肌瓣对自体及异体气管移植段血液循环建立的促进作用

目的: 探讨采用肌瓣包裹促进自体及异体气管移植段重建血运的方法. 方法: 将30只杂种犬随机等分为3组,均切取颈部5环气管段作为移植段.A组:无肌瓣包裹自体移植组;B组:采用自体双侧胸骨舌骨肌-胸骨甲状肌联合肌瓣包裹组;C组:采用异体双侧胸骨舌骨肌-胸骨甲状肌联合肌瓣包裹组. 于术后1,2,4和8 wk处死动物取材,观察和比较实验动物的存活情况、移植体气管标本的大体和组织学改变,以及新生微血管密度(MVD)等指标. 结果: 无肌瓣包裹自体移植组不能维持管腔结构;自体肌瓣包裹组移植段血供良好,管腔通畅,狭窄程度轻,存在炎症反应. 异体肌瓣包裹组移植体血供尚可,炎症反应重,管腔狭窄,但仍可维持通畅. 结论: 移植体的狭窄现象与血供关系密切. 肌瓣包裹气管自体移植段能够诱导出新生血管,维持气管形态,移植的气管可以存活8 wk以上. 自体较异体移植段血供好,虽可维持气管通畅,但存在狭窄.

Enhancement of revascularization in orthotopic canine tracheal autografts and allografts with muscular wrapping

AIM: To examine the effect of muscular wrapping for revascularization on airway healing in tracheal autografts/ allografts model. METHODS: Thirty mongrel dogs were randomly divided into 3 groups: autotransplantation without muscular wrapping (Group A), autotransplantation with muscular wrapping (Group B), and allotransplantation with muscular wrapping (Group C). A five-ring cervical tracheal segment was harvested as the grafts. The animals were sacrificed at 1, 2, 4 and 8 wk postoperation. The survival of the animals, gross and pathological characteristics of the specimens, and the neogenetic microvessel density were compared between the groups. RESULTS: The autografts failed to maintain their structure integrity without muscular wrapping in group A. In the muscular wrapping groups, the grafts maintained their structures, surrounded by well-vascularized connective tissues, and infections occurred around the grafts. CONCLUSION: Stenosis of tracheal grafts is closely correlated with blood supply. The autografts with muscular wrapping can induce new microvessels and maintain normal structure. The autografts can survive over 8 weeks. The allografts are surrounded by well-vascularized connective tissues and can keep trachea unobstructed, but with some stenosis.