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 CERVICAL TRACHEAL REPLACEMENT USING A PEDICLED PLATYSMA MYCOUTANEOUS FLAP WITH Ni -Ti ALLOY MESH STENT

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20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、及运动正常。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 using a pedicled platsma mycoutaneous flap with Ni-Ti alloy mesh stent. Methods Twenty adult dogs were included in the experimental study. After circumferentially resecting the cervical trachea with a length of eight to ten tracheal rings, composite implant consisting of a pedicled platsma myocutaneous flap, which were tubed firstly with a silicone tube inside of 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 fourth to sixth month after operation and the silicone tube was removed. Results: The two dogs developed wound infection and were ended off the experiment. The other dogs undergoing trachea replacement showed a good status. Respiration, phonation, diet, exercise were in good general conditions. The CT scan revealed that the lumen of the 'new trachea' was stable patency without evidence of stenosis. The dogs were killed after operation for six, eight, ten, twelve, fourteen and eighteen months Gross pathological examination demonstrated that the composite implant was incorporated completely into trachea and Ni-Ti shape memory alloy mesh stent was stuck to myocutaneous flap and surrounding tissue firmly. Histologic studies by light and scanning electron microscopy showed that the stratified squamous epithelium of skin diminished gradually and became simple shorter columnar epithelium in the end. There were no signs of either generalized or localized corrosion on the surface of Ni-Ti alloy. Conclusion: The 'new trachea' consisting of a pedicled platysma myocutaneous flap with Ni-Ti alloy mesh stent is an ideal implant and suitable to cervical tracheal replacement.