人工食管脱落时间对猪新生食管通道功能形成的影响

Impact of artificial esophagus slipped time upon the function formation of neoesophageal channel

目的观察人工食管不同脱落时间对新生食管通道功能形成的影响，探讨人工食管替代切除食管术后安全脱落的时间范围及新生食管狭窄的处理方法。方法观察一组（18只实验猪）人工食管替代切除食管术后，第1、2、3、6个月不同时间段发生人工食管脱落所出现的并发症，新生食管的组织结构，进食功能以及实验动物的生存情况。结果在1个月内发生人工食管脱落有3只，都发生新生食管严重狭窄（D〈0．5cm）造成重度进食困难（Bown’s Ⅳ级）并发症，食管扩张治疗失败，全部在短期内死亡。在2个月内发生脱管有4只，新生食管出现中至重度狭窄（φ0．5～0．9cm）导致进行性进食困难（Ⅲ～Ⅳ级），3只经反复食管扩张治疗效果不明显，短期内死亡，1只采用重置裸支架治疗能迅速解决进食问题，得以长期存活。在3个月内发生脱管有4只，新生食管出现轻至中度狭窄（φ0．9cm～1．5cm）导致轻至中度进食困难（Ⅰ级～Ⅱ级），除2只计划处死观察外，其余2只中度进食困难实验动物采用重置裸支架治疗迅速解决进食问题，长期存活。在3个月以后发生人工食管脱落有7只，新生食管呈现扩张并相对性狭窄（φ〉1．9cm）和短暂的轻度进食困难（Ⅰ级），其后进食困难自行缓解，无须治疗均能长期生存。结论人工食管（植入体）在原位停留时间2～3个月对形成一条具有通道功能的新生食管是必要的，停留时间越长，对形成具有通道功能的新生食管越有利，重置裸支架治疗对该时段脱管出现严重的新生食管狭窄有显著的治疗效果。超过3个月发生人工食管脱落，新生食管已形成具有通道功能的管道，对进食影响不大，实验动物都能长期生存。

Objective To observe the impact of artificial esophagus slipped time upon the function formation of neoesophageal channel, explore the scope of secure control time and assess the treatment methods of neoesophageal stenosis. Methods A total of 18 pigs in which artificial esophagus slipping at Month 1, 2, 3, 6 post-operation were observed with regards to complications, neoesophageal structures and functions and survival status of experimental animals. Results Three pigs had a slip of artificial esophagus within a month post-operation and severe eating difficulties（ Bown＇s Grade Ⅳ ）because the neoesophagus had a severe narrowing （ φ 〈 0. 5 cm）. All were dead shortly resulting from a failed treatment of esophageal dilation. Four pigs had a slip of artificial esophagus within 2 months post-operation. They all had dysphagia （Grade Ⅲ-Ⅳ ）as a result of moderate or severe neoesophageal stenosis （φ 0. 5-0. 9 cm）. Dysphagia was progressive. Repeated esophageal dilation was in vain. Three pigs were dead shortly and 1 pig achieved a long-term survival through a bare stent replacement therapy. Four pigs had a slip of artificial esophagus within 3 months post-operation. Dysphagia （Grade Ⅰ-Ⅱ ） occurred as a result of mild or moderate neoesophageal stenosis（φ0. 9-1.5 cm）. Two pigs with moderate dysphagia achieved a long-term survival through a bare stent replacement therapy while another two were sacrificed. Seven had a slip of artificial esophagus at 3 months post-operation. The neoesophagus showed expansion and a relative narrowing（φ〉 1.9 cm）. Experimental animals had a mild difficulty in eating（ Grade I ）, but it had an automatic relief. Experimental animals achieved a long-term survival and did not advance further. Conclusion Artificial esophagus （implant） stays in place for 2-3 months to form a functional esophageal channel. The longer an artificial esophagus is in place, a better channel of neoesophagus will form. Resetting a bare stent treatment of serious neoesophageal stenosis has significant therapeutic effects during this period. At 3 months postoperation, the slipping of artificial esophagus has little effects upon eating so that experimental animals may achieve a long-term survival.