CAJ | 학술논문

目的通过构建犬颈段气管缺损与重建的实验动物模型,寻找一种通过一期手术即能与自体气管完全愈合为一体的人工气管材料和手术方法.方法将8只犬一期手术切除3.5～4.0 cm长的颈部气管,采用可以永久保留在体内的聚丙烯网状材料与颈前皮瓣联合行气管重建,术后初期管腔内置入Z型金属覆膜气管支架,观察犬的生存期、生存质量,通过纤维气管镜、X线片及组织切片观察吻合口愈合情况及病理变化.结果 8只犬中1只犬因继发呼吸衰竭于术后2 d死亡,1只犬因吻合口感染术后10 d死亡.存活的6只犬中除1只并发轻度气管狭窄,其余5只犬生活质量好,术后第2 d即可正常饮水及进食,无呼吸困难等并发症.术后2、4、8周及6个月处死动物取出重建气管标本,见2周时有软组织长入聚丙烯网孔,使其硬度增加并具有一定的支撑度;4周时长入网孔的软组织增多;8周及6个月时软组织将聚丙烯网完全覆盖,并发生纤维化使网的支撑度明显增加.病理检查显示,术后2、4、8周时可见吻合口肉芽生长,术后6个月时肉芽组织较前缩小,皮瓣的鳞状上皮与黏膜的柱状上皮愈合良好.结论具有良好的组织相容性的聚丙烯网状材料与颈前皮瓣联合一期成形重建气管可与自体气管融为一体,成为自体气管的一部分,此种重建气管方法有望应用到临床.
목적 통과구건견경단기관결손여중건적실험동물모형,심조일충통과일기수술즉능여자체기관완전유합위일체적인공기관재료화수술방법.방법 장8지견일기수술절제3.5～4.0 cm장적경부기관,채용가이영구보류재체내적취병희망상재료여경전피판연합행기관중건,술후초기관강내치입Z형금속복막기관지가,관찰견적생존기、생존질량,통과섬유기관경、X선편급조직절편관찰문합구유합정황급병리변화.결과 8지견중1지견인계발호흡쇠갈우술후2 d사망,1지견인문합구감염술후10 d사망.존활적6지견중제1지병발경도기관협착,기여5지견생활질량호,술후제2 d즉가정상음수급진식,무호흡곤난등병발증.술후2、4、8주급6개월처사동물취출중건기관표본,견2주시유연조직장입취병희망공,사기경도증가병구유일정적지탱도;4주시장입망공적연조직증다;8주급6개월시연조직장취병희망완전복개,병발생섬유화사망적지탱도명현증가.병리검사현시,술후2、4、8주시가견문합구육아생장,술후6개월시육아조직교전축소,피판적린상상피여점막적주상상피유합량호.결론 구유량호적조직상용성적취병희망상재료여경전피판연합일기성형중건기관가여자체기관융위일체,성위자체기관적일부분,차충중건기관방법유망응용도림상.
Objective Canine model established for tracheal defect reconstruction,to investigate the outcome of tracheal reconstruction with combination of polypropynene and flap.Methods About 3.5 to 4 centimeter cervical trachea was resected and replaced with artificial trachea made from monofilament knitted polypropylene and surgical flap.Covered stent Was implanted postoperatively.Survival period and quality of life were recorded,brunchofibroscopy,X-ray films and HE sections were perfomed.Results Six dogs survived well and another two died.The causes of death were respiratory failure in 1 and infection in another.Stenosis of anastomosis in 1 Was recorded during survival period.The dogs started drinking and eating on the second postoperative day,no dyspnea Was found.The animals were sacrificed at 2,4,8 weeks and 6 months after surgery.Soft tissue growth Was found in polypropynene net 2 weeks after surgery and more at 4 weeks.The polypropynene net was covered completely with soft tissue at 8 weeks and 6 months postoperatively.the hardness and sustentation degree were enhanced following the growth and fibrosis of soft tissue.The squamous epithelium and columnar epithelium were ohserved healing well by HE staining method.Conclusions One-stage operative artificial trachea made from monofilament knitted polypropylene which has good histocompatibility and surgical flap is the closer artificial trachea to native trachea.It has a promising prospect in clinical use.