【摘要】 背景:多年来使用肌肉、皮肤、骨骼肌瓣及胃、肠等管腔组织等作为人工食管修补食管缺损,但效果都不甚理想。目的:探讨壳聚糖管状支架联合肌瓣修补颈段食管部分缺损的可行性。方法:取30只大耳白兔,制作颈段食管部分缺损动物模型,实验组20只破损处植入壳聚糖管状支架,外覆自体颈部肌瓣修补;对照组10只直接覆盖自体颈部肌瓣修补。于植入后第2,4,8周观察支架吸收及破损处组织学变化;植入后第10周行食管钡透,观察有无狭窄发生及食管蠕动。结果与结论:植入后2周,实验组及对照组均见肌肉组织结构,细胞肿大,炎性细胞浸润,表现为急性炎症反应。植入后4周,实验组替代物肌瓣组织结构清晰,炎性反应减弱,无明显纤维组织增生;对照组缺损处肌组织结构可见,肌肉组织表面可见纤维组织细胞生长,伴有少许炎性细胞。植入后8周,实验组肌肉组织瓣表面大部分鳞状上皮化,可见食管黏膜组织,黏膜下伴有慢性炎性反应,较4周时明显减轻;对照组为慢性炎症反应,伴有明显纤维组织增生,表面无鳞状上皮化生及黏膜再生。钡餐透视显示实验组食管通畅无狭窄,蠕动减弱;对照组食管部分狭窄,无蠕动。表明壳聚糖管状支架联合肌瓣可较好修补颈段食管部分缺损。更多还原

【Abstract】 BACKGROUND:Over the years,muscle,skin,skeletal muscle flaps and luminal tissues,such as stomach and intestines,are used as an artificial esophagus to repair esophagus defects,but the results are not good.OBJECTIVE:To investigate the feasibility of chitosan tube stent combined with muscle flaps to repair partial defects of the cervical esophagus.METHODS:Thirty white rabbits were used to make animal models of partial cervical esophageal defects,and randomly divided into experimental group(n=20) and control group(n=10).Esophagus defect in rabbits of experimental group was repaired using autologous muscle flap with a chitosan tube stent,and esophagus defect in the control group was repaired only with muscle flap.Gross and histological appearance was observed at weeks 2,4 and 8 after operation,and barium sulphate X-ray screen was performed at week 10 after operation.RESULTS AND CONCLUSION:After 2 weeks,muscle tissue structure,cell swelling,and inflammatory cell infiltration could be seen in the experiment and control groups,exhibiting an acute inflammatory reaction.After 4 weeks,the experimental group showed clear muscle flaps,reduced inflammatory reaction,and no obvious fibrosis;while in the control group,muscle tissue could be seen at defect site,with growth of fibrous tissue cells and a few of inflammatory cells.After 8 weeks,in the experimental group,squamous metaplasia could be seen on the gross surface of the muscle flaps,esophageal mucosa could be seen,accompanied by chronic inflammatory reaction under the mucosas that had a clear abate than that at 4 weeks after implantation;in the control group,chronic inflammatory reaction could be found,accompanied by clear fibrosis but no squamous metaplasia and mucosal regeneration.Barium sulphate examination found that the esophagus was smooth with a slight motility in the experimental group,but there was a part of stricture in the esophagus without motility.These findings suggest that the chitosan tube stent combined with muscle flaps could better repair partial defects of the cervical esophagus.更多还原