Crisera C A, Connelly P R, Marmureanu A R, Colen K L, Rose M I, Li M, Longaker M T, Gittes G K
Department of Surgery, New York University Medical Center, NY 10016, USA.
J Pediatr Surg. 1999 Jan;34(1):204-8. doi: 10.1016/s0022-3468(99)90258-0.
BACKGROUND/PURPOSE: The organogenesis of esophageal atresia with tracheoesophageal fistula (EA-TEF) is unknown. Using an established model for EA-TEF in rats, the authors proposed to study this aberrancy of development in the hope of gaining insight into its mechanism of formation.
Pregnant Sprague-Dawley rats were injected with 2.2 mg/kg of Adriamycin intraperitoneally on days 6 through 9 of gestation. Using microdissection, the trachea, blind-ending esophagus, TEF, and stomach were isolated from embryos of various gestional ages. The specimens were analyzed histologically with routine H&E staining.
The classic EA-TEF developed in the embryos, with proximal EA and distal TEF. As expected, the atresia formed as a blind-ending pouch, but the distal fistula began as an apparent equal trifurcation of the tracheal anlage into two mainstem bronchi and the fistula tract leading to the stomach. Histological analysis of the fistula tract showed respiratorylike pseudostratified columnar epithelium.
TEF develops as the middle branch of a tracheal trifurcation. EA-TEF occurs by a primary atresia of the esophagus. As a secondary phenomenon, the distal foregut anlage is switched toward the pulmonary phenotype. It trifurcates, and its middle branch grows caudally to fistulize into the stomach.
背景/目的：食管闭锁合并气管食管瘘（EA-TEF）的器官发生机制尚不清楚。作者利用已建立的大鼠EA-TEF模型，拟研究这种发育异常，以期深入了解其形成机制。
妊娠6至9天的Sprague-Dawley孕鼠腹腔注射2.2mg/kg阿霉素。采用显微解剖法，从不同 gestational ages 的胚胎中分离出气管、盲端食管、TEF和胃。标本用常规苏木精-伊红染色进行组织学分析。
胚胎中出现了典型的EA-TEF，近端为EA，远端为TEF。正如预期的那样，闭锁形成一个盲端囊袋，但远端瘘起始于气管原基明显等分为两个主支气管和通向胃的瘘管。瘘管的组织学分析显示为类似呼吸道的假复层柱状上皮。
TEF作为气管三分叉的中间分支发育。EA-TEF是由食管原发性闭锁引起的。作为一种继发现象，远端前肠原基转变为肺表型。它三分叉，中间分支向尾侧生长并与胃形成瘘管。
