带蒂颈阔肌肌皮瓣与镍钛合金网结合再造颈段气管实验研究  

Experimental Study of Replacement of Cervical Tracheal with Pedicled Platysma Mycoutaneous Flap Combined with Ni-Ti Alloy Mesh Stent

作　　者：刘月辉[1] 寇亚明[2] 卢明[1] 

机构地区：[1]江西医学院第一附属医院耳鼻咽喉科,江西南昌330006 [2]北京有色金属研究总院,北京100088

出　　处：《江西医学院学报》2002年第1期13-17,共5页Acta Academiae Medicinae Jiangxi

基　　金：江西自然科学基金资助项目 (984 0 2 2 )

摘　　要：目的 :探讨用带蒂颈阔肌肌皮瓣与镍钛合金网结合再造颈段气管。方法选健康狗 2 0只 ,袖状切除 8— 10个气管环长度的颈段气管 ,用带蒂颈阔肌肌皮瓣卷成肌皮管 ,表皮衬里 ,腔内置硅胶管临时扩张 ,将肌皮管移于气管缺损处 ,与气管切端吻合 ,再用相应长度镍钛合金网状支架套于肌皮管外 ,并固定。术后 4— 6月经气管镜拔出硅胶管。结果 2只动物术后切口感染而终止实验。余动物均健康存活 ,呼吸、发音、及远动正常。CT检查示新气管管腔宽敞 ,无狭窄现象。术后 6— 18月分期处死动物 ,见植入物与气管连为一体 ,镍钛支架与肌皮管及周围组织粘连紧密 ,不易分离。管壁皮肤的鳞状上皮逐渐变薄 ,并最终化生为单层矮柱状上皮组织。镍钛合金光洁如初。结论带蒂颈阔肌肌皮瓣与镍钛合金网结合组成的“新气管”可适用于颈部气管的重建。Objective: To investigate a method for cervical tracheal replacement with a pedicled plasma mycoutaneous flap combined with Ni Ti alloy mesh stent. Methods: The twenty adult dogs were included in the experimental study. After circumferentially resection of the cervical trachea of eight to ten tracheal rings, a composite implant consisting of a pedicled plasma mycoutaneous flap tubed with a silicone tube inside the lumen and Ni Ti shape memory alloy mesh stent outside the tube was applied to replace the segment. The dogs underwent endoscopic examination at four to six months after operation and the silicone tube was removed then. Results: Two dogs developed a wound infection and were withdrawn from the experiment, while the other dogs undergoing trachea replacement showed a good status. Their respiration, phonation, diet, and exercise were in good general condition. The CT scan revealed the lumen of the 'new trachea'was stable patency without evidence of stenosis. The dogs were killed at six, eight, ten, twelve, fourteen, and eighteen months after operation. Gross pathological examination demonstrated the composite implant was incorporated completely into trachea and Ni Ti shape memory alloy mesh stent were stuck to mycoutaneous flap and surrounded tissue firmly.Histology studies by light and scanning electron microscopy showed that the stratified squamous epithelium of skin diminished gradually and became simple shorter columnar epithelium lastly.There were nosigns of either generalized or localized corrosion on the surface of Ni Ti alloy. Conclusion:The 'new trachea'consisting of a pedicled platysma mycoutaneous flap with Ni Ti alloy mesh stent is a suitable implant for cervical tracheal replacement.

关 键 词：气管替代 外科皮瓣 外科手术 带蒂颈阔肌肌皮瓣 镍钛合金网 颈段气管重建 

分 类 号：R768[医药卫生—耳鼻咽喉科]