Two-piece cryopreserved tracheal allotransplantation: an experimental study
Two-piece cryopreserved tracheal allotransplantation: an experimental study
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DOI：
10.1016/j.ejcts.2009.04.050
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发表时间：
2009-10-01
影响因子：
3.4
通讯作者：
Elbeyli, Levent
中科院分区：
文献类型：
--
作者：
Iyikesici, Tuncel;Tuncozgur, Bulent;Elbeyli, Levent
目的：同种异体气管切除后，为了成功地重建气管，必须解决与气管移植物的保存和血管化有关的问题。在这项研究中，我们使用的是一分为二的移植物，而不是一节一节的移植物。目的是在冷冻保存后使用这种移植物，以减轻新生血管的形成，并通过将其移植到狗颈部气管的两个不同区域来保持气管的完整性。方法：在医学院动物实验室对11只混血犬进行实验研究。第一只狗的气管长8厘米，分成两块，每块4厘米，在-80℃的保存液中保存4周。在这之后，这只狗被献上了祭品。从第二只狗身上切除两段2厘米长的颈段气管。然后用两个与冷冻保存的气管长度相同的气管移植物重建这些部分。10只狗被分成五组，每组两只狗，每组接受相同的程序。受试者在术后第三周进行支气管镜检查。切除实验气管吻合区，进行组织病理学检查。结果：支气管镜检查发现7例患者有3度梗阻，2例接近4度梗阻。在组织病理学检查中，与支气管镜检查结果相反，75%的吻合口上皮完整。在所有的吻合口中，软骨具有保存完好的结构特征。吻合口轻度炎症12例，轻度炎症7例，重度炎症1例。所有吻合口的血管形成良好或非常良好。结论：采用冷冻保存和裂开吻合技术可以保持气管上皮的完整性。软骨尽管失去了生存能力，但仍保留了其结构特征，从而为维持呼吸道通畅提供了优势。(C)2009年欧洲胸心外科协会。爱思唯尔出版，版权所有。
Objectives: For successful reconstruction with tracheal allotransplants following tong tracheal resections, problems related to the preservation and vascularisation of the tracheal graft have to be solved. In this study, instead of using a tong-segment single-piece graft, we used a graft that has been split into two. The aim was to use this graft after cryopreservation in order to ease neo-vascularisation and to maintain tracheal integrity by transplanting it to two separate regions of the dog cervical trachea. Methods: This experimental study was conducted in animal laboratories of the medical school on 11 half-blood dogs. The trachea obtained from the first dog was 8 cm in length; it was split into two pieces of 4 cm each and stored in the preservation solution at -80 degrees C for 4 weeks. Following this, the dog was sacrificed. Two 2 cm portions of cervical trachea were excised from the second dog. These parts were then reconstructed with two tracheal grafts of the same Length as the cryopreserved ones. Ten dogs that were grouped into five groups of two dogs each underwent the same procedure. The subjects had a bronchoscopic evaluation on the third postoperative week. Anastomosis regions of the test tracheas were resected to be examined histopathologically. Results: Seven subjects were found to have third-degree obstructions during bronchoscopy; two had close to fourth-degree obstructions. In the histopathological examination, contrary to the findings of the bronchoscopies, 75% of the anastomoses had intact epithelium. The cartilage was seen to have well-preserved structural characteristics in all the anastomoses. Twelve anastomoses had moderate, seven mild and one had severe inflammation. All anastomoses had either good or very good level of vascularisation. Conclusions: The integrity of the tracheal epithelium can be maintained with cryopreservation and split anastomosis technique. The cartilage preserves its structural characteristics despite losing its viability, thereby offering an advantage to maintain airway patency. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.