“新生食管”再生过程的组织学观察

Histological Regeneration Process of "Neo-esophagus"

背景与目的:在器官及组织重建过程中,由于植入材料的组织相容性及材料界面不同可诱发不同的愈合结果。本研究通过观察新型生物材料人工食管植入后诱导机体修复、再生“新生食管”的生理过程,从而探讨“新生食管”的愈合机制。方法:以病理大切片技术及特殊染色法对术后1、3、6、12、24个月的实验犬“新生食管”标本进行组织学研究,观察其组织结构的动态变化、食管重塑及其组织结构再生的过程。结果:人工食管植入后早期可替代食管缺损,术后1个月左右人工食管完全脱落;诱导的“新生食管”于术后3～6个月完成粘膜爬覆,12个月左右出现粘膜下肌层、神经纤维、粘液腺、毛细血管等结构的再生,并完成纤维结缔组织层的重塑;“新生食管”术后3～6个月新生管腔狭窄较明显,12个月后狭窄缓解。结论:新型生物材料人工食管通过早期替代并诱导纤维结缔组织沉积、裹覆而形成“新生食管”;“新生食管”经过1年左右粘膜上皮爬覆、肉芽组织增生、血管、组织结构形成等过程而再生出可完成食物正常通过的再生食管;“新生食管”的狭窄与疤痕过度增生及收缩有关。

BACKGROUND ＆ OBJECTIVE. During the reconstruction process of organs or tissues, different implant materials can lead to different healing results because of different extracellular matrix interfaces and tissue biocompatibilities. This study was to observe the regeneration process of ＂neo-esophagus＂ after implanting an artificial esophagus, and investigate its healing mechanism. METHODS： Histopathologic studies on neo-esophagus in 1, 3, 6, 12, and 24 months after implantation were performed using grossgiant specimen technique and special staining methods. The processes of tissue molding and reconstruction, and regeneration of high-level cell organ in ＂neo-esophagus＂ were observed. RESULTS： The artificial esophagus temporarily replaced the defective esophagus at the early stage after implantation, and dropped off about 1 month after operation. The epithelization of neo-esophagus induced by host tissue was completed about 3-6 months after operation. The submucous muscle layer, mucous glands, nerve fiber, and capillaries were reconstructed about 12 months after operation. The narrowing of ＂neo-esophagus＂ occurred about 3-6 months after operation and was relieved 12 months after operation. CONCLUSIONS： The implanted artificial esophagus made of bio-material can replace the defective esophagus at the early stage, and induce connective tissues, including collagen and fibroblasts, to deposit and cover on it to form neo-esophagus. The neo- esophagus is developed by epithelization and reconstruction of submucous muscle layer, mucous glands, nerve fiber, and capillaries 12 months after operation. The narrowing of ＂neo-esophagus＂ is caused by overgrowth and contraction of scars.