带血管蒂膈肌瓣重建食管动物模型的制作

中国临床解剖学杂志 ›› 2013, Vol. 31 ›› Issue (5): 568-571.

带血管蒂膈肌瓣重建食管动物模型的制作

范义婷¹, 　王武军¹,　王雪莲²,　刘太省¹,　王昊飞¹

1.南方医科大学南方医院胸心血管外科，广州 510515； 2.南方医科大学第三附属医院麻醉科，广州 510630

收稿日期:2013-05-20 出版日期:2013-09-25 发布日期:2013-10-16
通讯作者: 王昊飞，博士，副主任医师，E-mail:whf0001@163.com E-mail:1664043151@qq.com
作者简介:范义婷（1987-），女，四川人，在读硕士，医师，研究方向：食管重建
基金资助:
南方医院院长基金(2009C003)

Experimental animal model of pedicled diaphragmatic muscle flap for reconstruction of defected esophagus on pigs

FAN Yi-ting¹, WANG Wu-jun¹, WANG Xue-lian², LIU Tai-sheng¹, WANG Hao-fei¹

1.Department of Cardiothoracic Surgery, Nanfang Hospital, Guangzhou 510515, China; 2. Department of anesthesiology, the Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China

Received:2013-05-20 Online:2013-09-25 Published:2013-10-16

摘要/Abstract

摘要：

目的　探索猪带蒂膈肌瓣重建食管动物模型的制作方法，对比以不同血管蒂的膈肌瓣重建食管的可行性及优劣，为进一步研究打下实验基础。方法　健康长白猪10头，体质量24~25 kg；根据血管蒂的不同随机分2组，每组5例。A组，以左膈下动脉为蒂；B组，以左心包膈动脉为蒂，左侧膈神经同蒂血管一同游离。全麻下切除部分下段食管（3~5 cm），取带血管蒂膈肌瓣管状成形并重建缺损食管，缺损膈肌涤纶补片修补。结果 B组的生存时间及长期存活动物例数均大于A组（P<0.05）；B组蒂血管心包膈动脉的游离长度显著大于A组膈下动脉的游离长度（P=0.004）；B组膈肌瓣长度及宽度均大于A组可切取的长度（P=0.001）及宽度（P<0.001）。结论　成功建立猪膈肌重建食管的动物模型，以心包膈动脉和以膈下动脉为蒂的膈肌瓣重建食管下段均是可行的；B组模型较A组模型更具优势。

关键词: 猪, 食管重建, 带蒂膈肌瓣, 心包膈动脉, 膈下动脉

Abstract:

Objective　This study aims to establish an animal model of diaphragmatic muscle flap with vascular pedicle for reconstruction of the esophagi in pigs, and compare the feasibilities, advantages and disadvantageso of using diaphragmatic muscle flaps with different vascular pedicles for reconstruction of the esophagusso as to lay an experimental foundation for further study.　Method　10 healthy Landrace, weighing between 24 and 25 kg, were divided randomly into two groups (A and B) according to different vascular pedicles. Group A (n = 5), left phrenic artery was used as the vascular pedicle. Group B(n = 5), left pericardium phrenic artery with left phrenic nerve was used as thevascular pedicle. The lower 3~5 cm segment of the esophagi of the pigs in the two groups were cut off under general anesthesia, and diaphragmatic muscle flaps with vascular pedicles were harvested and rendered into tubes to reconstruct the defected esophagi. The then defected diaphragmatic muscles were repaired by dacron patch.　Result　The survival time and the cases of long-term survival animals in group B were greater than group A (P < 0.05); the isolated length of pericardium diaphragmatic arteries in group B was significantly greater than the isolated length of phrenic arteries in group A (P = 0.004); the length and width of diaphragmatic valves in Group B were greater than the feasible length (P =0.001) and width (P<0.001) in group A.　Conclusion　The experimental animal model of pedicled diaphragmatic muscle flaps reconstructing defected esophagi on pigs has been successfully established. It is feasible for diaphragmatic muscle flaps with pericardium phrenic artery or phrenic artery to reconstruct esophagi; the model of group A has more advantages than group B.

Key words: Esophagus, Diaphragmatic muscle flap with vascular pedicle, Arteria pericardiacophrenica, Inferior phrenic artery, Esophageal reconstruction

中图分类号:

R655.6

范义婷, 王武军, 王雪莲, 刘太省, 王昊飞. 带血管蒂膈肌瓣重建食管动物模型的制作[J]. 中国临床解剖学杂志, 2013, 31(5): 568-571.

FAN Xi-Ting, WANG Wu-Jun, WANG Xue-Lian, LIU Ta-Sheng, WANG Hao-Fei. Experimental animal model of pedicled diaphragmatic muscle flap for reconstruction of defected esophagus on pigs[J]. Chinese Journal Of Clinical Anatomy, 2013, 31(5): 568-571.

参考文献

[1] Lauschke H, Tolba R, Hirner A. History of surgical esophageal replacement
[J]. Chirurg，2001,72(8):973-977.

[2] 李安富,侯书健,刘晓峰,等.应用显微外科技术重建食管远期疗效评价
[J]. 中华显微外科杂志,2009,32(1):84-85.

[3] 程邦昌,昌盛,黄杰,等.结肠代食管术中结肠血管结构的研究
[J].中华医学杂志, 2006, 86(21):1453-1456.

[4] 钟金龙,钮海弟.食管贲门癌术后近期并发症的诊治体会
[J].中华实用医学,2004,6(13):14.

[5] 吴彬,徐志飞,赵学维,等.高龄食管癌贲门癌患者术后主要并发症的原因分析
[J].第二军医大学学报,2003,24(1):113-115.

[6] Junemann MR, Awan MY, Khan ZM, et al. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on long term survival in a high volume center
[J]. Eur J of Cardiothoracic Surgery, 2005, 27(1):3-7.

[7] Lapii GA, Chikinev YV, Sudovykh IE, et al. Structural modifications of colonic transplant in plastic repair of the esophagus
[J]. Bull Exp Biol Med, 2008 ,146 (4): 480-484.

[8] Kinugasa S, Tachibana M, Yoshmura H, et al. Esophageal resection in elderly esophageal carcinoma patient improvement in post-operative complications
[J]. Ann Thorac Surg, 2001, 71(2):414-418.

[9] Marzaro M, Vigolo S, Oselladore B, et al. In vitro and in vivo proposal of an artificial esophagus
[J]. Biomed Mater Res A, 2006 , 77 (4):795-801.

[10]Parshin VD, Ruchkin DV, Bazarov DV, et al. The dissociation of artificial esophagus' fistula with trachea after esophagus extirpation for squamous cell carcinoma
[J]. Khirurgiia, 2008,(10): 68-69.

[11]Watanabe M, Sekine K, Hori Y, et al. Artificial esophagus with peristaltic movement
[J]. ASAIO J, 2005, 51 (2): 158-161.

[12] 张兰军,智发朝,戎铁华,等.生物型人工食管的实验研究
[J].中华胃肠外科杂志,2001, 4(3):157-160.

[13] 鲍春荣,丁芳宝.组织工程食管的研究进展
[J].第二军医大学学报,2005,26(3): 331-333.

[14]杨林珠．人工食管的研究进展
[J]．中国胸心血管外科临床杂志，2006,13(3):188-191.

[15]崔永, 王天佑, 王化生. 自发性食管破裂的诊断与治疗
[J]. 中华外科杂志, 2005,43(6):404-405.

[16]邹胜鲁, 周海滨, 李涛,等. 带血管蒂膈肌瓣成形术治疗贲门失弛缓症48例疗效观察
[J]. 山东医药 , 2007,47(26):32.

[17] D'Journo XB, Doddoli C, Avaro JP, et al. Long-term observation and functional state of the esophagus after primary repair of spontaneous esophageal rupture
[J]. Ann Thorac Surg, 2006 ,81 (5):1858-1862.

[18]邰智慧, 吴春涛, 邰军妹, 等. 自发性食管破裂修补术中修补材料的选择
[J].山东医药，2008,48(17):107-108.

[19] Loukas M, Jr Louis R G, Wartmann C T, et al. Superior phrenic artery: an anatomic study.
[J]. Surg Radiol Anat, 2007, 29(1): 97-102.

[20] Steinau G, Hohl C, Prescher A, et al. Experimental investigation of the elasticity of the human diaphragm
[J]. BMC Surg, 2010, 10: 5.

[21] 邓荟，王武军，王兴海，等. 膈肌代食管可行性的动物解剖学研究
[J].中国临床解剖学杂志，2011，29（3）：311-315.

[22] 郭少鸣，王武军，李鉴轶，等. 带蒂膈肌瓣重建食管的临床解剖学可行性研究
[J]. 中国临床解剖学杂志，2011，29（3）：256-259.