肌瓣包裹犬自体气管游离移植模型的建立

The investigation of tracheas transplantation by wrapping in a muscle flap

目的 探讨采用肌肉瓣包裹促进游离移植的自体气管重建血运的方法。方法 以犬单侧胸头肌瓣和双侧胸骨舌骨肌 胸骨甲状肌联合瓣采取肌肉包裹和不用肌肉包裹的 5个环气管段行自体气管游离移植。并在术后进行纤维支气管镜检查、粘膜血流量的测定、病理学检查、血管造影和通畅度的计算 ,了解各组犬的存活情况。结果 采用包裹自体气管游离移植组 ,术后 1周时激光多普勒血流仪即测得移植气管粘膜下有血流存在 ,移植气管充血、水肿 ;4周时粘膜血流量接近正常气管 ,移植气管完全成活。造影可见有密集的血管从包裹的肌肉长入移植气管 ;病理检查 :移植气管结构完整 ,管腔内为假复层纤毛柱状上皮所覆盖 ,软骨无变性坏死 ;移植气管能够长期存活。而无肌肉包裹组术后 1周时移植气管粘膜呈灰黑色 ,并在短期内坏死。结论 单侧胸头肌瓣和双侧胸骨舌骨肌 胸骨甲状肌联合瓣包裹可以为移植气管提供血运 ,移植的气管可以长期存活。

Objective To investigate the possibility of tracheas transplantation by wrapping it in a muscle flap. Methods With a dog model, a number of tracheas were separately wrapped in the unilateral sternocephalic muscle flap and the bilateral sternohyoid-sternothyroid muscle flap,and placed in the original site. The tracheas autografting was used as a control. The viability was evaluated by the examination of fiberoptic bronchoscopy, histopathology and microangiography, the measurement of tracheal mucosal blood flow and the calculation of survival rate and percentage of patency. Results The submucosal blood flow of the transplanted tracheas was detected in the unilateral sternocephalic muscle flap group and the bilateral sternohyoid-sternothyroid muscle flap group 1 week after the surgery and gradually reached the level close to the normal in 4 weeks, while the vascular ingrowth was also shown from the wrapped muscle flap into the transplanted tracheas by using a microangiography technique. The histopathological examination demonstrated that the structure of the transplanted tracheas was quite same as the original one and its inner surface was also covered with pseudostratified columnar ciliary epithelia. However, in the control group, the mucous membranes turned black one week after the transplantation and all dogs died from the graft necrosis. Conclusion The tracheas wrapped in a muscular flap could survive well for a long time.;