LONG-SEGMENTAL TRACHEA REPLACEMENT USING NICKEL-TITANIUM ALLOY STENT WRAPPED WITH AUTOLOGOUS PERICARDIUM_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUOYuekui ¹ , GUOPengming ¹ , LIBin ² , SONGTieniu ² , YULixin ³ ,  ZHANGJianhua ² , WANGCheng ² , JIANGPeng ²

1. The Second Clinical Medical College of Lanzhou University, Lanzhou Gansu, 730030, P. R. China;
2. Department of Thoracic Surgery, Lanzhou University Second Hospital;
3. Department of Anesthesia, Lanzhou University Second Hospital;

Corresponding?author：

ZHANGJianhua, Email: 972659434@qq.com

Keywords：

Trachea injury; Pericardium; Nickel-titanium alloy stent; Tracheal reconstruction; Tracheal epithelium; Pig

DOI：

10.7507/1002-1892.20150304

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To perfect the surgical process that trachea could be reconstructed by nickel-titanium (Ni-Ti) alloy stent wrapped with autologous pericardium, and to evaluate the effectiveness and observe the complications. Methods In the experiment, twelve healthy Bama suckling pigs with weight of 18-25 kg were selected. The pericardium was harvested to cover the Ni-Ti alloy stent. The compound artificial trachea was used to reconstruct long-segmental (6 cm) trachea defect. The effectiveness, complications, the properties, and growth rate of the new mucosa of the artificial trachea lumen were observed. Results Of 12 pigs, 2 died soon because of hemorrhage and infection, respectively; 7 died at 2-4 months after operation because of hyperplasia at the middle section and blockage of phlegm plug; 3 survived after 42 weeks postoperatively, but accompanied with dyspnea symptom. At 1, 2, 3, 4, and 5 months after operation, the average crawl length of the new trachea mucosa was 1, 3, 5, 7, and 10 mm, respectively; the occurrence rates of anastomotic stenosis were 0 (0/10), 0 (0/9), 0 (0/4), 33.3% (1/3), and 33.3% (1/3) respectively; and the occurrence rates of scar hyperplasia in the middle of lumen were 20% (2/10), 66.7% (6/9), 75.0% (3/4), 66.7% (2/3), and 100% (3/3), respectively. At 7 months postoperatively, the bronchoscopy examination showed that the scar in central part of artificial trachea had the trends of stagnation, softening, and narrowing, and respiratory symptom had the trend of slight ease. Hyperplasia tissue could be found in central part of artificial trachea by autopsy and was verified to be fiber cells and necrotic tissue by pathology examination. Conclusion Ni-Ti alloy stent with autologous pericardium can insure that the reconstructed tracheal lumen is unobstructed, and support the trachea epithelium regeneration; the main factors of the death of the experimental animals are the lumen hyperplasia of the artificial trachea and the blockage of the secondary phlegm plug.

Citation： LUOYuekui, GUOPengming, LIBin, SONGTieniu, YULixin, ZHANGJianhua, WANGCheng, JIANGPeng. LONG-SEGMENTAL TRACHEA REPLACEMENT USING NICKEL-TITANIUM ALLOY STENT WRAPPED WITH AUTOLOGOUS PERICARDIUM. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1419-1422. doi: 10.7507/1002-1892.20150304 Copy

1.	Bacon JL, Patterson CM, Madden BP. Indications and interventional options for non-resectable tracheal stenosis. J Thorac Dis, 2014, 6(3):258-270.
2.	Grillo HC. Tracheal replacement:a critical review. Ann Thorac Surg, 2002, 73(6):1995-2004.
3.	趙衍. 人工氣管重建氣管的研究進展. 中華心胸血管外科雜志, 2004, 20(2):65-66.
4.	王嵩, 史宏燦. 人工氣管研究進展. 中國修復重建外科雜志, 2011, 25(3):365-368.
5.	Ch'ng S, Wong GL, Clark JR. Reconstruction of the trachea. J Reconstr Microsurg, 2014, 30(3):153-162.
6.	Chang JW, Park SA, Park JK, et al. Tissue-engineered tracheal reconstruction using three-dimensionally printed artificial tracheal graft:preliminary report. Artif Organs, 2014, 38(6):E95-E105.
7.	Serrano C, Lostalé F, Rodríguez-Panadero F, et al. Tracheal selfexpandable metallic stents:a comparative study of three different stents in a rabbit model. Arch Bronconeumol, 2015.[Epub ahead of print].
8.	Haykal S, Salna M, Waddell TK, et al. Advances in tracheal reconstruction. Plast Reconstr Surg Glob Open, 2014, 2(7):e178.
9.	王曉明, 許林海, 孫高忠, 等. 大鼠心包膜組織對其缺血心肌的保護和再生作用. 中華醫學雜志, 2011, 91(42):3012-3015.
10.	姜格寧, 丁嘉安, 張鵬, 等. 心包加鎳鈦記憶合金支架氣管置換術. 中華胸心血管外科雜志, 2005, 21(5):313.
11.	Nassiri N, Yu A, Statkus N, et al. Imaging of cardiac herniation in traumatic pericardial rupture. J Thorac Imaging, 2009, 24(1):69-72.
12.	Makris D, Holder-Espinasse M, Wurtz A, et al. Tracheal replacement with cryopreserved allogenic aorta. Chest, 2010, 137(1):60-67.
13.	Kim J, Suh SW, Shin JY, et al. Replacement of a tracheal defect with a tissue-engineered prosthesis:Early results from animal experiments. J Thorac Cardiovasc Surg, 2004, 128(1):124-129.
14.	Neville WE, Bolanowski JP, Kotia GG. Clinical experience with the silicone tracheal prosthesis. J Thorac Cardiovasc Surg, 1990, 99(4):604-613.
15.	劉文亮, 肖鵬, 梁恒星, 等. 新復合型人工氣管移植實驗研究. 中國修復重建外科雜志, 2013, 23(3):330-334.
16.	Bujia J, Wilmes E, Hammer C. Immunologic behavior of human tracheal transplants. Laryngorhinootologie, 1992, 71(7):353-358.
17.	Jacobs JP, Elliott MJ, Haw MP, et al. Pediatric tracheal homograft reconstruction:a novel approach to complex tracheal stenoses in children. J Thorac Cardiovasc Surg, 1996, 112(6):1549-1560.
18.	紀子釗, 陳剛, 張蘇寧, 等. 記憶合金材料彈力金屬支架在犬肺組織瓣重建氣管缺損中的應用. 中國組織工程與臨床康復, 2011, 15(51):9549-9552.
19.	趙雪檸, 從波, 劉大昱, 等. 聚丙烯網狀材料與頸前皮瓣聯合重建氣管的實驗研究. 中國耳鼻喉頭頸外科雜志, 2008, 43(7):533-536.
20.	曹子昂, 顧旭東, 林海平, 等. 自體心包包裹人工氣管修復氣管缺損的組織相容性評估. 中國組織工程研究與臨床康復, 2008, 12(14):2645-2647.
21.	Schultz P, Vautier D, Dupret-Bories A, et al. Replacement of the trachea using surgical reconstruction:current state of research. Ann Otolaryngol Chir Cervicofac, 2009, 126(5-6):272-277.
22.	郭啟勇, 常鋼, 劉兆玉, 等. 氣管內留置螺旋狀金屬內支架的基礎研究. 中華放射學雜志, 1997, 29(7):484-487.
23.	郝可可, 于力克. 經支氣管鏡冷凍治療氣管支架管腔內再狹窄. 臨床肺科雜志, 2004, 10(1):101.
24.	劉兆玉, 郎旭, 盧再鳴, 等. 實驗犬留置不同類型氣管支架的基礎研究. 介入放射學雜志, 2007, 16(7):485-488.

1. Bacon JL, Patterson CM, Madden BP. Indications and interventional options for non-resectable tracheal stenosis. J Thorac Dis, 2014, 6(3):258-270.
2. Grillo HC. Tracheal replacement:a critical review. Ann Thorac Surg, 2002, 73(6):1995-2004.
3. 趙衍. 人工氣管重建氣管的研究進展. 中華心胸血管外科雜志, 2004, 20(2):65-66.
4. 王嵩, 史宏燦. 人工氣管研究進展. 中國修復重建外科雜志, 2011, 25(3):365-368.
5. Ch'ng S, Wong GL, Clark JR. Reconstruction of the trachea. J Reconstr Microsurg, 2014, 30(3):153-162.
6. Chang JW, Park SA, Park JK, et al. Tissue-engineered tracheal reconstruction using three-dimensionally printed artificial tracheal graft:preliminary report. Artif Organs, 2014, 38(6):E95-E105.
7. Serrano C, Lostalé F, Rodríguez-Panadero F, et al. Tracheal selfexpandable metallic stents:a comparative study of three different stents in a rabbit model. Arch Bronconeumol, 2015.[Epub ahead of print].
8. Haykal S, Salna M, Waddell TK, et al. Advances in tracheal reconstruction. Plast Reconstr Surg Glob Open, 2014, 2(7):e178.
9. 王曉明, 許林海, 孫高忠, 等. 大鼠心包膜組織對其缺血心肌的保護和再生作用. 中華醫學雜志, 2011, 91(42):3012-3015.
10. 姜格寧, 丁嘉安, 張鵬, 等. 心包加鎳鈦記憶合金支架氣管置換術. 中華胸心血管外科雜志, 2005, 21(5):313.
11. Nassiri N, Yu A, Statkus N, et al. Imaging of cardiac herniation in traumatic pericardial rupture. J Thorac Imaging, 2009, 24(1):69-72.
12. Makris D, Holder-Espinasse M, Wurtz A, et al. Tracheal replacement with cryopreserved allogenic aorta. Chest, 2010, 137(1):60-67.
13. Kim J, Suh SW, Shin JY, et al. Replacement of a tracheal defect with a tissue-engineered prosthesis:Early results from animal experiments. J Thorac Cardiovasc Surg, 2004, 128(1):124-129.
14. Neville WE, Bolanowski JP, Kotia GG. Clinical experience with the silicone tracheal prosthesis. J Thorac Cardiovasc Surg, 1990, 99(4):604-613.
15. 劉文亮, 肖鵬, 梁恒星, 等. 新復合型人工氣管移植實驗研究. 中國修復重建外科雜志, 2013, 23(3):330-334.
16. Bujia J, Wilmes E, Hammer C. Immunologic behavior of human tracheal transplants. Laryngorhinootologie, 1992, 71(7):353-358.
17. Jacobs JP, Elliott MJ, Haw MP, et al. Pediatric tracheal homograft reconstruction:a novel approach to complex tracheal stenoses in children. J Thorac Cardiovasc Surg, 1996, 112(6):1549-1560.
18. 紀子釗, 陳剛, 張蘇寧, 等. 記憶合金材料彈力金屬支架在犬肺組織瓣重建氣管缺損中的應用. 中國組織工程與臨床康復, 2011, 15(51):9549-9552.
19. 趙雪檸, 從波, 劉大昱, 等. 聚丙烯網狀材料與頸前皮瓣聯合重建氣管的實驗研究. 中國耳鼻喉頭頸外科雜志, 2008, 43(7):533-536.
20. 曹子昂, 顧旭東, 林海平, 等. 自體心包包裹人工氣管修復氣管缺損的組織相容性評估. 中國組織工程研究與臨床康復, 2008, 12(14):2645-2647.
21. Schultz P, Vautier D, Dupret-Bories A, et al. Replacement of the trachea using surgical reconstruction:current state of research. Ann Otolaryngol Chir Cervicofac, 2009, 126(5-6):272-277.
22. 郭啟勇, 常鋼, 劉兆玉, 等. 氣管內留置螺旋狀金屬內支架的基礎研究. 中華放射學雜志, 1997, 29(7):484-487.
23. 郝可可, 于力克. 經支氣管鏡冷凍治療氣管支架管腔內再狹窄. 臨床肺科雜志, 2004, 10(1):101.
24. 劉兆玉, 郎旭, 盧再鳴, 等. 實驗犬留置不同類型氣管支架的基礎研究. 介入放射學雜志, 2007, 16(7):485-488.

Chinese Journal of Reparative and Reconstructive Surgery

LONG-SEGMENTAL TRACHEA REPLACEMENT USING NICKEL-TITANIUM ALLOY STENT WRAPPED WITH AUTOLOGOUS PERICARDIUM

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content