Nagashima C, Masumori Y, Hori E, Kubota S, Kawanuma S, Shimada Y, Iwasaki T, Heshiki A, Mizuno H
Department of Nerosurgery, Saitama Medical School.
No Shinkei Geka. 1991 Apr;19(4):309-18.
Transplantation of omentum to the cervical cord was done in three cases with incomplete transection (Case 1) with posttraumatic progressing cervical myelopathy (Case 2) and with complete transection due to multisegmental, late cervical cord infarction (Case 3). Anastomoses were made between the occipital artery and the gastroepiploic artery of transplanting omentum and between the occipital vein and the gastroepiploic vein. In Case 2 and 3, omentum was maintained in tissue culture medium in an incubator (37 degrees C, 5% CO2) for about five hours following perfusion of the omentum with low molecular dextran containing urokinase, heparin, vitamin B12 until exploration of the dural tube and preparation of the occipital vessels were accomplished. Although complete transection with late infarct (Case 3) showed extremely slow improvement in follow-up period of 8 months, the incomplete traumatic lesions (Case 1 and 2) showed less slow but steady improvements in follow-up periods of 24 and 22 months with almost complete recovery of Case 2. Angiography showed patent anastomosis in all the cases. Dynamic CT at 4 (Case 1) and 6 (Case 2) months showed good perfusion in the compromised cord through the transplanted omentum.
对3例患者进行了大网膜移植至颈髓的手术，其中1例为不完全横断伤（病例1），1例为创伤后进行性颈髓病（病例2），1例为多节段晚期颈髓梗死导致的完全横断伤（病例3）。将移植大网膜的胃网膜动脉与枕动脉、胃网膜静脉与枕静脉进行吻合。在病例2和病例3中，在用含尿激酶、肝素、维生素B12的低分子右旋糖酐灌注大网膜后，将大网膜置于培养箱（37℃，5%二氧化碳）中的组织培养基中约5小时，直至完成硬脊膜管探查和枕部血管准备。尽管晚期梗死导致的完全横断伤（病例3）在8个月的随访期内改善极为缓慢，但不完全创伤性损伤（病例1和病例2）在24个月和22个月的随访期内改善较慢但较为稳定，病例2几乎完全恢复。血管造影显示所有病例的吻合口均通畅。病例1术后4个月和病例2术后6个月的动态CT显示，通过移植的大网膜，受损脊髓灌注良好。
