摘要
目的 应用犬自体肺组织瓣直接包绕或内衬金属支架修补胸段食管壁部分缺损，探讨其胸段食管重建的可行性。方法24只杂种犬，体重10～15kg，雌雄不限。将其制成食管壁长约4～6cm、宽为环1／2-2／3周径部分缺损的动物模型，结扎右中叶支气管使肺萎陷，制成肺组织瓣。随机分为2组，每组12只。实验组，肺组织瓣直接修补食管缺损；对照组，肺组织瓣内衬金属支架修补食管缺损。术后于第2、4、6、8、10和12周每组各处死1只犬，行大体观察、组织学和钡餐等检查。结果实验组术后第5、7天死于吻合口瘘各1只，脓胸1只；对照组术后第6、9、23天死于吻合口瘘各1只，溃疡穿孔2只，脓胸2只。术后实验组发生吻合口瘘2只，无明显食管狭窄，术后4周吻合口处有3～5层上皮细胞，术后8周肺组织瓣表面完全上皮化，电镜观察细胞间以紧密连接为主。对照组术后第6、9、23天发生吻合口瘘3只，溃疡穿孔2只，支架周围炎性反应较重，上皮细胞爬行较不完全，对肺组织瓣的压迫较重。两组存活8周以上的犬各1只，钡餐透视显示替代物中央的管腔轻度狭窄，蠕动减弱，但黏膜光滑，钡剂通过顺利，无梗阻和瘘，吻合口上端无扩张。结论肺组织瓣能为食管上皮细胞提供良好再生环境，用以重建犬胸段食管具有可行性，但金属支架对组织有损伤，尚需寻找合理支架材料并对替代节段性缺损进行研究。
Objective To apply self-pulmonary tissue flap to reconstruct esophagus directly or with alloy stent in this research. Methods Twenty-four dogs were divided into two groups, middle bronchus was ligated to prepare pulmonary flap and incised, a 4 to 6 cm long and 1/2 to 2/3 perimeter defect was made in esophageal wall. Esophagus defect was repaired only with pulmonary flap （experimental group） and with pulmonary flap having self-expanded stent inside （control group）. The gross appearance, histological apearance and barium X-ray films were observed at 2,4,6,8, 10 and 12 weeks after operation. Results Two dogs died of anatomotic leak in experimental group, three dogs died of anatomotic leak and two dogs died of perforation of ulcer in control group. The growth of esophagus epithelium was observed from periphery area to central area after 8 to 10 weeks of operation. In pulmonary flap mass fibrous tissue proliferated and fibroblasts were active, but no necrosis occurred. Barium X-ray of regenerated esophagus showed that mild stenosis and weakened peristalisis were observed in the middle of resophagus replacement, and that no obstruction, leakage, and dilation above anastomotic stoma occurred. Conclusion Pulmonary tissue flap can well support the mucosa crawl in the defect of esophagus. It is necessary to find a more suitable and satisfied stent for repairing segmental defect.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2006年第5期507-510,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
卫生部科技专项资助项目(wkz-2000-1-17)~~
关键词
食管缺损
肺组织瓣
金属支架
食管重建
犬
Esophagus defect Pulmonary tissue flap Alloy stent Esophagus reconstruction Dog
