脱细胞真皮基质联合镍钛合金支架修复犬喉腔缺损

摘要背景：镍钛合金支架可制作成甲状软骨的“V”型，有效修复其空间三维结构，最大程度保证喉通气及发声功能的恢复。目的：评估脱细胞真皮基质联合镍钛合金支架修复喉腔缺损的可行性。方法：将6只健康杂种犬分成两组，每组3只。均行喉次全切除术，实验组行脱细胞真皮基质联合镍钛合金支架修复，对照组用镍钛合金支架同期修复。分别于术后1，6个月行X射线检查及喉内窥镜检查，并于术后6个月处死动物，取出标本，分别行大体标本观察及组织学检查。结果与结论：X射线显示镍钛合金支架无移位及变形，大体标本观察可见实验组喉黏膜修复良好，除1例少量瘢痕生成外，余2例基本无瘢痕生成，喉腔通畅，均无喉腔狭窄，犬术后呼吸、吞咽功能恢复良好。对照组3例支架表面肉芽及瘢痕组织增生，其中1例于术后第63天死于呼吸困难。组织学观察显示实验组上皮基本为复层鳞状上皮，间质内可见血管组织及少量淋巴细胞。对照组肉芽组织及纤维组织增生明显，基本无复层鳞状上皮覆盖，间质内大量淋巴细胞及浆细胞。结果表明，脱细胞真皮基质联合镍钛合金支架可有效修复犬喉腔缺损，既可提供良好的支架作用，又可减少喉腔肉芽组织及瘢痕形成。关键词：镍钛合金支架；脱细胞真皮基质；喉重建；喉狭窄；犬doi:10.3969/j.issn.1673-8225.2010.42.008

Laryngeal defects repair using acellular dermal matrix and Ni-Ti alloy stent in a canine model

AbstractBACKGROUND: Ni-Ti alloy stent can be prepared into thyroid cartilage V-shape, and effectively repair the spatial three-dimensional structure, ensure the maximum ventilation throat and vocal function recovery.OBJECTIVE: To investigate the feasibility of applying acellular dermal matrix (ADM) and Ni-Ti alloy stent to repair laryngeal impairment in canine model. METHODS: Subtotal laryngectomy was performed in six healthy adult hybrid canines, which were divided into two groups with 3 dogs in each group. The ADM and Ni-Ti alloy stent were used to repair laryngeal skeleton of the canine in experiment group. In the control group, only Ni-Ti alloy stent was used to repair the laryngeal impairment. Animals were performed X-ray and endoscopic examination in 1 and 6 months after surgery, and were sacrificed at 6 months. The specimens were taken out for gross observation and histological examination.RESULTS AND CONCLUSION: The result of X-ray showed the Ni-Ti alloy stent was firmly attached to the reduced thyroid cartilage, without migration or extrusion. Gross anatomy examination revealed good repair effect of laryngeal mucosa in experimental group, except a small amount of scar formed in one case, the remaining 2 cases had no scar formation, with smooth throat and without laryngostenosis, postoperative breathing and swallowing function recovered well. In the control group, stent surface granulation and scar tissue proliferated in three cases, 1 patient of which died of dyspnea at 63 days after operation. Histological examination showed most of the epithelium in the experimental group was covered with stratified squamous epithelium, vascular tissue and some lymphocytes were seen in stroma. In the control group, granulation tissue and fibroplasia were evident, without the stratified squamous epithelium covered, there were massive lymphocytes and plasma cells in stroma. Ni-Ti alloy stent combined with ADM could effectively repair the laryngeal impairment. The method provides adequate support and reduces formation of granulation and scars.