肺组织瓣修补胸内食管不规则缺损的新术式研究

目的:探讨自体带血运的肺组织瓣修补胸内食管不规则缺损的手术新方法,为临床应用提供动物实验依据.方法:将14只实验犬的胸内食管行不同侧面的不规则切除,缺损面用自体带血运的肺组织瓣修补.观察其存活、进食情况以及愈合过程.结果:3只犬术后1周内死亡,11例存活,最长存活时间超过110周.存活犬食管缺损处的管腔表面可见新生的黏膜上皮爬覆.存活犬均能经口进食.结论:应用自体肺组织瓣修补胸内食管不规则缺损可作为一种简便易行的新术式.     

自体肺组织瓣行气管重建术的麻醉

目的:探讨与自体肺组织瓣行气管重建新术式相适应的麻醉方法.方法:通过对行自体肺组织瓣气管、支气管修补重建动物实验的麻醉,总结麻醉要点及相应措施.结果:24只犬实验手术麻醉及4例临床应用肺组织瓣修补和重建气管手术的麻醉均获成功.结论:麻醉配合的要点和各项技术措施切实可行.     

金属网架外覆肺组织替代气管的动物实验研究

目的：寻求气管重建的新方法,解决较为复杂的长段气管重建问题。方法：选用杂种成年犬12只,将一叶肺组织脏层胸膜向内翻转缝合成管状内衬记忆合金网架与切除后的气管远近端行端端吻合,完成气管重建。结果：8只实验犬获得存活,病理证实吻合口愈合良好,术后两周替代物管腔内即有新生上皮爬行,结论：该实验提出了带血运的肺组织内衬记忆合金网架替代气管这下 新方法。为长段气管缺损修补、重建提供一个有效的新途径。     

应用带血管蒂肋骨瓣修补气管侧壁缺损

目的：应用带血管蒂肋骨瓣修补气管侧壁缺损。方法：17例患者手术切除气管病变后，应用带血管蒂肋骨瓣修补气管侧壁缺损和重建气管。结果：15例患者术后气管管腔通畅无狭窄，2例患者出现气管狭窄，气管腔内置入支架后治愈。良性病变患者术后均可正常生活，长期生存。结论：应用带血管蒂肋骨瓣修补气管侧壁缺损是一种取材方便、安全可靠的手术方法。     

自体肺组织瓣内衬金属弹力支架替代气管缺损的临床应用

目的探讨应用自体肺组织瓣内衬金属弹力支架替代气管缺损的可行性。方法 5例气管恶性肿瘤及良性狭窄患者,采用自体肺组织瓣内衬金属弹力支架替代气管缺损方法行胸段气管重建术。结果按Medical Britain Research Council评分5例患者术前呼吸困难指数Ⅱ～Ⅳ级,术后呼吸困难均迅速缓解,术后呼吸困难指数均为Ⅰ级。术后肺功能及血氧分析指标均有不同程度的改变。气管缺损处肺组织瓣重建愈合良好。术后随访：1例1年后失访,4例患者随访10年至今健在。结论自体肺组织瓣内衬金属弹力支架替代气管缺损是一种可行的气管重建新方法。     

肺组织瓣内衬金属支架在气管重建中的临床应用

目的 探讨自体肺组织瓣内衬金属支架在胸段气管重建中的临床应用.方法 对5例胸段气管、主支气管病变的患者应用肺组织瓣内衬金属支架修补,完成气管重建.其中,气管中上段肿瘤1例,右主支气管瘢痕狭窄闭锁1例,气管下段混合瘤恶变1例,左主支气管类癌2例.结果 5例患者呼吸困难均明显缓解,重建气管无明显狭窄及肉芽组织形成.1例大咯血死亡,其余4例随访疗效稳定.结论 肺组织瓣内衬金属支架重建治疗胸内气管广泛缺损,可在临床有选择地应用.     

金属网架外衬肺组织修补犬胸内气管缺损的实验研究

气管肿瘤、气管损伤及气管损伤后造成的气管广泛狭窄 ,可根据病情进行气管的部分切除再重新进行端端吻合、局部的金属网架置放支撑、气管移植等术式。临床上气管良性肿瘤及部分限局的气管恶性肿瘤需进行气管侧壁的切除 ,缺损部位可用自体组织进行修补。本实验应用金属网架外衬肺组织修补犬胸内气管缺损 ,取得了较为满意的效果。1　材料与方法1.1实验材料　杂种成年犬 16只 ,体重 14～ 32ｋｇ ,雌雄不限。记忆合金金属网架 (沈阳永通医疗器械有限公司 )支架长 6ｃｍ ,直径 1.8～ 2 .4ｃｍ ,合金丝直径 0 .5ｍｍ。1.2实验方法　硫喷妥钠 (30～…     

自体组织移植修复气道缺损的实验研究

目的：探讨用自体支气管修复气管缺损的可行性。方法：取10只杂种犬切除其左主支气管，埋入自体大网膜中。2周后二次开腹开胸，用带网膜蒂的左主支气管段替代一段气管，观察移植物及吻合口愈合情况。结果：除2犬于Ⅱ期手术时死亡外，其余8只均存活至观察期满(3个月)，气管镜及组织学检查，见吻合口愈合良好，移植物血供丰富。结论：本动物实验表明，采用分期自体左主支气管移植、修复气管缺损是可行的。     

气管食管瘘与支气管食管瘘的临床诊治

目的:比较和分析治疗食管呼吸道瘘的不同方法及疗效.方法:回顾性分析18例气管食管瘘和支气管食管瘘病例资料,观察不同治疗方法的特点及效果.结果:9例良性食管呼吸道瘘中采取食管气管分开修补术5例,均治愈;3例行胃造瘘术,其中2例好转,1例死亡;1例因吞服硫酸致食管全程烧伤狭窄后行硬式扩张术并发的食管气管瘘病例的治疗中,采用带血管蒂的肋间肌瓣作为自体修补材料,利用其首创一次性双面修补手术治疗大口径气管食管瘘,获得成功.9例恶性瘘中,4例行胃造瘘术,其中3例肺内感染好转,1例术后短期内死亡;5例行内科保守治疗,其中2例肺内感染好转,3例失随访.结论:外科手术是治疗食管呼吸道瘘的主要方法,应用带血管蒂的肋间肌瓣作为自体修补材料双面修补治疗大口径气管食管瘘是有效可行的临床治疗方法.     

肺组织瓣包埋金属支架重建气管、食管的动物实验研究

目的 用犬的自体肺组织瓣包埋金属支架重建气管、食管,探索应用肺组织瓣重建气管、食管的可行性.方法 24只杂种犬,分别制成气管、食管缺损模型,用自体肺组织瓣内衬金属支架分别修补.定期处死实验犬,行大体观察、组织学观察和影像学检查.结果 18只实验犬存活超过2周以上.肺组织瓣与气管、食管紧密结合,未发生缺血坏死,术后12周被走行一致的胶原纤维替代.肺组织瓣表面有新生上皮爬行,且爬行较快.结论 自体肺组织瓣与气管、食管上皮细胞有较好的相容性,能为气管、食管上皮的爬行提供良好的载体.

Abstract：

Objective To study the feasibility of applying autogenous pulmonary tissue flap with alloy stent to correct the defects of trachea and esophagus. Methods Twenty-four dogs were divided into tracheal and esophageal groups. Bronchus was ligated to prepare a pulmonary flap. And a defect of 3 -4 cm long and 1/2-2/3 perimeter was made in tracheal or esophageal wall. Pulmonary arteries and veins were protected. Then the pulmonary gas was emitted to create a pulmonary tissue flap. The defect was repaired with a pulmonary flap with a self-expanded stent inside. The gross appearance, histological appearance, CT and barium X-ray films were observed at Weeks 2, 4, 6 and 8 post-operation. Results Eighteen experimental dogs survived over 2 weeks. Anatomotic leak was the main cause of death. Two dogs died of perforation of ulcer in esophageal group. Reliable cicatrisation was observed between the pulmonary tissue flap and damage area. A quick growth of new tracheal and esophageal epithelium was observed from periphery area to central area. During the first 2 weeks, a little epithelization was observed at free edge of anastomosis equivalent to 1 - 2 layers of new epithelial cells. At weeks 4-6 post-operation, the internal surface of defect was covered with 3 - 5 layers of epithelial cells. At Weeks 8-10 post-operation, the luminal surface was covered with 6 - 8 layers of stratified epithelial cells. More ulcers could be observed on the surface of pulmonary tissue flap in esophageal group. In pulmonary flap, massive fibrous tissue proliferated and fibroblasts were active, but no necrosis occurred. CT and barium X-ray showed no obstruction in anastomotic stoma. Conclusion With an excellent compatibility with epithelial cells of trachea and esophagus, the autogenous pulmonary tissue flap can support the mucosal crawl in the defect of trachea and esophagus. When combined with alloy stent, it may be a choice procedure for reconstructing the defect of trachea and esophagus.     

带蒂颈阔肌肌皮瓣与镍钛合金网结合再造颈段气管实验研究

目的：探讨用带蒂颈阔肌肌皮与镍钛合金网结合再造颈段气管。方法 选健康狗20只,0袖状切除8－10个气管环长度的颈段气管,用带蒂颈阔肌肌皮瓣卷成肌皮管,表皮衬里,腔内交管临床扩张,将肌皮管移于气管缺损处,与气管切端吻合,再用相应长度镍钛合金网状支架套于肌皮管外,并固定。术后4－6月经气管镜拔出硅胶管。结果 2只动物术后切口感染而终止实验。余动物均健康存活,呼吸、发音、及远动正常。CT检查示新气管管腔宽敞,无狭窄现象。术后6－18月分期处死动物,见植入物与气管连为一体,镍钛支架与肌皮管及周围组织粘连紧密,不易分离。管壁皮肢的鳞状上皮逐渐变薄,并最终化生为单层矮柱状上皮细胞。镍钛合金光洁如初。结论：带蒂颈阔肌肌皮瓣与镍钛合金风结合组成的“新气管”可适用于颈部气管的重建。     

食管缺损经肺组织瓣和金属支架重建后黏膜爬行的光镜和电镜观察

 目的 探讨肺组织瓣修复食管侧壁缺损内衬金属支架的方法进行食管重建的可行性。 方法 选取成年犬12条,切除中段食管,选用右中叶肺组织作为替代物,将金属支架放置于缺损处食管内,用游离的肺组织瓣修补食管缺损。术后行钡餐透视检查及病理学检查,通过光镜和电镜观察黏膜的爬行过程,爬行的新生上皮的超微结构。结果 新生食管复层上皮与肺组织瓣连接紧密,愈合良好。但术后18周腺体和平滑肌的再生均不明显。结论 肺组织瓣内衬金属支架重建食管为食管替代提供了一种新的尝试，作为支撑物其远期效果有待进一步探讨。     

Effect of three interventional bronchoscopic methods on tracheal stenosis and the formation of granulation tissues in dogs

Background Therapeutic approaches for tracheal stenosis caused by the formation of exuberant granulation tissues usually include electrocautery, mechanical dilation, laser therapy, argon plasma coagulation （APC）, cryotherapy and stent placement. However, restenosis after stent insertion remains a significant limitation. We examined the efficacy of three different approaches, including induction of mechanical lesions, APC performed with different powers or durations and cryotherapy, to identify the method that limited the formation of granulation tissue. Methods Twelve specially bred research mongrel dogs were divided into three groups. In group 1 （four dogs） mild （procedure 1; two dogs） or moderate （procedure 2; two dogs） damage was induced mechanically. Group 2 （six dogs） received APC at different powers or durations （procedure 3：30 W, 1 cm/s; procedure 4：30 W, 2 cm/s; procedure 5：25 W, 3 cm/s）. Group 3 （two dogs） received cryotherapy （procedure 6： two freeze-thaw cycles of 30 seconds）. Uncovered self-expandable metallic stents were inserted in all dogs to maintain a continuous stimulus to the trachea mucosa. Dogs were monitored for 4 weeks and the relationship between granulation tissue proliferation and method used was analyzed. Results In group 1, granulation tissue growth increased with more severe mechanical damage. The growth of granulation tissue in group 2 was more pronounced than in group 1, and both dogs in procedure 3 died because of severe stenosis. In this group, the formation of granulation tissue decreased with decreasing power and duration. In group 3, no obvious granulation tissue was found at week 4. Conclusions Lesions and stimuli from a foreign body （the stent） are two important factors that lead to overgrowth of granulation tissue. Thermal lesions, such as APC, seem to induce greater granulation tissue growth and cartilage damage compared with mechanical and cryotherapy lesions. Cryotherapy in combination with mechanical dilation may be a safe and effective treatment method for managing tracheal stenosis caused by the formation of granulation tissue.     

血管化腓骨肌皮瓣修复下颌骨缺损

摘目的：总结应用腓骨肌皮瓣修复下颌骨缺损的经验。方法：对8例因肿瘤切除造成的下颌骨缺损患者，用血管化腓骨肌皮瓣修复。将腓骨截为2-4段以恢复下颌骨外形，用钛板内固定，皮瓣用于修复软组织缺损或作为观察其血液循环的观察窗。结果：8例患者移植的腓骨肌皮瓣全部成活，颌面部外形和功能恢复良好。结论：可根据下颌骨缺损的部位和形态对腓骨肌皮瓣进行截骨和塑形。血管化的腓骨肌皮瓣移植是下颌骨缺损较为理想的修复方法。     

腓肠神经滋养血管皮瓣逆行转移修复小腿或足部皮肤缺损

目的:介绍小腿或足部皮肤缺损,以腓肠神经滋养血管皮瓣逆行转移修复的临床效果。方法:受区彻底清创,清除失去活力的组织,再依软组织缺损面积切取腓肠神经营养血管皮瓣,共修复软组织缺损22例。切取皮瓣面积最大25 cm×10cm,最小8 cm×6 cm,逆行转移时全部开放隧道以保证蒂部的宽松,同时确保皮瓣的筋膜蒂宽度在5 cm以上。结果:应用该方法共处理22例,术后皮瓣21例全部成活,1例皮瓣远端部分坏死,经换药后肉芽生长良好,2期植皮愈合。随访6个月～2年,皮瓣质地良好,功能良好、外形满意。结论:逆行腓肠神经滋养血管皮瓣解剖位置恒定、血供可靠、可切取面积大、耐磨且操作简单,是修复小腿中下段胫前区及足踝部软组织缺损的理想皮瓣。     

颧骨缺损不同修复重建方法和预后的回顾性分析

目的: 探讨颧骨缺损不同治疗方法的修复效果及特点。方法: 选择2012年8月至2019年8月于北京大学口腔医院口腔颌面外科就诊的颧骨缺损行修复重建的37例患者。根据颧骨缺损涉及的部位,将缺损分为四类:0类,缺损不涉及颧骨区段结构,仅为厚度(突度)变化;Ⅰ类,单个缺损位于颧骨体部或只涉及一个突起方向的缺损;Ⅱ类,单个缺损累及两个突起方向;Ⅲa类,单个缺损累及三个突起方向以上的缺损;Ⅲb类,颧骨缺损同时累及相应上颌骨的大范围缺损。统计分析各类颧骨缺损的病因、缺损时间、缺损大小及特点、采用的修复重建方式,并随访记录术后并发症等。术后CT评价颧骨突度及对称性恢复效果,进行色谱差值分析评价术后稳定效果。结果: 本组患者中,由创伤引起的颧骨缺损有25例(67.57%),肿瘤切除引起的颧骨缺损有11例(29.73%),另1例为骨发育畸形导致的颧骨缺损。19例患者行单纯自体骨移植修复,6例患者行血管化组织瓣修复,5例患者仅使用外植入物,另外7例患者使用血管化组织瓣联合外植入物修复。导航组和非导航组健、患侧颧骨突度差值中位数分别为0.45 mm(0.20~2.50 mm)和1.60 mm(0.10~2.90 mm),两组差值有统计学意义(P=0.045)。2例使用钛网结合股前外侧皮瓣修复的患者术后钛网发生明显变形或断裂,2例铸造个性化钛修复术后因感染而取出。结论: 对于无明显结构改变的颧骨缺损,可以用自体骨游离移植或异体材料修复。颧骨缺损存在骨支柱破坏、慢性炎症、口鼻腔相通或伴有明显软组织量不足时,建议带蒂颅骨骨膜瓣或血管化骨组织瓣修复。钛网可用于修复大量骨组织缺损的病例,同时建议联合血管化骨组织瓣移植修复。