聚氨酯-胶原蛋白复合人工食管替换犬颈段食管的实验研究

目的 采用生物可降解材料与非降解材料复合制成人工食管，通过诱导自身食管组织爬行再生与生物材料降解相匹配，最终新生食管完全替代人工食管。方法 将医用聚氨酯内管表面覆盖海绵状胶原蛋白膜制成人工食管，并通过手术置换20条犬颈段5cm食管缺损，术后给予营养支持，禁食4周后通过内镜取出聚氨酯内管。结果 术后发生吻合口瘘4条（20%），14条（70%）存活1个月以上，其中食管狭窄5条（25%），存活达8个月的3条。现仍存活良好，未见明显并发症。术后1个月，新生食管完全上皮化；术后3个月，粘膜全层结构完整再生；术后6个月，食管肌层部分再生。结论 聚氨酯-胶原蛋白复合人工食管置换犬颈段食管具有可行性，通过聚氨酯内管提供暂时支撑，海绵状胶原蛋白膜提供适宜细胞爪爬行再生的三维支架并维持足够长的降解时间，能够促使自身食管的完全再生。

Experimental replacement of a cervical esophagus segment of the dog with an artificial prosthesis of polyurethane-collagen

Objective: Attempts have been made to replace esophageal defects with artificial prosthesis composed of biodegradable and nonbiodegradable materials, which is gradually replaced by host tissue. Methods: The artificial esophagus was a two layered tube consisting of a collagen sponge matrix and an inner polyurethane stent. A 5 cm esophageal segmental defect was replaced using the artifial esophagus in twenty dogs. Nutritional support was given after operation. The inner polyurethane stent was removed endoscopically after 4 weeks fasting. Results: Four dogs (20%) died from anastomotic leakage. Fourteen dogs (70%) survived more than 1 month, and only two (10%) suffered from esophageal stricture. Three of the fourteen dogs survived for 8 months up to now without any complications. Complete epithelization of the regenerated esophagus was observed 1 month after surgery. Complete regeneration of esophageal mucosa structures was observed 3 months after surgery, and partial regeneration of esophageal muscle tissue was observed 6 months after surgery. Conclusion: The feasibility that is the artificial prosthesis of polyurethane collagen in reconstruction of the cervical esophagus segment of the dogs is warranted. Esophageal high order structures can be regenerated providing a temporary support by polyurethane stent and an adequate three dimensional structure for a sufficient period by collagen sponge.