碳-碳复合材料气管重建的实验研究  

Carbon-carbon materials and composites for experimental tracheal reconstruction

作　　者：刘鑫[1] 姜召阳[2] 秦永[1] 

机构地区：[1]北京大学第一医院耳鼻咽喉头颈外科,100034 [2]航天材料及工艺研究所

出　　处：《中华耳鼻咽喉头颈外科杂志》2010年第8期669-673,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金（50372003）

摘　　要：目的 探讨碳纤维增强碳基体复合材料（以下简称碳-碳复合材料）气管假体用于气管环形缺损修复的可行性.方法 采用的实验动物为健康成年杂种犬8只.用于制作气管假体的碳-碳复合材料分为Ⅰ、Ⅱ两型,两者分别采用了不同的碳纤维编织方法.采用Ⅰ型或Ⅱ型碳-碳复合材料制备的气管假体各用于4只犬,切除犬颈段第2气管环下4个气管环长度的气管段,将长2 cm的管型假体分别与远近两个气管残端妥善吻合固定,其中采用对端吻合的1只,外套式吻合3只,内嵌式吻合4只.术后对犬的呼吸、进食及有无感染等状况进行观察.4个月后处死存活的实验动物,取出植入的碳-碳复合材料气管假体及其周围组织,进行组织病理学和扫描电镜检查.结果 所有犬术后均有不同程度的咳喘症状,多持续1～4周便逐渐消失,2只外套式吻合犬有不同程度的进食障碍.最早采用对端吻合手术方式的1只实验犬因吻合部位断裂死于术后第3周;采用外套吻合方式的3只实验犬中2只因肉芽组织增生严重而窒息,分别死于第11、12周.1只外套式吻合与4只内嵌式吻合实验犬均正常存活,植入的气管假体4个月内位置无明显改变.假体为纤维结缔组织所包裹,Ⅰ型碳-碳复合材料气管假体与自身组织结合疏松;而Ⅱ型碳-碳复合材料气管假体与组织结合相对紧密,扫描电镜可见假体与组织间有纤维组织连接.假体内腔大部分腔面未见有上皮覆盖,仅假体两端可见有少量纤维组织长人,组织病理学检查示存在少量纤毛上皮.结论 通过正确的手术吻合方法,碳-碳复合材料气管假体能够维持实验动物的呼吸道通气功能,吻合部位的肉芽组织增生和气管假体内腔上皮化等问题有待于进一步解决.Objective The Carbon fiber reinforced carbon matrix composites were employed for reconstruction of large circumferential defect of the cervical trachea. The biocompatibility and biofunctionality of the new type carbonaceous tracheal prosthesis were evaluated, and the feasibility for cervical tracheal reconstruction discussed. Methods Two types of carbonaceous tracheal prosthesis with different weaving methods of carbon fiber were used on eight healthy canines. Three to six tracheal cartilage rings were resected circumferentially. The 2 cm long tracheal prosthesis was transplanted into canines and the anastomosis was completed by end-to-end, tracheal-into-prosthesis and prosthesis-into-tracheal method. The function of breathing, eating and infection was observed after surgery. Four months later, the five survival canines were sacrificed and the prosthesis with surrounding tissues was removed for observation by optical microscopy and scanning electron microscopy. Results All dogs had cough symptom in different degree lasted 1 -4 weeks after surgery. Two dogs with tracheal-into-prosthesis anastomosis showed eating disorders in different degree. One canine died due to airway obstruction caused by dislocation of prosthesis within three weeks after operation. Another two deaths in 11th week and 12th week were attributed to suffocation because of hypergranulation and scar formation. Prosthesis was surrounded by connective tissues and anchored firmly to the neighboring tissues. Most part of the luminal surface of tracheal prosthesis was not covered by respiratory mucosa. However, the inner layer showed scant re-epithelialization beyond the anastomosis.Conclusions The implantation of the carbonaceous tracheal prosthesis can maintain the normal respiratory function of the experimental canines, but hypergranulation and scar formation around the end of the tracheal prosthesis and repithelium on the luminal surface of the prosthesis are questions still remained to be solved.

关 键 词：假体植入 气管 碳 气管疾病 

分 类 号：R318.08[医药卫生—生物医学工程]