CAJ | 학술논문

背景:控制感染是保证喉移植成功的关键.在实践中应探索如何最低限度地减少感染,使重建血运后的供体喉在免疫抑制状态下先成活,之后再恢复喉的呼吸、吞咽、发音功能.目的:为减少感染,探讨采用分期移植方法进行同种异体喉移植的可行性.方法:根据体质量、喉体大小将10只雄性同种比格犬配对成5组供受体,采用异体喉移植方式,埋置在受体犬颈部皮下,每日应用免疫抑制剂抗机体免疫排斥,待喉体成活后再将供体喉与受体分别行咽部、气管对位吻合,建立Ⅱ期喉移植动物模型.结果与结论:Ⅰ期喉植入后,供喉生存良好,血运可.颈部纵切口的1号和颈部横切口的4,5号犬伤口生长良好,4,5号供喉未发生感染现象,最长可至4周后行Ⅱ期再植;U形切口的2,3号犬皮瓣坏死,供喉不同程度发生感染,2号喉坏死,3号经处理后喉存活.供喉在受体内生存最长可达4周.提示将喉移植分期进行,供喉摘除后预埋置法模式可以避免、减少移植后的喉体感染,受体犬耐受,供喉易成活,可以进行Ⅱ期的喉再造.移植后的主要组织学变化是黏膜上皮的改变,可以此作为观察免疫抑制反应的指标.需要处理的是埋置喉的腺体分泌问题,免疫抑制剂必须连续长期应用.
배경:공제감염시보증후이식성공적관건.재실천중응탐색여하최저한도지감소감염,사중건혈운후적공체후재면역억제상태하선성활,지후재회복후적호흡、탄인、발음공능.목적:위감소감염,탐토채용분기이식방법진행동충이체후이식적가행성.방법:근거체질량、후체대소장10지웅성동충비격견배대성5조공수체,채용이체후이식방식,매치재수체견경부피하,매일응용면역억제제항궤체면역배척,대후체성활후재장공체후여수체분별행인부、기관대위문합,건립Ⅱ기후이식동물모형.결과여결론:Ⅰ기후식입후,공후생존량호,혈운가.경부종절구적1호화경부횡절구적4,5호견상구생장량호,4,5호공후미발생감염현상,최장가지4주후행Ⅱ기재식;U형절구적2,3호견피판배사,공후불동정도발생감염,2호후배사,3호경처리후후존활.공후재수체내생존최장가체4주.제시장후이식분기진행,공후적제후예매치법모식가이피면、감소이식후적후체감염,수체견내수,공후역성활,가이진행Ⅱ기적후재조.이식후적주요조직학변화시점막상피적개변,가이차작위관찰면역억제반응적지표.수요처리적시매치후적선체분비문제,면역억제제필수련속장기응용.
BACKGROUND: The key to success in laryngeal transplantation is to control the infection. In practice, how to minimize the risk of infection should be considered first, so that the laryngeal allograft can survive after revascularization under the immunosuppressive state. Then the therapeutics methods should be focused on the functional recovery of respiratory, swallowing and phonation.OBJECTIVE: To explore the feasibility of staged allogeneic larynx transplant for dogs in order to decrease the infection rate.METHODS: Ten male conspecific Beagle dogs were assigned into five pairs of donor and receptor according to body mass and the size of larynx. The allogeneic larynx was embedded under the neck skin by allotransplantation. The dogs were treated with immunosuppressant daily to resist immnological rejection. The pharynx and trachea were contraposed after larynx survived to establishⅡstage laryngeal transplantation animal model.RESULTS AND CONCLUSION: InⅠstage of laryngeal transplantation, the laryngeal allograft survived well, blood supply was passable. Receptor dog 1 with vertical midline incision in the neck, receptor dogs 4 and 5 with transverse incisions in the neck grew well. No infection phenomena was found in receptor dogs 4 and 5. The lastⅡstage laryngeal transplantation was performed in the 4th week afterⅠstage laryngeal transplantation. Skin flap necrosis occurred in receptor dogs 2 and 3 with U-shape incisions. The donor larynx had different degree infection. Laryngeal allograft of receptor dog 2 died; laryngeal allograft of receptor dog 3 survived after treatment. The survival period of donor larynx in receptors was as long as 4 weeks. These findings indicate that the larynx infection is avoid or reduced by staged larynx transplantation with pre-embed laryngeal allograft after total laryngectomy. The receptor dog is tolerant; the donor larynx is easy to survive. The main histological change occurs in the epithelial mucosae which can be used as an inspect index of immunosuppressive agents. However, glandular organ secretion is a troublesome problem and immunodepressant must be continuously administrated for a long time.