支气管成形术对呼吸道粘液纤毛清除功能的影响

Effects of bronchoplasty on mucociliary clearance of respiratory tract

目的 观察支气管成形术对术后早期呼吸道粘液纤毛清除功能 (MCC)的影响。方法 将 1 6条成年杂种犬随机分成两组 ,一组行左肺上叶袖式切除术和左主支气管成形术 ,另一组行标准左肺上叶切除术。术前和术后第 3、7、1 0天对气管支气管粘液纤毛清除功能和粘膜微血流进行测定 ,并用光镜和扫描电镜对气管支气管纤毛上皮结构进行观察。结果 支气管成形术组术侧呼吸道的粘液纤毛清除功能在术后早期明显下降 [与术前比较 ,差异有非常显著性 (P <0 .0 1 ) ] ,支气管吻合口远端粘膜微血流在术后第 3、7、1 0天分别下降到术前的 60 %、67%和 76 %。光镜和扫描电镜检查发现吻合口远端粘膜纤毛上皮有局灶性脱落 ,纤毛排列疏松。结论 支气管成形术后早期术侧呼吸道的粘液纤毛清除功能明显下降 。

Objective To investigate the effects of bronchoplasty on mucociliary clearance (MCC) in the early period after operation.Methods Sixteen adult mongrel dogs were divided into two groups.Dogs in the group A underwent left upper sleeve lobectomy and bronchoplasty,while those in the group B received standard left upper lobectomy.The mucociliary clearance was determined by observing the movement of carbon particles through a bronchoscope before and 3,7,10 days after operation.The bronchial mucosa blood flow was measured by laser Doppler velocimetry (LDV) before and 3,7,10 days after operation.All dogs were sacrificed on the 10th postoperative day and bronchial samples including the anastomoses were taken out for microscopic (light and electron) analysis.Results MCC of the operated respiratory tract in group A was decreased markedly in the early period after operation (P<0.01).The bronchial mucosa blood flow distal to anastomosis on 3,7 and 10 day after operation was decreased to nearly 60%,67% and 76% of the preoperative level.Light and scanning electron microscopic studies showed marked focal denudation of ciliary epithelium and scatteredly arranged cilia distal to anastomosis.Conclusion Bronchoplastic procedures cause significant depression of MCC in the operated respiratory tracts in the early postoperative period.MCC impairment was mainly attributed to structural and functional disorders of the components of mucociliary apparatus resulting from bronchial dissection and bronchial devascularization related to bronchoplasty.