄常采取外科手术治疗,然而,有些患者无法接受,并且手术瘢痕可导致再狭窄。因此,支架置入成为治疗中心气道狭窄的重要手段之一。 目的：总结人工气管及气管支架材料在临床中的应用进展。 方法：应用计算机检索PubMed数据库及CNKI数据库,在标题和摘要中以“组织工程支架,人工气管,气管支架”或“tissue engineering scaffolds,artificial trachea,trachea scaffolds”为检索词进行检索。根据纳入标准选择22篇文献进行综述。 结果与结论：近年来随着组织工程学的兴起和发展,在生物组织工程化气管的研究方面取得了一定的进展,目前已能够以软骨细胞或骨髓间质细胞为种子细胞构建出与自体气管相近的组织工程化气管,而且能够用软骨细胞及上皮细胞构建出带有气管黏膜上皮的复合组织工程化气管,但这些组织工程化气管移植到体内能否长期具有活性、发挥正常的生理功能等还需要进一步的实验验证。     

三种方法制备组织工程气管支架的比较

背景：气管支架制备是组织工程学方法修复长段气管缺损的关键步骤。 目的：通过比较分析3种制备异体脱细胞气管支架的方法,为组织工程气管支架制备寻找更适宜的途径。 方法：手术获得兔新鲜气管,分为对照组、玻璃化液冷冻法组、酶洗法组、改良玻璃化液冷冻法组。处理后对各组标本行苏木精-伊红染色,电镜扫描观察,并测量气管最大拉伸力、破裂力和组织拉伸率等生物力学性能。 结果与结论：组织学观察显示对照组、玻璃化液冷冻法组可见部分完整黏膜上皮细胞,酶洗法组、改良玻璃化液冷冻法组未见黏膜上皮细胞。电镜观察示对照组、玻璃化液冷冻法组、改良玻璃化液冷冻法组有丰富的细胞外基质和胶原纤维,而酶洗法组无细胞外基质,只有胶原纤维。组间两两比较,气管支架的最大拉伸力、最大破裂力和组织拉伸率比较,差异均无显著性意义。说明应用改良玻璃化液冷冻法制备气管支架能够有效地去除抗原性、保留细胞外基质,并维持生物力学性能,是一种较为理想的组织工程气管支架制备方法。     

脱细胞近交系微型猪肌腱修复兔跟腱缺损

背景：异体肌腱移植是目前修复肌腱缺损的理想方法,但移植后的排斥反应是其使用受到限制的主要原因。 目的：观察脱细胞处理的版纳近交系微型猪肌腱移植修复兔跟腱缺损的疗效,以及其作为异种肌腱移植支架材料的可行性。 方法：将40只日本大白兔制作双后肢跟腱缺损实验动物模型后,随机均分为2组,脱细胞猪肌腱组用脱细胞版纳近交系微型猪肌腱修复,自体肌腱组用自体肌腱修复,术后用3-0肌腱线改良HEMI-KESSLER法进行端端原位吻合。 结果与结论：①移植后2周内,脱细胞猪肌腱组与自体肌腱组白细胞计数、C-反应蛋白测量结果差异无显著性意义(P > 0.05)。②两组移植后局部反应小,伤口一期愈合,屈踝功能恢复正常。③组织学检查均未见明显淋巴细胞浸润,肌腱缝合处胶原纤维相互衔接。结果说明脱细胞版纳近交系微型猪肌腱能成功修复兔跟腱缺损,且具有组织相容性好、移植排斥反应轻的优点。     

Hog cholera virus infection in tracheal organ cultures

Summary Organ cultures prepared from tracheas that were either infected with hog cholera virus (HCV)in vitro or collected from HCV-infected swine supported replication of the virus. Replication was confirmed by an increase in the titer of extracellular virus as well as by the appearance and increase in the number of fluorescent cells observed in the tracheal epithelium. Ciliary activity was reduced in cultures prepared from the trachea of a pig that had been persistently infected with HCV for 3 weeks but otherwise was not altered detectably by infection. Brief exposure of infected trachea to neutralizing antibody had only a transient effect on detection and titer of virus in the culture medium.     

计算机辅助构建气管软骨环并行气管前壁缺损修复实验研究

目的探讨利用人工材料在计算机辅助下体外构建气管软骨环进行颈段气管缺损修复的可行性。方法用β-磷酸三钙(β-TCP)材料制造出气管环。12只成年杂种犬,雌犬4只,雄犬8只,犬龄约2岁,体质量11~13kg。随机均分为2组。行气管前壁3~5环全层缺损造模(缺损2cm×5cm),在气管切除部位形成一直径约2cm、长约5cm的皮管。实验组利用计算机辅助构建气管软骨环阴模,以β-TCP材料制作的内径约2cm的2个C形气管软骨环支架置于人工皮管外侧,外侧以肌肉覆盖,逐层缝合关闭术腔。对照组以相同方法行气管前壁全层缺损造模,并形成与实验组相同的人工皮管,但皮管外面不置β-TCP构建的软骨环支架。动物饲养至8周时处死取材,行大体解剖、纤维喉镜、CT及常规组织学检查。结果术后所有动物伤口局部未见明显感染征象。对照组1只皮下严重气肿,当日死亡;大体解剖可见修复部分气管前壁塌陷,管腔狭小;其余动物均存活至8周,术后1周出现气喘,术后2周出现进食呕吐及颈部活动受限;纤维喉镜检查,修复部位气管前壁已出现塌陷,有明显的反常呼吸运动。实验组动物均成活良好,未见上述症状。纤维喉镜检查:重建气道通畅。CT检查:植入物位置良好。组织学检查,支架材料已与周围组织融合为一体,组织已长入支架材料的孔隙中。结论实验应用计算机辅助技术,使修复支架制作达到个体化,β-TCP材料具有良好的生物相容性,且应用计算机辅助技术依个体需要快速塑型,能较好地修复气管缺损。     

A comparative study of mammalian tracheal mucous glands

We have compared the distribution, numbers and volume of mucous glands in the tracheas of 11 mammalian species. No glands were present in the rabbit. The mouse only contained glands at the border between the trachea and larynx. In the rat, glands were commonest in the cephalad third of the trachea, but on average were much scarcer than in the larger species. Between species, there was a significant correlation between airway diameter and gland volume per unit surface area, suggesting that the rate of deposition of inhaled particles may increase in large airways. In the ventral portion of the trachea of about half the species, the glands were concentrated between the cartilaginous rings; in others they were evenly distributed over and between the rings. In most species in which the trachealis muscle attached to the internal surface of the cartilaginous rings, the glands were external to the muscle. In all species in which the muscle attached to the external surface of the cartilaginous rings, the glands were internal to the muscle. In the ox, goat, dog and sheep, the volume of glands per unit tracheal surface area was markedly greater in the ventral than the dorsal aspect of the trachea. The reverse was true of the pig. In humans, gland density in the 2 regions was similar. The frequency of gland openings was determined in the ox, goat, pig, dog and sheep tracheas, and ranged from 0.3 per mm² in the dorsal portion of the sheep trachea to 1.5 per mm² in the ventral portion of the ox trachea. For these 5 species, the volume of gland acini per unit luminal surface area varied linearly with the numbers of gland openings, with the volume of individual glands being constant at ∼ 120 nl.     

可吸收胶原蛋白线与丝线编织非吸收线在口腔种植中的应用

背景：胶原蛋白线由动物的胶原蛋白制备而成,由于其具备可降解、无排异、易于制备、使用方便等优点,现在已开始大量使用于临床。 目的：比较胶原蛋白线与丝线编织线对口腔种植手术切口愈合的影响。 方法：100例种植手术患者随机等分为可吸收胶原蛋白线组和丝线编织非吸收性缝线组,分别使用2-0带圆针可吸收胶原蛋白缝合线与4-0带圆针丝线编织非吸收性缝线对伤口进行间断无张力缝合。植入后3,5,7 d观察缝线及伤口愈合情况,植入后第7天拆线,植入后14 d复诊。 结果与结论：可吸收胶原蛋白线组患者切口甲级愈合率明显多于丝线编织非吸收性缝线组(P < 0.05)。可吸收胶原蛋白线组患者口腔切口中的2-0带圆针可吸收胶原蛋白缝合线在治疗7 d时大多数被吸收,而丝线编织非吸收线组患者口腔切口中4-0带圆针丝线编织非吸收性缝线未见吸收。且使用2-0可吸收胶原蛋白线的患者口内缝线未见污物附着,线体清洁。而使用4-0丝线编织非吸收线缝合的患者口内可见线体周围有软垢附着。提示胶原蛋白线比丝线编织线更适合口腔种植手术切口的无张力缝合,能够获得更好的愈合效果,且时间能够与伤口愈合时间匹配,并能维持更好的口腔卫生。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

The differentiation potential of tracheal basal cells

The objective of this study was to examine the differentiation potential of basal cells purified from rabbit tracheas by means of centrifugal elutriation. Cell suspensions containing between 83 and 94% basal cells were inoculated into tracheal grafts denuded of their own epithelium and transplanted to the backs of nude mice. Within 1 week after inoculation, the basal cells reestablished a continuous poorly differentiated epithelial sheet which at 2 to 4 weeks showed typical mucociliary differentiation. Basal cells, ciliated cells, goblet cells, and secretory cells with small granules were present. Some of the latter contained abundant rough endoplasmic reticulum and others contained predominantly smooth endoplasmic reticulum. These data indicate that basal cells can give rise to all major tracheal cell types suggesting that they are the main stem cell in the large airways of rabbits.     

The differentiation capacity of Clara cells isolated from the lungs of rabbits

The purpose of our studies was to determine the growth and differentiation potential of Clara cells isolated from rabbit lungs. The Clara cell preparations were enriched (80 to 85%) by density gradient-elutriation procedures and then were inoculated into rat tracheas denuded of their own epithelium. These tracheas then were transplanted subcutaneously on the backs of nude mice. For purposes of comparison, other denuded tracheas were inoculated with mixed epithelial cells obtained from rabbit tracheas by enzymatic procedures. Control tracheas were inoculated with cell-free media. At 2, 4, and 14 weeks after transplantation, the tracheal grafts were removed from the recipient nude mice and examined by light and electron microscopy. Tracheal grafts not receiving cell inocula contained no epithelial lining, and the tracheal lumens were filled with loose connective tissue. Tracheas inoculated with 2 X 10(4) mixed tracheal cells showed a columnar, pseudostratified epithelium composed of five cell types: (a) poorly-differentiated cells, (b) ciliated cells, (c) mucous cells, (d) Clara-like cells, and (e) typical basal cells. A very different epithelium was established in tracheas repopulated with Clara cell isolates. This epithelium, at all time points examined, was cuboidal, single layered (never pseudostratified), and lacked basal cells. The tracheal lumens were lined with ciliated and nonciliated cells. The latter showed typical features of mature Clara cells (i.e., electron dense granules and smooth endoplasmic reticulum). At 14 weeks, the same two cell types were present, and often they were located on ridges and furrows of the tracheal walls. Mixed tracheal cells inoculated into denuded tracheas gave rise to a normal-appearing pseudostratified mucociliary epithelium, whereas the Clara cells inoculated under identical conditions gave rise to a low cuboidal epithelium resembling that seen in normal bronchioles. Establishment of these two types of epithelial linings occurred in the presence of the same mesenchymal components. Thus, we conclude that Clara cells have considerable self-renewal capacity, and their differentiation potential appears to be quite narrow.