| The most effective method to solve the problem of esophageal stenosis with difficulty in eating is to resect the lesion by surgical operation and to reconstruct the esophagus. But due to the segmental character of esophagus blood supply, the end to end anastomosis after re-sectiong is almost impossible, so we are trying to find a suitable replacement to rebuild the digestive continuity. At present the nomal clinical substitutes are celiac organs such as stomach, colon and jejunum , but there are many negative reactions after operation. There are also many other methods such as with skin flap, muscuio - cutaneous flap and artificial esophagus, but each of them had defects. After the clinical success of using self - lung tissue flap to reconstruct trachea, we try to apply self - pulmonary tissue flap to reconstruct esophagus in this research, and we explore its feasibility, possible problems and the solutions.Materails and Methods1. Materials1. 1 Experimental animals; 24 healthy adult mongrel dogs, weigh 10 ~ 15kg, male to female, provided by our hospital animal center.1.2 Appliances: anesthesia appliance, tracheal int - ubator, surgical equipments, self - expanded alloy stand, microscope, transmission electron microscope, gastrofiberscope.1. 3Drugs: introlipid, penicilli, potassium chloride, sodium tm'o-pental, Ketamine Ethrane.2. Methods2.1 Dogs are divided into two groups according if there is alloy stand in the pulmonary tissue flap (PTF).2. 2 Operation methods: Dogs are fasted 12 hours before operation. The dog is anesthetized by injecting sodium thiopental (30mg/ kg) in peritoneal cavity and intubating immediately. We use brea -thing maching to maintain mechanical venti - lation, with Ketamine and Ethrane combining anesthetized. The dog lies on left lateral position. A right thoracotomy is performed through the fifth intercostals space Middle bronchus is ligated and incised, so the PTF is made. A 4 ~ 6 centimeter long and 1/2 ~ 2/3 perimeter defect is made in e-sophageal wall, then we reconstruct esophagus only with PF ( Team A) or repair it using PF with the self - expanded stent inside ( Team B). Except the method of inserting the stent, the other process is same. Then the anastomosis is completed with two layers suture between the prothesis and esophageal wall. At last, we bundle pleura, wash thorax, set up thorax drainge tube, suture lays of chest tissue.2.3 Nursing method; The dog is fed intra - venously for seven days,80 cal/kg and 60ml/kg per day. Three days later ,nutritious milk is given by gastrostomy. In next seven days liquid foof is startedorally, and semisolid food gradually. At the same time the antibiotics is injected routinely.2.4 Observing method: We observe the animal's changes such as in the eating action and weight. The dogs are killed at the following times:2,4,6,8,10 weeks after the reconstruction operation. Esophago - graphy and endoscopic examination are performed in adequate time. When the dogs die naturally or are executed, the substitute is taken out. We observe pathology morphologic changes and make pathologic study by light microscope and transmission electron microscope (TEM).2. 5 Making section:2.5. 1 Pathological section making: The specimen is fixed by 10% Formalin, gradient dehydrated by 75 - 10% Alcohol, treated by xylene, embedded by paraffin and then section is made. At last the section is stained by eosin and haematoxylin.2.5.2 Elctron microscope section making; The speciment is iorefixed by glutaraldehyde, poached by buffer solution, afterfixed by osrnlc acid, guadient dehydrated by Alcohol and acetone,.treated by embedding agent and polymerizated In the incubator. At last we tidy up the pieces and ultramislice is completed.Experimental resultsThe dogs survived from 5 days to one and half year after operation. In team A two dogs died of anatomotic leak and one survived 38 days and died of chronic pyothorax. In team B three dogs died of anatomotic leak, two cases died of perforation of ulcer and one died... |
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