Tracheal Diseases Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Iran.
Eur J Cardiothorac Surg. 2012 Mar;41(3):676-9. doi: 10.1093/ejcts/ezr010. Epub 2011 Oct 18.
Segmental resection and anastomosis of oesophageal lesions are not performed as a routine clinical practice because of complications and associated problems, whereas tracheal resection and anastomosis are a routine clinical practice. In this experimental study, we resected a segment of cervical oesophagus and replaced it with a tracheal segment.
In eight dogs (mixed races), weighing 20-30 kg, ageing 1-2 years, under general anaesthesia, through a cervical incision, 5 cm of cervical trachea was separated while preserving its attachments to surrounding fibroareolar tissues. Afterwards, 5 cm of the oesophagus was resected and replaced with a prepared segment of the trachea. Oral liquids were started at the first post-operative day; the animals were kept for 2 months and then euthanized. Quality of swallowing and voice were evaluated. After an autopsy, anastomoses were examined grossly and histopathologically.
No complications occurred during surgery. Swallowing function and voice were normal in all eight dogs after the operation. No sign of aspiration was seen in clinical and radiographic examinations after starting oral diet. In autopsy examination, anastomoses were patent without narrowing or abnormal mucosal changes. Remarkable histopathological findings in replaced tracheal segments were squamous metaplasia, atrophy and degeneration of mucosal glands and degeneration of cartilages.
Replacement of a segment of the oesophagus with an autogenous tracheal segment is a practical procedure with low complications and can probably be used for the treatment of cervical oesophageal lesions in human beings.
由于并发症和相关问题，食管病变的节段切除术和吻合术并不作为常规临床实践，而气管切除术和吻合术则是常规临床实践。在这项实验研究中，我们切除了一段颈段食管并用气管段替代。
在 8 只（混合品种）体重 20-30 公斤、1-2 岁的狗中，在全身麻醉下，通过颈部切口，分离 5 厘米的颈气管，同时保留其与周围纤维脂肪组织的附着。然后，切除 5 厘米的食管并用准备好的气管段替换。术后第一天开始口服液体；动物被饲养 2 个月，然后安乐死。评估吞咽和声音质量。尸检后，肉眼和组织病理学检查吻合口。
手术过程中无并发症发生。术后 8 只狗的吞咽功能和声音均正常。开始口服饮食后，临床和影像学检查均未见吸入迹象。尸检检查显示吻合口通畅，无狭窄或异常黏膜改变。替代气管段的显著组织病理学发现是鳞状上皮化生、黏膜腺萎缩和退化以及软骨退化。
用自体气管段替代一段食管是一种并发症低且实用的手术方法，可能可用于治疗人类颈段食管病变。
