液氮冷冻对犬胸腔脏器及邻近器官效应的观察

Effect of cryosurgery on bronchial stump and adjacent organs

目的 探讨犬支气管残端及邻近器官行冷冻的生物效应。方法 18只犬肺切除后液氮冷冻支气管残端 ,2 2只犬开胸冷冻肺邻近器官 (其中食管 4例 ,膈肌 3例 ,胃 3例 ,肝脏 2例 ,气管 7例 ,上腔静脉口窦房结 3例 ) ,观察 1～ 2 12d。结果 冷冻的支气管残端均有坏死并逐渐形成纤维瘢痕 ,未发生残端破裂或支气胸膜瘘 ,3例食管冷冻区为较薄的纤维膜状瘢痕 ;胃内壁形成瘢痕溃疡 (食管、胃穿孔各 1例 ) ;3例膈肌未见膈肌破裂 ;气管软骨环消失 ,内面形成一膜状瘢痕 ;1例冻后 14d发生气管食管瘘 ;余未发生气管胸膜瘘 ;2例肝脏见形成黄色瘢痕。结论 冷冻坏死发生缓慢 ,纤维组织对冷冻的耐受性较强 ,使坏死组织不致很快脱落 ;原有的组织细胞结构坏死消失 ,纤维结缔组织明显增生 ,各冷冻区坏死组织边缘新生毛细血管多。

Objective To analyze the biochemical effect of cryosugery on residual bronchial tissue and the adjacent organs in dogs. Methods Bronchial stumps of 18 dogs after lobectomy and the adjacent tissues and organs(including 4 samples of esophagi, 3 diaphragms, 3 stomachs, 2 livers, 7 tracheae and 3 superior saphenous vein sinuses) of 22 dogs after thoracectomy were frozen. The observation from 1～212 d was conducted after surgery. Results Cryonecrosis and fibrosis were found in all 18 samples of the frozen bronchial stumps, but no fistula of bronchial stump was found. Three cryodamaged esophagi in 4 dogs developed fine sheet of fibrous membrane like scars in the situs of cryosurgery. Perforation was found in 2 dogs, one in the esophagus, another in stomach. No perforation was found in dogs with diaphragm cryosurgery. Cartilaginous ring disappeared in 7 dogs by cryosurgery of the trachea and a membrane like scar developed in the inner wall of trachea. There were yellow scars on the liver after cryosurgery. Conclusion Exfoliation of the necrotic tissues is slow due to the slowly developed cryonecrosis and good tolerance to cryosurgery of the fibrotic tissues. The original construction disappears but fibrosis develops. At the edge of cryo necrotic area, proliferation of capillary can be found.