游离空肠复合镍钛合金网重建犬气管的实验研究  

Experimental reconstruction of canine trachea with free jejunal graft coupled with titanium-nickel alloy mesh

作　　者：郑德育[1] 崔鹏程[1] 罗家胜[1] 何冰[2] 吕小星[3] 李海立[1] 高鹏飞[1] 白建军[4] 李术芹[1] 

机构地区：[1]第四军医大学唐都医院耳鼻咽喉科,陕西西安710038 [2]解放军第三医院耳鼻咽喉科,陕西宝鸡721004 [3]第四军医大学唐都医院整形烧伤科,陕西西安710038 [4]第四军医大学唐都医院放射科,陕西西安710038

出　　处：《第四军医大学学报》2008年第20期1907-1910,共4页Journal of the Fourth Military Medical University

摘　　要：目的:探讨游离空肠复合镍钛合金网进行气管重建的可行性.方法:选健康杂种犬10只,对照组1只,实验组9只.两组均切除5cm长颈段气管,采用吻合血管的游离空肠替代缺损气管段,空肠内置入T形硅腔管作临时内支架,实验组空肠浆膜面外套镍钛合金网作为外支架,对照组未采用镍钛记忆合金网作为外支架.术后1mo拔除T形硅胶管,行纤维内窥镜、CT检查,3,6mo处死动物,行大体标本观察、光镜组织学检查.结果:对照组拔除T形管后行纤维支气管镜检查可见肠蠕动,且管腔塌陷,拔管后出现明显呼吸困难,当即死于窒息.实验组有1只死于术后24h内,2只拔除T形管后,行纤维支气管镜检查见移植空肠全部坏死,镍钛合金网暴露于气道中,2只拔除T形管后,行纤维支气管检查见移植空肠大部存活,仅上下吻合口处部分肠壁坏死,余下4只拔除T形管后,行纤维支气管检查见移植空肠全部存活,吻合口无明显肉芽形成,未见明显肠蠕动,CT显示新气管管腔通畅.全部实验犬术后1～2mo内有不同程度的咳嗽,未发现因肠液分泌过量所致肺部感染致死者.结论:采用游离空肠复合镍钛合金网重建长段气管,为解决重建气管的血运和管腔通畅,达到重建气道提供了一种方法,但应用于临床仍需慎重,还应作进一步的研究.AIM： To explore the feasibility of the reconstruction of tracheal defects with free jejunal graft coupled with titaniumnickel alloy mesh. METHODS： Ten healthy mongrel dogs were divided into 2 groups randomly ： control group （ n = 1 ） and experimental group（n =9）. In two groups,a 5 cm segment of the cervical trachea was reseeted and replaced by the free jejunal graft through the operation of vascular anastomosis and the ＂T-shaped＂ silicone tube was placed into the jejunal lumen as the temporary stent. In experimental group, the titanium-nickel alloy mesh was placedrinto the space between the jejunal and the surrounding tissue. But in control group, there was no titanium-nickel alloy mesh implanted. The ＂T-shaped＂ silicone tube was removed after I month, and the endoscopic and CT examinations were performed. When the surviving dogs were sacrificed after 3 and 6 months postoperatively, macroscopic observation and histological examinations were performed. RESULTS： In control group, endoscopic examination showed enterocinesia and the airway collapsed after extubation. The dog had severe dyspnea and died of asphyxia immediately. In experimental group, one animal died within 24 hours after operation. Endoscopic examination of two animals showed entire necrosis of jejunal graft and the titanium-nickel alloy mesh was exposed in the airway. Endoscopic examination of two animals showed partial necrosis in the tracheointestinal anasto- mosis. Endoscopic examination of the other four animals showed the survival of jejunal graft and no evidence of enterocinesia and proliferation of granulation at the tracheointestinal anastomosis sites. CT showed that the new airways of 4 dogs were wide enough for breath, All animals had cough during 1 - 2 months after operation. No animal died of pneumonia resulting from hypefsecretion. CONCLUSION： Reconstruction of the canine trachea with free jejunal graft coupled with titanium-nickel alloy mesh can achieve the tracheal reconstruction. But we should be circumspect

关 键 词：气管重建 空肠 镍钛合金网 移植 血管吻合 

分 类 号：R768.1[医药卫生—耳鼻咽喉科] R318.13[医药卫生—临床医学]