保留术侧一个肺叶的主支气管重建气管隆突的研究

Tracheal-carina reconstruction using main bronchus with operative side pulmonary lobe retained

目的 探讨更具临床应用价值的气管隆突替代手术。方法 将 40条成龄杂种犬均分为 4组 ,分别进行保留右肺上叶、下叶或左肺上叶 ,下叶的主支气管行重建气管隆突手术 ,术后1、3、6、12、18、2 4个月每组处死 1条犬 ,进行气道造影及移植物组织学检查 ,存活期超过 2 4个月者任其自然存活至死亡。结果 4组实验犬平均生存期 6个月 ,术后存活期最长为 3 2个月。保留左肺上叶主支气管重建气管隆突组平均生存期最短 ,为 2 .1个月。其他组平均存活期为 5 .8～ 8.3个月。死亡犬及按计划处死犬均按计划进行检查 ,发现吻合口 1个月后愈合良好 ,3～ 6个月多为瘢痕性愈合 ,12个月以上可达生物愈合 ,所移植的支气管与肋间肌之间呈愈合性附着 ,有血管网生成 ,部分支气管有灶状钙化 ,未发现支气管软化塌陷。结论 本实验为需同时切除气管下段及隆突的病例提供了根据不同机体情况几种可选择的。

Objective To investigate if tracheal carina replacement method can be adopted in clinical practice.Methods 40 Mongrel dogs were divided into 4 groups and tracheal carina operation was performed using main bronchus with right upper,lower lobe or left upper,lower lobe retained.In each group,one dog was killed after operation on first,third,6th,12th,18th and 24th month respectively and underwent bronchgraphy and biopsy.The dogs with a survival time more than 24 months were not killed until death.Results Average survival period of 4 groups was 6 months and the longest was 32 months.The survival time in left upper lobe retained group was shortest in 2.1 months whereas that in other groups was 5.8～8.3 months.The anastomotic stoma in the dead dogs and killed dogs healed well after 1 month,mainly healed with scar during 3 to 6 months and biologically healed over 12 months respectively.After 12 months,the transplanted bronchus was found having been healed with intercostal muscle.Microcirculation net and local calcification was found in some bronchus without softening and deformation.Conclusion This trial provided selectable and more applicable substitution operation methods for patients who need to cut lower tracheal and carina simultaneously according to different conditions.