摘要
目的完善镍钛合金支架联合自体心包重建长段气管的手术流程,评价治疗效果及研究术后并发症。方法选取健康巴马香猪12只,体质量18-25 kg;取猪心尖周围心包组织包裹镍钛合金支架重建长段（6 cm）气管缺损。观测术后实验动物的生存状况及术后并发症,气管镜观察人工气管管腔新生上皮的性质及生长速度。结果 2只动物于术后早期分别死于感染和出血,7只于术后2-4个月因管腔中段增生、痰栓堵塞死亡;42周有3只动物存活,但有呼吸困难症状。术后1、2、3、4、5个月新生上皮平均爬行长度分别为1、3、5、7、10 mm;气管镜检查吻合口狭窄发生率分别为0（0/10）、0（0/9）、0（0/4）、33.3%（1/3）、33.3%（1/3）,管腔中段瘢痕增生发生率分别为20%（2/10）、66.7%（6/9）、75.0%（3/4）、66.7%（2/3）、100%（3/3）。术后7个月,气管镜发现人工气管中段的瘢痕增生较前有生长停滞、软化和缩小的趋势,呼吸道症状稍有缓解。尸检均可见人工气管中段瘢痕增生明显;病理检查示管腔中段增生为坏死组织和纤维组织。结论镍钛合金支架联合自体心包重建气管能保障气管管腔通畅,且支持气管上皮再生;人工气管内壁增生、继发痰栓堵塞是实验动物死亡的主要因素。
Objective To perfect the surgical process that trachea could be reconstructed by nickel-titanium（NiTi） alloy stent wrapped with autologous pericardium, and to evaluate the effectiveness and observe the complications. Methods In the experiment, twelve healthy Bama suckling pigs with weight of 18-25 kg were selected. The pericardium was harvested to cover the Ni-Ti alloy stent. The compound artificial trachea was used to reconstruct long-segmental（6 cm） trachea defect. The effectiveness, complications, the properties, and growth rate of the new mucosa of the artificial trachea lumen were observed. Results Of 12 pigs, 2 died soon because of hemorrhage and infection, respectively; 7 died at 2-4 months after operation because of hyperplasia at the middle section and blockage of phlegm plug; 3 survived after 42 weeks postoperatively, but accompanied with dyspnea symptom. At 1, 2, 3, 4, and 5 months after operation, the average crawl length of the new trachea mucosa was 1, 3, 5, 7, and 10 mm, respectively; the occurrence rates of anastomotic stenosis were 0（0/10）, 0（0/9）, 0（0/4）, 33.3%（1/3）, and 33.3%（1/3） respectively; and the occurrence rates of scar hyperplasia in the middle of lumen were 20%（2/10）, 66.7%（6/9）, 75.0%（3/4）, 66.7%（2/3）, and 100%（3/3）, respectively. At 7 months postoperatively, the bronchoscopy examination showed that the scar in central part of artificial trachea had the trends of stagnation, softening, and narrowing, and respiratory symptom had the trend of slight ease. Hyperplasia tissue could be found in central part of artificial trachea by autopsy and was verified to be fiber cells and necrotic tissue by pathology examination. Conclusion Ni-Ti alloy stent with autologous pericardium can insure that the reconstructed tracheal lumen is unobstructed, and support the trachea epithelium regeneration; the main factors of the death of the experimental animals are the lumen hyperplasia of the artificial trachea and the blockage of the secondary phlegm plug.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第11期1419-1422,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
气管损伤
心包
镍钛合金支架
气管重建
气管上皮
猪
Trachea injury
Pericardium
Nickel-titanium alloy stent
Tracheal reconstruction
Tracheal epithelium
Pig
