Liu Wenliang, Xiao Peng, Liang Hengxing, An Ran, Cheng Gang, Yu Fenglei
Department of Thoracic Surgery, Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Mar;27(3):330-4.
To construct a new composite artificial trachea and to investigate the feasibility of trachea repair and reconstruction with the new composite artificial trachea transplantation in dogs.
The basic skeleton of the new composite artificial trachea was polytetrafluoroethylene vascular prosthesis linked with titanium rings at both ends. Dualmesh was sutured on titanium rings. Sixteen dogs, weighing (14.9 +/- 2.0) kg, female or male, were selected. The 5 cm cervical trachea was resected to prepare the cervical trachea defect model. The trachea repair and reconstruction was performed with the new composite artificial trachea. Then fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction were conducted at immediate, 1 month, and 6 months after operation. Gross observation and histological examination were conducted at 14 months to evaluate the repair and reconstruction efficacy.
No dog died during operation of trachea reconstruction. One dog died of dyspnea at 37, 41, 55, 66, 140, and 274 days respectively because of anastomotic dehiscence and artificial trachea displacement; the other 10 dogs survived until 14 months. The fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction showed that artificial tracheas were all in good location without twisting at immediate after operation; mild stenosis occurred and anastomoses had slight granulation in 6 dogs at 1 month; severe stenosis developed and anastomosis had more granulation in 1 dog and the other dogs were well alive without anastomotic stenosis at 6 months. At 14 months, gross observation revealed that outer surface of the artificial trachea were encapsulated by fibrous connective tissue in all of 10 dogs. Histological examination showed inflammatory infiltration and hyperplasia of fibrous tissue and no epithelium growth on the inner wall of the artificial trachea.
The new composite artificial trachea can be used to repair and reconstruct defect of the trachea for a short-term. Anastomotic infection and dehiscence are major complications and problems affecting long survival.
构建新型复合人工气管，探讨新型复合人工气管移植修复重建犬气管缺损的可行性。
新型复合人工气管的基本骨架为两端连接钛环的聚四氟乙烯人工血管。在钛环上缝合双层网。选取16只体重（14.9±2.0）kg的犬，雌雄不限。切除5 cm颈段气管制备颈段气管缺损模型，采用新型复合人工气管进行气管修复重建。术后即刻、1个月、6个月行纤维支气管镜检查、CT扫描及三维重建。术后14个月行大体观察及组织学检查，评价修复重建效果。
气管重建手术过程中无犬死亡。1只犬分别于术后37、41、55、66、140及274天因吻合口裂开及人工气管移位死于呼吸困难；其余10只犬存活至14个月。纤维支气管镜检查、CT扫描及三维重建显示，术后即刻人工气管均位置良好，无扭曲；1个月时6只犬出现轻度狭窄，吻合口有轻微肉芽组织；6个月时1只犬出现重度狭窄，吻合口肉芽组织较多，其余犬存活良好，无吻合口狭窄。14个月时，大体观察显示10只犬人工气管外表面均被纤维结缔组织包裹。组织学检查显示人工气管内壁有炎症浸润及纤维组织增生，无上皮生长。
新型复合人工气管可用于短期修复重建气管缺损。吻合口感染及裂开是影响长期存活的主要并发症和问题。
