犬获得性食管气管瘘模型建立及食管双瓣修补食管气管瘘实验研究

发布时间：2018-06-24 00:32

本文选题：犬 + 食管气管瘘　；参考：《第四军医大学》2010年硕士论文

【摘要】： 背景获得性食管气管瘘(Tracheoesophageal Fistula,TEF)是一种临床上较少见的由各种原因引起的食管和气管相邻管壁受侵导致的疾病,处理较为棘手。对于瘘口较大,气管壁、食管粘膜缺损范围较大,或者局部感染严重者,缺乏效果良好的治疗方法。食管双瓣修补良性TEF是我科设计的一种新术式,已治愈11例由食管支架导致的TEF,临床近期效果良好。但用该术式修补TEF后食管瓣与气管、食管长瓣与短瓣间愈合如何、对气管结构和功能有何影响尚不清楚,有待进一步研究。为此,我们建立了TEF动物模型,研究食管双瓣修补术后气管、食管的病理、生理变化情况及食管瓣间组织形态改变,为临床提供实验依据。目的1)通过手术方式建立获得性TEF动物模型,为进一步研究TEF提供良好、稳定的动物模型。2)应用食管双瓣修补TEF,观察修补局部的大体改变、组织病理学改变及愈合情况,为临床上治疗TEF的术式选择及进一步改进此种术式提供理论依据。方法1)成年健康杂种犬28只,随机分为3组,A、B组各12只,C组4只,A、B组均建立TEF模型后应用食管双瓣修补TEF,A组为剔除食管长瓣粘膜修补组,B组为保留食管长瓣粘膜修补组,C组作为空白对照。2)模型建立:经食管左侧壁切口,在食管腔内切开食管前壁和气管膜部,间断缝合食管、气管膜部切口边缘,形成TEF,术后通过电子支气管镜检查验证模型是否建立成功。3)模型建立1周后,行食管双瓣修补术:显露瘘所在段气管和食管后,距瘘口上、下缘2cm处横断食管,后壁偏左1/3处纵行切开食管,使食管壁呈长、短两个肌瓣,先用短瓣与对应的瘘口边缘直接缝合,再用长瓣覆盖短瓣缝合固定,其中A组剔除长瓣粘膜层,B组保留长瓣粘膜层。4)术后1、2、8周A、B组各处死犬4只,观察实验犬存活情况、修补局部的组织病理学改变,测定气管狭窄指数及食管瓣羟脯氨酸含量。结果1)电子支气管镜检查见气管膜部与食管前壁间瘘口形成,经胃管向食管腔内注入亚甲蓝,可见气管腔内迅速蓝染,验证模型建立成功。2)修补术后,A、B组犬均存活至实验预定时间,食管瓣和气管间愈合良好,食管瓣血供良好;A组均未出现气管狭窄,B组术后8周处死犬气管狭窄指数为0.170±0.007,C组狭窄指数为0.137±0.010,P0.05, B组术后8周处死犬气管通畅程度较差;A组双瓣间愈合良好,未形成假性囊肿,B组2只犬8周后双瓣间形成假性囊肿,涂片未见脓细胞,排除了感染积脓可能,可能与B组长瓣未剔除粘膜层,残存的食管腺体仍有分泌功能有关。3) A组术后1、2、8周处死动物食管瓣羟脯氨酸含量分别为488.0±13.3、632.3±21.0、763.8±17.8,B组术后1、2、8周处死动物食管瓣羟脯氨酸含量分别为421.5±25.0、578.8±14.4、685.8±12.3,C组食管羟脯氨酸含量为414.0±20.9,A组较B组羟脯氨酸含量增加更早更显著,Masson三色法胶原染色A组较B组胶原染色更强。结论1)通过手术方式经食管腔内建立TEF模型可靠。2)采用食管双瓣修补TEF后,食管瓣和气管壁愈合良好,形成了坚实的修补瓣。3)采用食管双瓣修补TEF,剔除长瓣的粘膜层更有利于双瓣间愈合及防止气管狭窄和假性囊肿的发生。
[Abstract]:Background acquired Tracheoesophageal Fistula (TEF) is a relatively rare disease caused by the invasion of the adjacent tube wall of the esophagus and trachea caused by various causes. It is difficult to deal with the disease. The treatment of large fistula, the wall of the trachea, the defect of the esophageal mucosa, or the severe local infection, and the lack of good treatment Methods. The repair of benign TEF by esophagus double valve is a new type of operation designed by our department. 11 cases of TEF have been cured by esophageal stent, and the clinical effect is good in the near future. However, how to repair the esophagus and trachea and the long and short flap between the esophagus and the esophagus after the operation of TEF is not clear, so further study is needed. To this end, I need further study. We established the TEF animal model to study the pathological changes of the trachea and the esophagus, the physiological changes of the esophagus and the morphological changes of the tissue in the esophagus after the double valve repair of the esophagus, and provide the experimental basis for the clinical.
Objective 1) to establish an acquired TEF animal model by operation, and to provide a good and stable animal model for the further study of TEF to provide a good and stable animal model.2) to apply the double flap of the esophagus to repair the TEF, to observe the general changes of local repair, histopathological changes and healing, and to provide a theoretical basis for the selection of the surgical treatment of TEF and the further improvement of this type of operation.
Method 1) 28 adult healthy hybrid dogs were randomly divided into 3 groups, A, group B, group C, 12, group C, 4, A, group B, TEF model was established by esophagus double valve repair TEF, A group was removed from esophagus long flap repair group, B group was reserved for esophageal long flap repair group, C group was established as blank control.2) model: incision of the left wall of the esophagus, incision in the esophagus The anterior esophageal wall and the tracheal membrane, intermittent suture of the esophagus, the edge of the tracheal membrane incision, TEF, and the establishment of a successful.3 model by electronic bronchoscopy after 1 weeks of establishment of the esophagus double flap repair: exposed to the trachea and esophagus of the fistula segment, the distance from the fistula, the lower edge of the 2cm, and the left posterior wall to the left 1/3. Open esophagus, make the esophagus wall long and short two muscle flap, first use short flap to suture directly with the corresponding fistula edge, and use long flap to cover short flap suture, in which group A excludes long flap layer, B group keeps long flap.4) and 4 dogs in group B after A and B group, observe the survival condition of the dog, repair local histopathological changes, determine the local histopathological changes. The index of tracheal stenosis and the content of hydroxyproline of the esophagus.
Results 1) electronic bronchoscopy revealed the formation of the fistula orifice of the endotracheal membrane and the anterior esophageal wall, and intratumoral injection of methylene blue into the cavity of the esophagus, the rapid blue staining of the endotracheal cavity, and the successful.2) repair, A and B dogs survived the experimental predetermined time, the healing of the esophagus and the trachea was good, the blood supply of the esophagus was good, and the group A had not been out. The stenosis index of trachea in group B was 0.170 + 0.007 after operation in group B, the stenosis index of group C was 0.137 + 0.010, P0.05 and group B had poor tracheal patency at 8 weeks after operation; in group A, the double valve healing was good, no pseudocyst was formed, and 2 dogs in group B formed pseudocyst between the double petals after 8 weeks, and no pus cells were found in the smear, excluding the septic infection. It may be possible that the mucosa of the B group was not removed from the mucosa, and the remaining esophageal glands still had secretory function related to the secretion of.3). The content of hydroxyproline in the esophageal valve of the A group was 488 + 13.3632.3 + 17.8 respectively after 1,2,8 weeks after the operation, and the content of hydroxyproline in the esophagus flap of the B group was 421.5 + 25.0578.8 + 14.4685.8 + 12.3 respectively after 1,2,8 weeks after the operation of the B group, respectively. The content of hydroxyproline in the esophagus group was 414 + 20.9, and the hydroxyproline content in group A increased earlier and more significantly than that in group B, and the collagen staining in Masson group was stronger than that in B group in Masson trichrome staining.
Conclusion 1) by establishing TEF model reliable.2 in the cavity of the esophagus through operation, the esophagus and trachea wall healed well, and the wall of the trachea was healed well, and the solid mending flap was formed by the esophagus double flap to repair the TEF. The double flap of the esophagus was used to repair the TEF. The long petal mucosa was more beneficial to the healing of the double valve and prevent the stenosis of the trachea and the occurrence of the pseudocyst.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R-332;R655

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