摘要
目的：分析犬自体肺组织瓣修补食管壁部分缺损的可行性。方法：实验于2003-01/2004-11在中国医科大学附属第二医院动物实验室完成。选用健康成年杂种犬20只,按随机数字表法分为2组,即支架组和无支架组,每组10只。20只实验犬经右胸第5肋间进胸,于胸内中段食管处胸内食管侧壁制成长4cm,环1/2-2/3周径全层缺损。于相应部位选择适当的肺组织,制成带蒂类舌状肺组织瓣。两组均将肺组织瓣覆盖并缝合固定于食管缺损处,支架组于食管缺损内衬自扩性记忆合金支架（管腔直径2.0cm、长6.0cm）并固定。术后抗炎及营养支持治疗。观察实验犬术后情况,并于术后2,4,6,8,10和12周定期处死实验犬行组织学观察。结果：无支架组实验犬存活7只,其中1只犬存活〉24个月;支架组存活6只。①实验犬术后一般情况：存活犬于术后均能正常经口进食,早期有进食后呕吐,再吃下呕吐食物的现象,以支架组明显。②组织学观察结果：术后2周,无支架组均可见替代物表面有胶原及炎性渗出物,边缘见1-2层鳞状上皮细胞;支架组除有无支架组基本表现外,可见支架固定良好,光镜下见网架压迫处有较多中性粒细胞浸润。4-6周,两组均可见替代物表面有新生的3-5层复层鳞状上皮细胞;支架组见支架已基本陷入黏膜层内。8-10周,两组均可见管腔表面有6-8层新生复层鳞状上皮细胞;支架组网架边缘瘢痕组织增生,支架完全被包裹,炎症较重的局部有细胞爬行中断现象或新生细胞层数较薄,多为一两层。结论：应用自体肺组织瓣修补食管壁部分缺损是可行的,但支架组支架对食管修补处组织刺激大,炎性反应重,瘢痕重,因此如何选择合适的支撑物是今后替代节段性食管缺损面临的重要问题。
AIM： To analyze the feasibility of repairing the partial esophageal defect with pulmonary tissue flap of dogs.
METHODS： The experiment was conducted at the Animal Laboratory, Second Affiliated Hospital, China Medical University from January 2003 to November 2004. Twenty adult mongrel dogs were used for the study, which were divided into two groups： stent group and non-stent group with 10 in each group. The partial full-thickness esophageal wall defect, which was 4 cm long and 1/2-2/3 circled esophagus was repaired by pulmonary tissue flap at the fifth rib of right thorax in the 20 dogs. The lobar bronchus of lung was ligated, so the pulmonary tissue flap was made. In the two groups, pulmonary tissue flap was covered, sutured and fixed at esophageal wall defect. In the stent group, esophagus replacement was done by pulmonary tissue flap with the self-expanded alloy stent inside in dogs （the diameter of lumina of 2.0 cm and length of 6.0 cm）. Antibiotics and nutritious therapy were used after operation. The dogs were put to death at weeks 2, 4, 6, 8, 10 and 12 routinely and histological examination was used for the study.
RESULTS： Totally 7 dogs were survival in the non-stent group, of which 1 dog was survival for more than 24 months, and 6 dogs were survival in stent group.①General condition of experimental dogs after operation： The survival dogs could eat normally after operation, but vomited and ate the vomited in the early phase, especially in stent group. ② Observational result of histology： Two weeks after operation, the esophageal defect was covered with collagen layer and inflammation exudation. A little epithelization was observered at free edge of the anastomosis, which was 1-2 layers of stratified squamous epithelium cells in both groups. In stent team, stents were fixed well and there were many neutrophilic granulocytes at the spots where stents oppressed under light microscope. At weeks 4-6 after operation, the intemal surface of the defect was covered with 3-5 layers of stratified squamous epithelium cells in both groups. In stent team, stents entered into the mucosa. At weeks 8-10, the luminal surface of the defect was covered with 6-8 layers of stratified squamous epithelium cells in both groups. In stent team, scar hyperplasia was found at the edge of stents that were wrapped entirely, interruption and a little epithelization were observered at the spots with serious inflammation that was 1-2 layers of stratified squamous epithelium cells.
CONCLUSION： It is feasible to repair the partial esophageal defect with the pulmonary tissue flap in dogs, but the stent in the stent group has great stimulation on repaired esophagus, with severe inflammatory reaction and severe scar. Therefore, how to choose suitable stent is a major problem for replacing segmental esophageal defect in the future.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第8期1405-1407,I0001,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
卫生部科技专项立项资助项目(WKZ-2000-1-17)~~
