自体肺组织瓣内衬记忆合金支架替代长节段气管缺损:动物实验及临床观察

Long segmental trachea replacement using autogeneic pulmonary tissue flap with memory alloy stent:Animal trial and clinical observation

背景：气管代替物的研究处于实验研究阶段，临床上对于那些长节段的气管病变尚缺乏有效的治疗方法。目的：观察应用自体肺组织瓣内衬记忆合金支架替代长节段气管缺损的可行性。设计、时间及地点：观察性动物实验，于2002-03／2003-09在中国医科大学第二临床学院动物实验室完成。病例分析，于2004-06／2005-06在中国医科大学附属盛京医院胸外科进行。材料：①选用12只健康成年杂种犬，犬龄1．0～2．0岁，体质量10～18k。②患者，男性，40岁，经CT及三维重建检查显示气管中上段近7cm长肿物，纤维支气管镜检查示管腔堵塞近2／3。方法：将犬的右肺上叶支气管结扎，保护肺动、静脉，排出肺内气体，制成肺组织瓣，包裹记忆合金支架，形成复合人工气管，替代长节段胸内气管缺损。同期应用此方法完成1例患者长7cm的气管切除并气管重建手术。主要观察指标：呼吸状态，自体肺组织瓣内衬记忆合金支架替代长节段气管缺损后动物管腔内病理学表现，患者支气管镜下表现。结果：①12只犬存活8只，存活犬无呼吸困难表现，术后8周吻合口愈合良好，新生上皮已越过吻合口7mm。②患者术后呼吸困难迅速缓解，胸CT显示替代物管腔通畅，中间部分略狭窄，金属支架位置固定良好；随访12个月胸CT显示替代物处气管通畅，纤维支气管镜下已看不见金属网架，中间部分狭窄未见加重，14个月死于大咯血。结论：应用自体肺组织瓣内衬记忆合金支架替代长节段气管缺损能保障重建气管的管腔通畅，并支持气管上皮的再生。

BACKGROUND： Research of tracheal replacement is at empirical study stage. There is no available therapy for the long segmental tracheopathy clinically. OBJECTIVE： To study the feasibility of autogeneic pulmonary tissue flap roll with memory alloy stent to substitute long segmental tracheal defect. DESIGN, TIME AND SETTING： Animal experiment was performed at the Animal Experimental Center of Shengjing Hospital of China Medical University from March 2002 to September 2003; Case analysis was performed at Department of Thoracic Surgery of Shengjing Hospital of China Medical University from June 2004 to June 2005. MATERIALS： Twelve adult healthy mongrel dogs were selected, aged 1.0-2.0 years old, and weighing 10-18 kg. A male 40-year-old patient was selected, whose CT and 3D reconstruction showed a 7-cm tumor in the superior segment of the common trachea, and bronchofiberscopy showed a tumor with obstruction of 2/3 lumens. METHODS： The right superior canine bronchia were ligated, and pulmonary arteries and veins were protected, then the gas in the lung ventinged to create pulmonary tissue flap. And then alloy stent was covered with the pulmonary tissue flap. The compound artificial trachea was used to substitute the long segment thoracic tracheal defect. The 7-cm common trachea was resected for one patient and the tracheal reconstruction operation was done by this way. MAIN OUTCOME MEASURES： Respiration status; pathologic manifestation in animal lumens after replacement of autogeneic pulmonary tissue flap with memory alloy stent; representation of trachea lumens through the bronchofiberscopy. RESULTS： Eight dogs survived with no dyspnea. Stoma healed well in 8 weeks after the operation, and there was 7 mm neogenetic epithelium on the surface of lumen over stoma. Dyspnea in the patient relieved rapidly after the operation. CT showed replacement trachea lumen was unobstructed. The alloy stent was not revealed and the replacement of the trachea lumen was unobstructed through bronchofiberscopy in the 12-month follow-up visiting. But the patient died for great hemoptysis after 14 months. CONCLUSION： Autogeneic pulmonary tissue flap with memory alloy stent can keep the reconstructed tracheal lumens patent and support the regeneration of the tracheal epithelium.