目的 研究游离自体静脉补片修复实验犬气管膜部缺损的可行性。方法 颈部正中切口。取8只成年实验犬右侧颈静脉壁作为补片移植物。暴露实验犬颈部气管,切除环状软骨下方第四气管环水平部分膜部形成约2 cm×2 cm大小全层缺损,并使用静脉补片移植物修补受损气管膜部缺损。术后使用纤维支气管镜检查气管通畅度。实验犬存活至术后6个月实施安乐死,取气管标本计算收缩率,并进行组织学检查。结果 所有实验犬均未出现手术并发症,术后支气管镜检查未发现吸气或者呼气时气管塌陷,说明本方法修补气管具有足够通畅率。术后6个月处死实验犬,计算移植物修补气管最狭窄部位的横截面积与补片下第三软骨环部位的横截面积之比(收缩率)为1.07±0.04,说明修补部位气管管腔未出现明显狭窄。组织学检查发现所有补片移植物表面新生上皮。结论 颈静脉补片修补气管膜部缺损安全有效。
Abstract
Objective To investigate the feasibility of vein patch grafts being used to repair defective tracheal membranous walls.Methods The right jugular veins of eight adults dogs were harvested though midline cervical incisions and used as patch grafts. Each cervical trachea was exposed and a full-thickness lesion (2 cm×2 cm) was created in the cervical tracheal membranous wall by resecting part of the trachea at the forth ring below the cricoid cartilage. The defect was repaired by grafting a vein patch to the posterior surface of the injured part.Results All the eight dogs survived without complications until euthanasia 6 months later. Bronchoscopic examination demonstrated adequate tracheal patency with no inspiratory or expiratory collapse. The experimental dogs were killed 6 months after operation, and the constrictive ratio of the cross-sectional area of the most stenotic site to that of the third tracheal ring below the membranous patch was 1.07±0.04, suggesting that there was no obvious stenosis in the tracheal lumen. Histological examination revealed neoepithelium on the surfaces of all the patch grafts.Conclusions Our Results indicate that jugular vein patch grafts can be effectively and safely used to repair tracheal membranous wall lesions.
关键词
静脉补片 /
气管膜部缺损 /
修补
Key words
vein patch grafts /
defective tracheal membranous walls /
repair
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Steger V,Hampel M,Trick I, et al. Clinical tracheal replacement:transplantation, bioprostheses and artificial grafts[J]. Expert Rev Med Devices,2008, 5(5):605-612.
[2] Macchiarini P, Jungebluth P, Go T, et al. Clinical transplantation of a tissue-engineered airway [J]. Lancet,2008, 372(9655):2023–2030.
[3] Hamilton N, Bullock A J, Macneil S, et al. Tissue engineering airway mucosa: a systematic review[J]. Laryngoscope,2014, 124(4):961-968.
[4] Gonfiotti A,Jaus M O,Barale D, et al.The first tissue-engineered airway transplantation: 5-year follow-up results[J].Lancet,2014,383(9913):238-244
[5] Klepetko W, Marta G M,Wisser W, et al. Heterotopic tracheal transplantation with omentum wrapping in the abdominal position preserves functional and structural integrity of a human tracheal allograft[J]. J Thorac Cardiovasc Surg, 2004, 127(3): 862-867.
[6] Shi H, Xu H, Lu D, et al. Animal models of tracheal allotransplantation using vitrified cryopreservation[J]. J Thorac Cardiovasc Surg,2009 ,138(5):1222-1226
[7] Iyikesici T, Tuncozgur B, Sanli M, et al. Two-piece cryopreserved tracheal allotransplantation: an experimental study [J]. Eur J Cardiothorac Surg, 2009, 36(4): 722-726.
[8] Huang X, Yan X, Zhang Z, et al. Seeding of recipient-originated epithelial cells attenuates epithelial to mesenchymal transition in rat tracheal allotransplantation [J]. Otolaryngol Head Neck Surg,2015, 152(6): 1068-1074.
[9] Pfitzmann R, Kaiser D, Weidemann H, et al. Plastic reconstruction of an extended corrosive injury of the posterior tracheal wall with an autologous esophageal patch[J]. Eur J Cardiothorac Surg,2003,24(3):463-465.
[10] Fabre D, Singhal S, De Montpreville V, et al. Composite cervical skin and cartilage flap provides a novel large airway substitute after long-segment tracheal resection[J]. J Thorac Cardiovasc Surg, 2009, 138(1): 32-39.
[11] Hazekamp M G, Koolbergen D R, Kersten J, et al. Pediatric tracheal reconstruction with pericardial patch and strips of autologous cartilage[J]. Eur J Cardiothorac Surg,2009, 36(2): 344-351.
[12] Anoosh F, Hodjati H, Dehghani S, et al.Tracheal replacement by autogenous aorta[J]. J Cardiothorac Surg, 2009,4: 23.
[13] 李 文,杨 柳,袁莉清, 等. 带蒂胸锁乳突肌锁骨骨膜皮瓣修复喉气管缺损的初步研究[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(2): 117-120.
[14] Fabre D, Kolb F, Fadel E, et al. Successful tracheal replacement in humans using autologous tissues: an 8-year experience[J]. Annals Thorac Surg, 2013, 96(4): 1146-1155.
[15] Wurtz A, Hysi I, Kipnis E, et al. Tracheal reconstruction with a composite graft: fascial flap-wrapped allogenic aorta with external cartilage-ring support [J]. Int Cardiovasc Thoracic Surg,2013, 16(1): 37.
[16] Martinod E, Seguin A, Radu D M, et al. Airway transplantation: a challenge for regenerative medicine[J]. Eur J Med Res,2013,18(1):25.
PDF(1832 KB)
