Liu Jun, Shi Wenjun, Zhang Suning
Department of Thoracic Surgery, the Second Affiliated Hospital of China Medical University, Shenyang Liaoning, 110004, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2006 May;20(5):507-10.
To apply self-pulmonary tissue flap to reconstruct esophagus directly or with alloy stent in this research.
Twenty-four dogs were divided into two groups, middle bronchus was ligated to prepare pulmonary flap and incised, a 4 to 6 cm long and 1/2 to 2/3 perimeter defect was made in esophageal wall. Esophagus defect was repaired only with pulmonary flap (experimental group) and with pulmonary flap having self-expanded stent inside (control group). The gross appearance, histological appearance and barium X-ray films were observed at 2,4,6,8, 10 and 12 weeks after operation.
Two dogs died of anastomotic leak in experimental group, three dogs died of anastomotic leak and two dogs died of perforation of ulcer in control group. The growth of esophagus epithelium was observed from periphery area to dental area after 8 to 10 weeks of operation. In pulmonary flap mass fibrous tissue proliferated and fibroblasts were active, but no necrosis occurred. Barium X-ray of regenerated esophagus showed that mild stenosis and weakened peristalsis were observed in the middle of esophagus replacement, and that no obstruction, leakage, and dilation above anastomotic stoma occurred.
Pulmonary tissue flap can well support the mucosa crawl in the defect of esophagus. It is necessary to find a more suitable and satisfied stent for repairing segmental defect.
本研究应用自体肺组织瓣直接或联合合金支架重建食管。
将24只犬分为两组，结扎中间支气管制备肺组织瓣并切开，在食管壁制造一个长4至6厘米、周长1/2至2/3的缺损。食管缺损仅用肺组织瓣修复（实验组），并在肺组织瓣内置入自膨式支架（对照组）。术后2、4、6、8、10和12周观察大体外观、组织学外观及钡剂X线片。
实验组2只犬死于吻合口漏，对照组3只犬死于吻合口漏，2只犬死于溃疡穿孔。术后8至10周可见食管上皮从周边向齿状区生长。肺组织瓣内纤维组织增生，成纤维细胞活跃，但无坏死发生。再生食管的钡剂X线检查显示，食管置换中段有轻度狭窄和蠕动减弱，吻合口上方无梗阻、渗漏及扩张。
肺组织瓣能很好地支持食管缺损处黏膜的爬行。为修复节段性缺损，有必要寻找更合适、满意的支架。
