Liu Jun, Shi Wen-Jun, Zhang Su-Ning
Department of Thoracic Surgery, Shengjing Hospital, China Medical University, Shenyang 110001, China.
Zhonghua Yi Xue Za Zhi. 2011 Jan 4;91(1):65-8.
To study the feasibility of applying autogenous pulmonary tissue flap with alloy stent to correct the defects of trachea and esophagus.
Twenty-four dogs were divided into tracheal and esophageal groups. Bronchus was ligated to prepare a pulmonary flap. And a defect of 3 - 4 cm long and 1/2 - 2/3 perimeter was made in tracheal or esophageal wall. Pulmonary arteries and veins were protected. Then the pulmonary gas was emitted to create a pulmonary tissue flap. The defect was repaired with a pulmonary flap with a self-expanded stent inside. The gross appearance, histological appearance, CT and barium X-ray films were observed at Weeks 2, 4, 6 and 8 post-operation.
Eighteen experimental dogs survived over 2 weeks. Anastomotic leak was the main cause of death. Two dogs died of perforation of ulcer in esophageal group. Reliable cicatrisation was observed between the pulmonary tissue flap and damage area. A quick growth of new tracheal and esophageal epithelium was observed from periphery area to central area. During the first 2 weeks, a little epithelization was observed at free edge of anastomosis equivalent to 1 - 2 layers of new epithelial cells. At weeks 4 - 6 post-operation, the internal surface of defect was covered with 3 - 5 layers of epithelial cells. At Weeks 8 - 10 post-operation, the luminal surface was covered with 6 - 8 layers of stratified epithelial cells. More ulcers could be observed on the surface of pulmonary tissue flap in esophageal group. In pulmonary flap, massive fibrous tissue proliferated and fibroblasts were active, but no necrosis occurred. CT and barium X-ray showed no obstruction in anastomotic stoma.
With an excellent compatibility with epithelial cells of trachea and esophagus, the autogenous pulmonary tissue flap can support the mucosal crawl in the defect of trachea and esophagus. When combined with alloy stent, it may be a choice procedure for reconstructing the defect of trachea and esophagus.
探讨应用自体肺组织瓣联合合金支架修复气管及食管缺损的可行性。
将24只犬分为气管组和食管组。结扎支气管制备肺组织瓣。在气管或食管壁上制造3 - 4厘米长、周长1/2 - 2/3的缺损，保护肺动脉和肺静脉。然后排出肺内气体形成肺组织瓣。用内置自膨式支架的肺组织瓣修复缺损。术后第2、4、6和8周观察大体外观、组织学表现、CT及钡餐X线片。
18只实验犬存活超过2周。吻合口漏是主要死亡原因。食管组2只犬死于溃疡穿孔。肺组织瓣与损伤区域之间形成可靠的瘢痕化。观察到气管和食管新上皮从周边区域向中央区域快速生长。术后前2周，吻合口游离边缘可见少量上皮化生，相当于1 - 2层新上皮细胞。术后4 - 6周，缺损内表面覆盖3 - 5层上皮细胞。术后8 - 10周，管腔表面覆盖6 - 8层复层上皮细胞。食管组肺组织瓣表面可见更多溃疡。肺组织瓣内大量纤维组织增生，成纤维细胞活跃，但无坏死发生。CT及钡餐X线显示吻合口无梗阻。
自体肺组织瓣与气管和食管上皮细胞具有良好的相容性，可支持气管和食管缺损处的黏膜爬行。联合合金支架时，可能是修复气管和食管缺损的一种选择术式。
