| PrefaceIn clinical practice, many patients suffer from benign or malignant esophageal tumors, burns or strictures, thus needing esophagec-tomy and appropiate esophageal substitutes to resume its continuity and to guarantee its physiological function. Therefore researchers have made great efforts in finding an esophageal substitute that would cause little trauma, operate easily and safely, be soft and accordant with physiological properties. This has been an focus to which researchers have endeavored for a long time. They've tried many kinds of auto-grafts or artificial esophagus to replace esophagus, which did obtain some effect, but the operative injuries were severe and procedures complex, besides the histocompatibility and dynamics problems of artificial esophagus. All of above limited its clinical indications. In recent years, the thoracic surgery department of the 2nd clinical hospital of CMU choose dogs ' pulmonary tissue possessed vessel pedicle (PTVP) lined (inside packed) with memory ( elastic) alloy stent to reconstruct esophageal defect, and obtained perfect effect. This article provided credible information to ameliorate this approach by observing postoperative complications, analyzing the causes and taking preventive and therapeutic procedures.Methods24 healthy crossbred dogs were chosen.Experimental materials;Operation appliances and anaesthesia appliances, memory (elastic) alloy stent.Experimental method:Thiopental sodium was injected into abdominal cavity (30mg/kg) before operation and uni-lumen tube was intubated into trachea. Then combined intravenous and inhalant anaesthetization was performed. Thorax was burrow into through the 4th intercostals space, pulmonary hilus of right upper lobe or middle lobe was dissociated, the bronchi of either of the two lobes were isolated and ligated respectively with double 7-size suture to peel of and extend it, and mediastinal pleura of esophageal bed was incised by electric knife. Then esophagus was dissociated and tracted by trading band (divided into Group A and B, 12 dogs in each) and about 40 - 60mm long and 1/2 - 2/3 perimeter wide esophagus was resected. A pipe was made from upper and middle lobes of right lung and was anastomosed to esophageal defect. Memory (elastic) alloy stent was lined (inside packed) in B group. Mediastinal pleura was then sutured, thorax drainage tube'was setup and fixed, and thoracic cavity was closed. Finally gastric tube or gastric fistulation was setup and fixed.Postoperative nursing (tendness) ;Experimental dogs were fasted in the 1st and 2nd day after operation, and intravenous fluid supply by 60 ml/kg/day (sodium chloride) and caloric supply by 80cal/kg/d(glucose, fatty chyle) was given together with 4 million units of penicillin. In the 3rd to 7th day, mixed milk was fed through gastric tube, and 7 days after operation, general fed. Antibacterial therapy had been performed for 1 week. Observation method;1. general (common) condition observation.2. in the 8th week after operation, dogs were examined by barium-swollen perspective and gastrofibroscopy.3. when natural death after operation or in the 2, 4, 6, 8, 10, 12 weeks, dogs were killed respectively and taken to pathological examination.ResultsThere were 24 dogs in this experiment surviving from 5 days to 129 days. No. 1 and 6 of group A died of empyema on the 7th and 38th day after operation respectively. No. 4 and 5 died of AF on the 5th and 7th day respectively. No. 7 and 8 of group B died of empyema on the 22nd and 43rd day respectively. No. 1,2,9 and 12 died of AF (AF) on the 6th ,63rd ,9th ,23rd day respectively. No. 4 of group B died of hematemesis on the 129th day. No. 5 of group B was killed on the 14' day after operation due to stenosis of anastomosis. No. 6 was killed on the 28th day for the ulcer on the surface of PTVP. All the dogs with survival longer than 2 weeks complicated with stenosis of anastomosis incoordinately.Barium-swollen perspective and chest photograph; th... |
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