颈部肌肉联合瓣包裹自体气管游离移植的实验研究

The autotransplanted tracheas wrapped in united muscle flap of the neck: an experiment

目的 研究肌肉瓣在再植气管重建血运中的作用。方法 实验用犬 3 2只 ,采用单侧胸头肌瓣和双侧胸骨舌骨肌 胸骨甲状肌联合瓣包裹不同长度的气管段 ,以及不用肌肉瓣包裹 5个环的气管段 ,分别行自体气管游离移植。术后通过纤维支气管镜检查、粘膜血流量的测定、病理学检查、血管造影以及存活率和通畅度的计算 ,研究各组犬的存活情况。结果 有肌肉瓣包裹组中 ,短于 4cm的再植气管术后第 1周时粘膜充血水肿 ,易出血 ;激光多普勒血流仪检测到粘膜下有血流存在 ,粘膜血流量达到正常的 60 % ,其在近吻合口和中间部位无明显差别 ;造影显示有密集的血管从肌肉瓣长入再植气管 ;病理检查其结构完整 ,管腔内为假复层柱状纤毛上皮所覆盖 ,软骨无变性坏死 ;再植气管均能长期存活。但长于 4cm的再植气管术后第 1周时 9只犬有 6只的中间段粘膜呈苍白或灰黑色 ,近吻合口处粘膜充血水肿 ,易出血 ;中间部位的粘膜血流量明显低于近吻合口处 ;7只犬再植气管的中间段管腔塌陷或肉芽组织增生。无肌肉瓣包裹组再植气管的粘膜在术后第 1周时即呈黑色 ,5只犬有 4只无法检测到粘膜血流 ,实验只犬随后因再植气管坏死而死亡。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维持短于 4cm再植气管的长期存活。

Objective To investigate the way of revascularization of donator′s trachea wrapped in united muscle flap. Methods Using fiberoptic bronchoscopy, histopathology and microangiography, we evaluated the tracheal mucosal blood flow, the survival rate, the percentage of patency, and the graft viability of autograft tracheas with varying lengths wrapped in one sided sternocephalic muscle flap and two sided sternohyoid sternothyroid muscle flap and autograft tracheas with the length of 5 rings without wrapped in muscle flap in 32 dogs. Results In the tracheal autograft wrapped in the united muscle flap group with a length less than 4 centimeters , the submucosal blood flow of graft could be detected by laser blood flowmetry one week after transplantation, and it reached 60% of the normal, which had no significant difference between the place near the site of anastomosis and the middle part of the graft. Dense vessels could be found to grow from the wrapped muscles into the autografted trachea by microangiography. Histopathological examination demonstrated that the structure of the autograft was the same as what it originally was. the inner surface of the autograft was covered with pseudostratified columnar ciliary epithelia, and no necrotic tracheal cartilages were found. Every autograft could survive over long time.However, at 1 week, most mucous membrane in the middle part of the graft with length over 4 cm was in gray or in pale; hyperemia, edema, and haemorrhage were found near the site of anastomosis. Mucosal blood flow measured by laser blood flowmetry in the middle part of the graft was significantly less than that near the site of anastomosis. Malacia, dissolution or granulation hyperplasia occurred in midportion of the major grafts shortly after transplanatation. As for those autografted trachea without wrapping in muscles flap, mucous membranes turned black one week after the transplantation and all dogs died of graft necrosis later. Conclusion One sided sternocephalic muscle flap and two sided sternohyoid sternothyroid muscle flap can provide blood for the graft and the grafted trachea can survive for a long time.