同种异体气管移植后长段气管的再血管化

Revascularization of long-segment trachea following trachea transplantation

背景:移植气管再血管化是气管移植外科需要解决的首要问题。目的:观察同种异体气管移植后长段气管再血管化过程中气管软骨支架的生长情况,以实现长段气管的在血管化。设计、时间及地点:动物实验观察,于2007-06/2008-06在山东省胸科医院胸外科完成。材料:健康新西兰兔20只,由山东大学医学院实验动物中心提供,随机抽取10只家兔做供体,剩余10只家兔作为受体。方法:将同种异体供体家兔气管去除气管黏膜及膜部平滑肌,形成仅余气管软骨及部分环状韧带的气管支架,在气管软骨环之间将环状韧带剪开或密集打孔,使气管软骨支架裂隙化或网孔化,但要保留气管软骨环两端及正中部环状韧带,以保持气管软骨支架的完整连接状态。受体游离并切取带血管蒂的空肠,其长度略长于备用供体的软骨支架的长度,将大网膜环绕贴附于备用供体的气管软骨环外面充当外膜。将构建好的模拟气管置于腹腔中。主要观察指标:气管外膜的网膜及气管软骨的生长情况。结果:2周后打开腹腔,大体及病理切片观察:重建的气管替代物管腔无塌陷,按压管壁弹性良好,夹裹气管软骨的肠黏膜与大网膜血运好,异体气管软骨无坏死及吸收。结论:实验在受体腹腔内成功完成了一期气管替代物重建,实现了同种异体气管移植长段气管的再血管化。受体带蒂肠黏膜、大网膜夹裹供体网孔化或裂隙化的气管支架使移植体不再受长度的限制,是实现长段气管再血管化的关键。

BACKGROUND：Revascularization of trachea following trachea transplantation needs to be solved.OBJECTIVE：To explore the empirical methods of allogeneil graft of long-segment trachea and its revascularization.DESIGN,TIME AND SETTING：The animal observation experiment was performed at the Department of Chest Surgery,Shandong Provincial Chest Hospital between June 2007 and June 2008.MATERIALS：Totally 20 healthy,New Zealand rabbits,were provided by animal center of Medical School of Shandong University.Additional 10 rabbits were used as donors,and 10 rabbits were served as recipients.METHODS：The mucosa and smooth muscle in trachea of donor rabbits was removed,and the anular ligaments were shear opened or intensive drilling to obtain tracheal cartilage scaffold with fissure or mesh.A jejunum with vascular pedicle was harvested from recipient rabbits,which was longer than tracheal cartilage scaffold.The cartilages rings were wrapped with greater omentum.Finally,the constructed simulating trachea was replaced in the abdominal cavity.MAIN OUTCOME MEASURES：Growth of retina and tracheal cartilage.RESULTS：Abdominal cavity of recipient rabbit was opened after 2 weeks,and it was observed with gross observation and pathological section：There was no collapse in the lumens of tracheal allografts with good elasticity tracheal wall.The blood of omentum and intestinalmucosa that wrapped tracheal allograft was circulating well;and there was no cellular necrosis and merging in xenogenic cartilagines tracheales.CONCLUSION：The study fulfilled the stage one reconstruction and revascularization of tracheal allograft in abdominal cavity of recipient.Stenopeic tracheal stand wrapped with pedicled omentum and intestinalmucosa of recipient made allograft not restricted by length,which is critical to revascularization of long-segment trachea.