背景:当食管有病变时通常用胃来替代食管,这样将改变生理性消化通道,从而导致一些诸如返流、进食不畅、消化不良等并发症.如果有一种人工食管来替代病变食管,这些可能的并发症将显著减少,并简化手术操作.目的:观察食管部分切除后,应用钛镍合金硅橡胶组合式人工食管重建缺损部分的情况.设计、时间及地点:观察性动物体内实验,于1999-05/2001-05在广州医学院第二附属医院动物实验室完成.材料:选用普通家猪16只,体质量30～35 kg,雌雄不拘.钛镍合金硅橡胶人工食管,长10 cm,内径20mm,内层为硅橡胶,外层为钛镍合金网,由北京有色金属研究总院稀贵所提供.方法:以普通家猪作动物实验,切除一段长约7 cm的胸段食管,以人工食管替代,分别于术后第1,2,3,4,5,6,7,8周及第3,4,6,8,10,12个月处死动物,尸体解剖,标本作连续切片、苏木精-伊红染色病理观察.主要观察指标:动物尸体解剖情况,组织病理学观察缺损食管部分新生情况.结果:纳入家猪16只,1只因术中大出血休克死亡,1只因麻醉意外死亡,其余14只动物生存期从7 d～1年不等.①动物处死后,从原胸壁切口开始进胸,4只动物见胸壁存在小脓腔,腔内见黄白色脓液,已包裹,与胸腔不相通,1只动物人工食管脱落后滞留于胃内;1只动物因术中吻合时缝合的人工食管过多且边距不均匀,导致人工食管扭曲,形成食管内嵌.1周时间人工食管周围形成假道,即"新生食管",包绕人工食管.②"新生食管"起初以肉芽组织为主(约2周),2周后代以纤维结缔组织,4周后,食管上皮细胞爬行并可完全覆盖"新生食管"内腔,可观察到新生的平滑肌细胞,但未见到腺体再生.人工食管脱落后"新生食管"中间段均见不同程度的狭窄,随着时间的增加(约6个月后),狭窄段趋于稳定.结论:一定长度下的食管缺损可通过应用钛镍合金硅橡胶组合式人工食管重建修复.
揹景:噹食管有病變時通常用胃來替代食管,這樣將改變生理性消化通道,從而導緻一些諸如返流、進食不暢、消化不良等併髮癥.如果有一種人工食管來替代病變食管,這些可能的併髮癥將顯著減少,併簡化手術操作.目的:觀察食管部分切除後,應用鈦鎳閤金硅橡膠組閤式人工食管重建缺損部分的情況.設計、時間及地點:觀察性動物體內實驗,于1999-05/2001-05在廣州醫學院第二附屬醫院動物實驗室完成.材料:選用普通傢豬16隻,體質量30～35 kg,雌雄不拘.鈦鎳閤金硅橡膠人工食管,長10 cm,內徑20mm,內層為硅橡膠,外層為鈦鎳閤金網,由北京有色金屬研究總院稀貴所提供.方法:以普通傢豬作動物實驗,切除一段長約7 cm的胸段食管,以人工食管替代,分彆于術後第1,2,3,4,5,6,7,8週及第3,4,6,8,10,12箇月處死動物,尸體解剖,標本作連續切片、囌木精-伊紅染色病理觀察.主要觀察指標:動物尸體解剖情況,組織病理學觀察缺損食管部分新生情況.結果:納入傢豬16隻,1隻因術中大齣血休剋死亡,1隻因痳醉意外死亡,其餘14隻動物生存期從7 d～1年不等.①動物處死後,從原胸壁切口開始進胸,4隻動物見胸壁存在小膿腔,腔內見黃白色膿液,已包裹,與胸腔不相通,1隻動物人工食管脫落後滯留于胃內;1隻動物因術中吻閤時縫閤的人工食管過多且邊距不均勻,導緻人工食管扭麯,形成食管內嵌.1週時間人工食管週圍形成假道,即"新生食管",包繞人工食管.②"新生食管"起初以肉芽組織為主(約2週),2週後代以纖維結締組織,4週後,食管上皮細胞爬行併可完全覆蓋"新生食管"內腔,可觀察到新生的平滑肌細胞,但未見到腺體再生.人工食管脫落後"新生食管"中間段均見不同程度的狹窄,隨著時間的增加(約6箇月後),狹窄段趨于穩定.結論:一定長度下的食管缺損可通過應用鈦鎳閤金硅橡膠組閤式人工食管重建脩複.
배경:당식관유병변시통상용위래체대식관,저양장개변생이성소화통도,종이도치일사제여반류、진식불창、소화불량등병발증.여과유일충인공식관래체대병변식관,저사가능적병발증장현저감소,병간화수술조작.목적:관찰식관부분절제후,응용태얼합금규상효조합식인공식관중건결손부분적정황.설계、시간급지점:관찰성동물체내실험,우1999-05/2001-05재엄주의학원제이부속의원동물실험실완성.재료:선용보통가저16지,체질량30～35 kg,자웅불구.태얼합금규상효인공식관,장10 cm,내경20mm,내층위규상효,외층위태얼합금망,유북경유색금속연구총원희귀소제공.방법:이보통가저작동물실험,절제일단장약7 cm적흉단식관,이인공식관체대,분별우술후제1,2,3,4,5,6,7,8주급제3,4,6,8,10,12개월처사동물,시체해부,표본작련속절편、소목정-이홍염색병리관찰.주요관찰지표:동물시체해부정황,조직병이학관찰결손식관부분신생정황.결과:납입가저16지,1지인술중대출혈휴극사망,1지인마취의외사망,기여14지동물생존기종7 d～1년불등.①동물처사후,종원흉벽절구개시진흉,4지동물견흉벽존재소농강,강내견황백색농액,이포과,여흉강불상통,1지동물인공식관탈락후체류우위내;1지동물인술중문합시봉합적인공식관과다차변거불균균,도치인공식관뉴곡,형성식관내감.1주시간인공식관주위형성가도,즉"신생식관",포요인공식관.②"신생식관"기초이육아조직위주(약2주),2주후대이섬유결체조직,4주후,식관상피세포파행병가완전복개"신생식관"내강,가관찰도신생적평활기세포,단미견도선체재생.인공식관탈락후"신생식관"중간단균견불동정도적협착,수착시간적증가(약6개월후),협착단추우은정.결론:일정장도하적식관결손가통과응용태얼합금규상효조합식인공식관중건수복.
BACKGROUND: The stomach is usually used to substitute the diseased esophagus, which will change the physical digestive passage and results in some complications, such as back-streaming, poor food intake, and dyspepsia. If there is an artificial esophagus to replace the diseased esophagus, then the complications would be greatly reduced, and surgical procedures would be simplified. OBJECTIVE: To investigate the effects of artificial prosthesis of titanium-nickel alloy and silicone on repairing esophageal defect after part excision of esophagus. DESIGN, TIME AND SETTING: An in vivo observation experiment based on animals was performed at the animal laboratory of Second Affiliated Hospital of Guangzhou Medical College between May 1999 and May 2001. MATERIALS: Sixteen pigs of either gender, weighting 30 35 kg, were included. The artificial esophagus constructed by titanium-nickel alloy and silicone were provided by General Research Institute for Nonferrous Metals. Its length was 10 cm and its internal diameter was 20 mm. Its inner layer was made of silicone and its outer layer was titanium-nickel alloy net. METHODS: A segment of 7-cm thoracic esophagus was resected and was replaced by an artificial prosthesis constructed by titanium-nickel alloy and silicone. At 1, 2, 3, 4, 5, 6, 7, and 8 weeks, as well as 3, 4, 6, 8, 10, and 12 months after surgery, animals were sacrificed to take specimens. Sedal slices were stained by hematoxylin-eosin for pathological examination. MAIN OUTCOME MEASURES: Autopsy and histopathological findings of neo-esophagus. RESULTS: Of initial 16 pigs, 1 died owing to shock caused by hemorrhee, 1 died of excessive anesthesia, and the remaining 14 pigs survived a period from 7 days to 1 year. Following sacrifice, some vomicas containing yellow and white liquor purls on the chest wall of 4 pigs were observed, which were wrapped but did not communicate the thoracic cavity. One artificial esophagus was not in place but found in the stomach. One artificial esophagus was twisted and formed an esophagus diverticulum. The false passage around the prosthesis formed so long as the animals survived more than 1 week, which was called as neo-esophagus. The neo-esophagus was constructed primadly by granulation tissue within approximately 2 weeks, and then fibrous connective tissue replaced it. Four weeks later, esophageal epithelial cells covered the internal cavity of the "nee-esophagus". At this time, neonatal smooth muscle cells could be observed, but gland regeneration was not found. Following artificial esophagus displacement, the middle segment of "neo-esophagus" presented with stenosis to different degrees. The stenosis segment tended to stabilize with time (approximately 6 months later). CONCLUSION: Esophageal defect within a certain range of length can be repaired by an artificial esophagus constructed by titanium-nickel alloy and silicone.
