壳聚糖管状支架联合肌瓣原位重建颈部整段食管的可行性研究

Feasibility study on the reconstruction of the whole cervical esophagus with a chitosan tubular stent combined with a muscle flap in situ

目的探讨壳聚糖管状支架联合肌瓣原位重建颈部食管整段缺损的可行性。方法将大耳白兔(30只)制成3~5 mm食管整段缺损动物模型,缺如处置入壳聚糖管状支架,外覆颈部肌肉组织瓣包裹缝合形成肌性管道。术后观察实验兔成活率、并发症的发生情况及原因,植入后不同时间段支架降解、食管结构重建情况,钡餐透视观察食管通畅状态、有无狭窄发生及食管蠕动功能。结果术后动物存活17只,术后第4周肌瓣组织愈合,壳聚糖管部分吸收,见炎症反应;第8周肌瓣修复良好,无纤维组织增生,壳聚糖管吸收;第16周壳聚糖管完全吸收,肌瓣内表面黏膜再生,无狭窄。钡透见食管通畅、无狭窄,蠕动弱。结论壳聚糖管状支架联合肌瓣原位重建颈部食管整段缺损具有一定可行性,狭窄及吻合口瘘是关键问题。

Objective To study the feasibility of the reconstruction of cervical esophageal defects with a chitosan tubular stent combined with a muscle flap in situ.Methods The cervical esophageal tissue of rabbits was resected 3-5 mm,and animal models of esophageal defects were obtained.Chitosan tubular stents were placed in the absence of the esophagus,and the muscle tissue of the neck was wrapped and continuously sutured to form a muscle canal.Postoperative observation:survival rate and causes of complications in experimental rabbits group;at different times after implantation,the degradation of the stent and reconstruction of the esophageal structure were observed;barium meal fluoroscopy was used to observe the continuous integrity and unobstructed state of the esophagus,peristalsis function,and the occurrence of stricture.Results Seventeen rabbits survived.Muscle flap tissue healed at 4 weeks postoperatively.The chitosan tube was partially absorbed with an inflammatory reaction.At 8 weeks,the muscle flap healed properly without fibrous tissue hyperplasia,and the chitosan tube was absorbed.Sixteen weeks later,the peripheral chitosan tube was completely absorbed,and the inner surface of the muscle flap regenerated without stenosis.Through a barium meal,the esophagus was seen unobstructed,without stenosis,and with weak peristalsis.Conclusion Chitosan tubular stents combined with muscle flap in situ reconstructions of the entire cervical esophageal defect has some feasibility.Stenosis and anastomotic leakage are key issues.