部分去黏膜游离空肠重建长段气管后肠黏膜组织学研究

发布时间：2018-10-05 20:04

【摘要】：目的:通过建立部分去除黏膜层的带蒂游离空肠段重建6.5cm袖状气管缺损动物模型,研究部分去黏膜空肠重建气管后空肠黏膜层的组织学变化。方法:比革犬8只,在制作好带蒂部分去黏膜游离空肠段后,肠腔内放置硅胶管内支架,空肠外面放置形状记忆镍钛合金外支架,切除犬的6.5cm长袖状气管后,将肠系膜动静脉分别与右侧颈总动脉、颈内静脉相吻合,重建气管缺损。术后分别于1、2、3、4个月各处死2只犬,于吻合口和移植空肠肠腔中部取活检,标本行光镜及电镜观察。结果:8只犬术后全部生存到预期时间,移植游离空肠全部成活。组织学观察术后1个月时空肠段重建气管的上皮层大量缩短的小肠绒毛,绒毛间有大量的纤维素性渗出和炎性细胞。术后2个月时小肠的绒毛明显稀疏减少、长度明显缩短,腺体萎缩,腺腔缩小,肠黏膜上皮层明显变薄。术后3个月时移植空肠腔上皮基本化生为鳞状上皮,4个月时移植空肠内腔部分鳞状上皮化生为假复层纤毛柱状上皮。结论:部分去黏膜游离空肠重建长段气管后可以加速肠腔黏膜层的萎缩及化生过程,3个月可见肠腔黏膜层化生为鳞状上皮、4个月时有部分鳞状上皮化生为假复层纤毛柱状上皮。
[Abstract]:Aim: to study the histological changes of 6.5cm cuff tracheal defect after partial mucosal removal of trachea with pedicled free jejunum segment. Methods: after making free jejunum segment with pedicle, silicone tube stent was placed in intestinal cavity, shape memory Ni-Ti alloy external stent was placed outside jejunum, and long sleeve trachea of 6.5cm was removed. Mesenteric artery and vein were anastomosed with right common carotid artery and internal jugular vein to reconstruct tracheal defect. Two dogs died 4 months after operation. Biopsy was performed at the middle of the anastomotic stoma and the jejunum graft. The specimens were observed by light microscope and electron microscope. Results all of the 8 dogs survived to the expected time after operation, and all the free jejunum grafts survived. Histological observation showed that the tracheal epithelium was reconstructed by jejunal segment at 1 month after operation, and a large number of fibrous exudates and inflammatory cells were found in the villi. At 2 months after operation, the villi of the small intestine decreased obviously, the length of the small intestine decreased obviously, the gland shrank, the glandular cavity shrank, and the intestinal mucosal epithelium became thinner. At 3 months after operation, the basic metaplasia of the transplanted jejunum epithelium was squamous epithelium, and at 4 months the partial squamous epithelium of the jejunum was pseudostratified ciliated columnar epithelium. Conclusion: partial mucosal free jejunum reconstruction of long trachea can accelerate the atrophy and metaplasia of the mucosal layer of intestinal cavity. The mucosa layer of intestinal cavity is squamous epithelium in 3 months and pseudociliary columnar epithelium in 4 months.
【作者单位】：佛山市第一人民医院耳鼻咽喉-头颈外科;广州市红十字会医院耳鼻咽喉科;暨南大学医学院第四附属医院;
【基金】：2012年佛山市卫生局医学科研立项课题(No:2012017)
【分类号】：R762

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