镍钛合金人工食管替代食管后的组织反应与损伤

背景：前期实验证实镍钛合金人工食管是一种可用于替代被切除食管段，重建食管通道的食管人工代用品。 目的：观察镍钛合金人工食管替代食管术后的组织反应及对邻近组织器官的损伤。 方法：切除8只小型香猪一段70 mm胸段食管，将镍钛合金人工食管两端分别套入远近端正常食管腔内约   10 mm，在食管与镍钛合金人工食管涤沦连接环作全层连续缝合吻合连接。术后第7天开始应用饮食调控方法调控脱管时间。分别在术后1，2，3，4个月各处死2只带管实验猪进行解剖，观察植入镍钛合金人工食管在新生食管形成过程中的组织反应和对紧密接触邻近组织器官的损伤。 结果与结论：各时间段植入镍钛合金人工食管原位停留支撑，未见胸内出血、气胸、脓胸、食管穿孔、吻合口瘘等术后邻近组织器官损伤并发症。实验动物带管进食半固体食物无进食困难(Bown'SⅡ级)。解剖所见：壁层胸膜与肺轻度膜状粘连，胸腔内无胸液，新生食管完全包裹人工食管，新生食管与邻近肺、主动脉器官组织轻度膜状粘连，未对邻近肺、主动脉及食管黏膜造成严重损伤，植入周期食管黏膜由食管残端向新生食管中间部再生延伸直到完全覆盖整条新生食管。新生食管组织学所见：镍钛合金人工食管替代食管植入周期的组织反应表现为无菌性炎症反应和异物反应，以术后1个月组织反应最为严重，随后逐渐减轻。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：

Tissue reaction and injury after nitinol artificial esophagus replacement

BACKGROUND:Previous experiment has confirmed that the nitinol artificial esophagus is an artificial succedaneum which can be used for replacing an esophagus resected and rebuilding esophageal tube. OBJECTIVE:To observe the tissue reaction of the neo-esophagus and the adjacent organs injury contacted with the nitinol artificial esophagus after replacement. METHODS:Eight miniature pigs were selected and modeled by resection of a 70 mm segment of the thoracic esophagus. After modeling, the nitinol artificial esophagus was inserted into the proximal and distal end of the thoracic esophagus at an insert distance of about 10 mm. After that, the nitinol artificial esophagus with polyester connecting ring was sewed into the thoracic esophagus in a manner of full-thickness anastomosis. After operation, the pigs were subjected to feeding regulation measures to control the shedding time of the artificial esophagus. Two model pigs were sacrificed for anatomical observation at 1, 2, 3, 4 months postoperatively, respectively. The tissue reaction during the neo-esophagus formed procedure and adjacent organs injury contacted with the nitinol artificial esophagus were observed. RESULTS AND CONCLUSION:All pigs survived without complications such as thoracic hemorrhage, pneumothorax, pyothorax, esophageal perforation and anastomotic leakage. The experimental animals with the nitinol artificial esophagus fixed in situ had no dysphagia for eating semisolids food (Bown’SⅡ). Autopsy findings showed that there was slight membrane-like adhesion between partial pleura and lung. No hydrothorax was found. The nitinol artificial esophagus was wrapped up by the neo-esophagus. There was slight membrane-like adhesion between the neo-esophagus and the adjacent organs such as the lung, aorta and esophageal mucosa. The esophageal mucosa covered the neo-esophageal entocoele from esophageal stumps to intermedius of neo-esophagus until completely covered. Histological findings of the neo-esophagus showed that in imbed cycle of the nitinol artificial esophagus the tissue reaction showed aseprtic inflammation reaction and foreign body reaction around the implant. These tissue reactions were most severe at 1 month after operation and thereafter relieved gradually.