Kitada M
First Department of Surgery, Asahikawa Medical University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Nov;44(11):2011-8.
The success of tracheal transplantation largely depends on the revascularization process of the graft. We studied blood supply to the graft with 7 tracheal rings in an autotransplantation model; Group I, II and III. Then, a technique to promote blood supply to the graft with 14 tracheal rings was evaluated; Group IV and V. In group I, autotransplantation of the graft with 7 tracheal rings to the intact host trachea was performed. In group II, peritracheal sheath was dissected from the host trachea in the length of 2 tracheal rings prior to autotransplantation of the same graft. In group III, omentopexy was added to the graft of group II. In group IV, two circular incisions into the tissue between the 4-5th cartilage from the host trachea except the posterior wall were made in the graft with 14 tracheal rings. Omentopexy was added to the graft was autotransplanted to the intact host trachea. In group V, a procedure similar to that of group IV was performed without circular incisions in the graft. The rate of successful transplantation in group I, II, III, IV and V was 82.1%, 0%, 72.7%, 76.8% and 16.7% respectively. In the successful groups with transplantation (I, III, IV), establishment of blood supply through the newly developed blood vessels on the mucosal and outer surface of the anastomotic site was observed between 4 and 7 postoperative day. At that time, recanalization of the native vessels in the graft via new vessels was observed. The omentopexy enhanced the blood supply at the anastomotic sites, but it showed no improvement of the blood supply in the middle portion of the graft with intact sheath. The circular incisions in the long graft had additional effect on enhancement of blood supply to the middle portion of the graft. In conclusion, preservation of the host peritracheal sheath, omentopexy, in general, and the circular incisions in the long graft were the keys for successful tracheal transplantation.
气管移植的成功很大程度上取决于移植物的血管再生过程。我们在自体移植模型中研究了含7个气管环的移植物的血液供应情况，分为I、II、III组。然后，评估了一种促进含14个气管环的移植物血液供应的技术，分为IV、V组。在I组中，将含7个气管环的移植物自体移植到完整的宿主气管上。在II组中，在进行相同移植物自体移植之前，从宿主气管上剥离长度为2个气管环的气管周围鞘。在III组中，在II组移植物上增加了网膜固定术。在IV组中，对含14个气管环的移植物，在距宿主气管第4 - 5个软骨之间的组织（后壁除外）做两个环形切口。将增加了网膜固定术的移植物自体移植到完整的宿主气管上。在V组中，进行了与IV组类似的操作，但移植物未做环形切口。I、II、III、IV和V组的成功移植率分别为82.1%、0%、72.7%、76.8%和16.7%。在成功移植的组（I、III、IV）中，术后4至7天观察到通过吻合部位黏膜和外表面新形成的血管建立了血液供应。此时，观察到移植物中天然血管通过新血管实现了再通。网膜固定术增强了吻合部位的血液供应，但在完整鞘的移植物中间部分，血液供应未见改善。长移植物中的环形切口对增强移植物中间部分的血液供应有额外作用。总之，保留宿主气管周围鞘、一般的网膜固定术以及长移植物中的环形切口是气管移植成功的关键。
