游离兔耳软骨移植修复广泛气管前壁缺损的研究

Experimental Reconstruction of Extensive Anterior Defect of Rabbit Trachea with the Use of Free Auricular Cartilage

目的 探讨用游离兔耳廓软骨修复广泛气管前壁缺损的可行性 ,并观察自体移植与异体移植的差异。方法 取新西兰大耳白兔 2 0只 ,分为自体移植组 (n=10 )与异体移植组 (n=10 ) ,取右耳游离耳廓软骨行自体或异体移植修复 8～ 10环气管前壁缺损 ,术后 1、2、4、8和 12周每组分别处死 1～ 2只行内窥镜检查、生物力学测试及组织学观察。结果 18只兔存活 ,内窥镜发现气管狭窄不明显 ,以瘢痕增生为主。生物力学测试发现 ,移植软骨单位最大应力在 0、4、8、12周分别为 2 .5 4± 0 .19、1.31± 0 .2 1、1.72± 0 .2 2和 1.96± 0 .0 8k Pa/ mm .组织学观察发现移植软骨部分发生变性和坏死 ,但存活软骨、新生软骨在术后 12周时分别占 6 2 .0 %± 3.45 %、6 5 .8%± 9.48%(自体移植组 ) ,6 0 .1%± 3.98%、5 5 .2 %± 7.5 7% (异体移植组 )。自体移植与异体移植的炎性反应差异不大 ,免疫排斥反应较轻。结论 游离耳软骨可用来修复广泛的气管前壁缺损 。

Objectives To determine whether free auricular cartilage grafts can be used to reconstruct the extensive anterior defect of rabbit trachea and observe the difference between autograft and allograft. Methods Twenty New Zealand white rabbits were divided into autograft group (n=10) and allograft group(n=10). All grafts were taken from the right auricle, and defect included 8 to 10 rings of trachea. The gross morphorlogical features, endoscopic examinations, biomechanic determinations and histological findings of grafts were assessed at 1,2,4,8 and 12 weeks after operation. Results Eighteen rabbits survived. Mild tracheal stenosis was observed under endoscope. The maximum stress per mm at 0,4,8 and 12 weeks was 2.54±0.19,1.31±0.21,1.72±0.22 and 1.96±0.08 kPa/mm, respectively. Histological analysis revealed that the viable chondrocytes and neochondrocytes at 12 weeks accounted for 62 0%±3.45%,65.89%±48% in the autograft group and 60.1%±3.98%,55.20%±7.57% in the allograft group. No marked immunological differences between the auto- and allo-graft groups were noted. Conclusions Free auricular cartilage can be used to reconstruct the extensive anterior defect of trachea in both auto- and allo-transplantations.