Nakanishi R, Nagaya N, Yoshimatsu T, Hanagiri T, Yasumoto K
Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
J Thorac Cardiovasc Surg. 1997 Jan;113(1):26-36. doi: 10.1016/S0022-5223(97)70396-9.
When a primary anastomosis of the trachea is not feasible, extensive grafting is required. However, despite the use of omental wrapping for revascularization, long-segment tracheal grafts frequently do not maintain structural integrity because of insufficient blood supply. We examined the use of basic fibroblast growth factor for preservation of long-segment tracheal autografts after orthotopic transplantation with omental wrapping in 23 dogs. All animals received orthotopic tracheal transplantation, with 14-ring autografts that occupied a major part of the thoracic trachea, and omental wrapping. The 23 animals were classified randomly into six groups as follows: no treatment (group I, n = 3), topical administration of fibrin glue alone (group II, n = 4), fibrin glue enriched with 1 microg/cm2 basic fibroblast growth factor (group III, n = 4), fibrin glue enriched with 5 microg/cm2 basic fibroblast growth factor (group IV, n = 4), and fibrin glue enriched with 10 microg/cm2 basic fibroblast growth factor (groups V and VI, each n = 4). The omentum that was used to wrap the autografts was fed by the right gastroepiploic artery in groups I to V and by both the right gastroepiploic artery and splenic artery in group VI. All autografts in groups I and II showed dissolution. Ten of 12 autografts in groups III, V, and VI did not maintain long-term structural integrity. By contrast, all autografts in group IV showed long-term viability, as demonstrated by graft patency, epithelialization, cartilage morphology, and vascularity. We conclude that treatment with fibrin glue enriched with 5 microg/cm2 basic fibroblast growth factor in combination with omental wrapping may prolong the viability of long-segment tracheal autografts.
当气管的一期吻合不可行时，就需要进行广泛的移植。然而，尽管使用网膜包裹来促进血管再生，但由于血供不足，长段气管移植物常常无法维持结构完整性。我们研究了在23只犬原位移植并进行网膜包裹后，使用碱性成纤维细胞生长因子来保存长段气管自体移植物的情况。所有动物均接受原位气管移植，移植的是占据胸段气管大部分的14环自体移植物，并进行网膜包裹。23只动物被随机分为六组，如下：未治疗组（I组，n = 3）、仅局部应用纤维蛋白胶组（II组，n = 4）、富含1微克/平方厘米碱性成纤维细胞生长因子的纤维蛋白胶组（III组，n = 4）、富含5微克/平方厘米碱性成纤维细胞生长因子的纤维蛋白胶组（IV组，n = 4）、富含10微克/平方厘米碱性成纤维细胞生长因子的纤维蛋白胶组（V组和VI组，每组n = 4）。I至V组用于包裹自体移植物的网膜由胃网膜右动脉供血，VI组由胃网膜右动脉和脾动脉供血。I组和II组的所有自体移植物均出现溶解。III组、V组和VI组的12个自体移植物中有10个未能维持长期结构完整性。相比之下，IV组的所有自体移植物均显示出长期存活，表现为移植物通畅、上皮化、软骨形态和血管形成。我们得出结论，用富含5微克/平方厘米碱性成纤维细胞生长因子的纤维蛋白胶结合网膜包裹进行治疗，可能会延长长段气管自体移植物的存活时间。
