Yang Guang, Zhou Yong-An, Bai Guang-Zhen, Han Yong, Li Wei-Miao, Wang Jian, Li Xiao-Fei, Yan Xiao-Long
Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China.
Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China; Department of General Surgery, No. 291 Hospital of the People's Liberation Army, Baotou, China.
J Surg Res. 2017 Mar;209:1-7. doi: 10.1016/j.jss.2016.10.009. Epub 2016 Oct 14.
The management of acquired benign tracheoesophageal fistula (TEF) and bronchogastric stump fistula (BGSF) is a challenge. This study aimed to assess the "double-patch" technique with or without esophageal mucosa in treating nonmalignant TEF and BGSF.
We established a dog model with TEF by incising the esophageal and tracheal membranes and suturing them together. The dogs were divided into three groups (n = 12 per group). Groups A and B received a double-patch 7 d later. The esophageal mucosa of the patches was cauterized in the group A dogs, kept intact in group B dogs, and group C dogs did not receive surgical intervention. Tissue healing was measured using hydroxyproline levels.
Morphologic and histopathologic changes of the esophagus were assessed by gross observation of the specimens, hematoxylin and eosin staining, tracheal stenosis index, and hydroxyproline levels. On day 56 after surgery, group A showed a tracheal stenosis index comparable with that of group C (0.140 ± 0.009 versus 0.138 ± 0.014, P = 1.00), whereas group B showed a higher stenosis index (0.170 ± 0.007) than group C (P = 0.029). The hydroxyproline levels were higher in group A than in B and C on day 7 (P = 0.029), and this difference was statistically significant on days 14 and 56 (all P < 0.001).
The use of an esophageal "double-patch" technique without mucosa showed faster and more stable recovery than patches with mucosa in the repair of acquired nonmalignant complicated TEF and BGSF.
后天性良性气管食管瘘（TEF）和支气管胃残端瘘（BGSF）的治疗颇具挑战。本研究旨在评估采用或不采用食管黏膜的“双补片”技术治疗非恶性TEF和BGSF的效果。
通过切开食管和气管膜并将它们缝合在一起，建立犬TEF模型。将犬分为三组（每组n = 12）。A组和B组在7天后接受双补片治疗。A组犬补片的食管黏膜被烧灼，B组犬的黏膜保持完整，C组犬未接受手术干预。使用羟脯氨酸水平来测量组织愈合情况。
通过对标本的大体观察、苏木精-伊红染色、气管狭窄指数和羟脯氨酸水平来评估食管的形态学和组织病理学变化。术后第56天，A组的气管狭窄指数与C组相当（0.140±0.009对0.138±0.014，P = 1.00），而B组的狭窄指数（0.170±0.007）高于C组（P = 0.029）。术后第7天，A组的羟脯氨酸水平高于B组和C组（P = 0.029），在第14天和第56天，这种差异具有统计学意义（所有P < 0.001）。
在修复后天性非恶性复杂性TEF和BGSF时，不使用黏膜的食管“双补片”技术比使用黏膜的补片恢复更快且更稳定。
