| It needs cutting a stage of trachea to cure the disease of trachea sometimes. In general, it thinks that it could be end to-end anastomosis directly if the length of the cut trachea is less than four centimeters. The tracheal limiting length which could be cut is six centimeters. It is diffficult to end to-end anastomosis directly if it exceeds six centimeters and it needs practicing the reconstruction of trahea. The disease which need cutting a stage of trachea is tracheal tumors (TT) mainly. The pristine clinical symptom of the TT is not very obvious and the tracheal affection length is more longer when the patient has the clinical symptom to see the doctor. At this time, the defective incomplete trachea is hard to practice end to-end anastomosis directly and it needs practicing the reconstruction of trahea (RT) after cutting the trachea. At present, the RT still is one of the tracheal surgery cosmopolitism tough problems.Objective:We will use the ripe dogs whole ribs pleura and intercostal muscle valve ring (IMVR) to replace several tracheal rings in the thoracic cavity. It studies the feasibility using the autologous tissue to rebuilt the trachea, and provides the theoretical and practical basis for surgical curing the TT in the afterward clinical work through the experiment.Methods:The empirical dogs are fixed after general anesthesia. The empirical dog is female or male and the scope of the body weight is 25-36 kilograms. We choose the posterolateral incision on the right third rib space and show the second to fourth rib, intercostal muscle, costal cartilage. Stripping the third rib periosteum near the angle of rib and cutting 1.5 centimeters rib completely near the vertebral column. Cutting off the intercostal muscle along the inferior border of the second rib and the fourth rib and reserving the 1.5 centimeters costal cartilage on the front of the third rib. Making the dogs' third ribs and intercostal muscle to pentagon, and than sewing up the free edge and root part to make a rib intercostal muscles valve ring. Putting a silica gel pipe (SGP) into the valve ring. Using the IMVR to replace four or six tracheal rings. Retainning one pipe of the closed drainage of thoracic cavity. Observing the dogs' living circumstance and the complication which concerned with the death after the operation. Observing the RT specimen morphological change and histopathology change in the thirtieth, the sixtieth day and over one hundred days after the operation. The statistic method is listed to the average inner diameter (ID) of the dogs' normal trachea, reconstruction trachea in the operation, reconstruction trachea after operation.Results:1 The Observiation of the dogs' living state after the operation.Three dogs die of the anesthetic accident in the operation. One dog die of pneumatothorax after operation. One dog die of thoracic cavity infection. All the dogs could braethe smoothly but the drink and food is little in the earlier period after operation. The dogs have irritable cough and only eat a little of liquid diet. Several dogs' facial expression are painful when taking the food. The dogs' physical strength gradually regain and the activity amount increase after extracting the closed drainage of thoracic cavity pipe. The dogs can breathe steadily, take food and exercise normally before expectorating the SGP. Twenty dogs can expectorate the SGP in three to four weeks after operation but one. After expectorating the SGP, the irritable cough symptom is disappear. Five dogs are put to death in the thirtieth day. The left fifteen dogs wheeze lightly in the 43th day, take little food and do little exercise obviously in the early period of expectorating the SGP. With the time extending, the wheezeing symptom aggravate gradually and it is obvious all the more after exercising. Five dogs which wheezeing aggravatly are put to death in the sixtieth day. After expectorating the SGP, the left ten dogs wheeze lightly at the activity, but this release mostly after three to five weeks and the living is steady gradually after three monthes.2 Complication concerned with the death after the operationThree dogs die of the anesthetic accident in the operation. The infection and the pneumatothorax are the main complication in the early period afer operation. One dog die of pneumatothorax in eight hours after operation. One dog dies of thoracic cavity infection in four days after operation. The pulmonary atelectasis and the narrow of the IMVR are the main complication in the long-term( >30days) afer operation. The left ten dogs living is steady gradually after three monthes.,but with the time extending, the wheezeing symptom aggravate gradually again and it is obvious all the more after exercising. In the end, the dogs succumb to respiratory failure(RF).3 The whole ribs pleura and intercostal muscle pedicle skin flap valve ring morphological changeWe find that the pentagon whole ribs pleura and intercostal muscle pedicle skin flap valve ring which made by the third rib exceed the normal trachea bed and the trachea no deflexion through dissecting the died dogs. One of the five dogs SGP is not expectorated which put to death in the thirtieth day. The IMVR is edema lightly and the pleura endepidermis ablate partly in the thirtieth day. The corner of the IMVR is partly swelling seriously, but it is very stable. The IMVR no collapsing and the blood supply is very good. The SGP do not fall off in the trache. The ID and section area of the IMVR is bigger. In the sixtieth day, the edema resolve obviously and the pleura shrinkage. The SGP is expectorated. The IMVR still no collapsing and the blood supply is good. It is also stable and can keep the RT tubiform shape. The ID and section area of the IMVR is bigger. The IMVR exceeding 100 days is more stable, the edema resolve and it can keep the RT tubiform shape better. The blood supply is still good, but the individual IMVR pleura shrinkage obviously and it shows bigger scar tissue at the stoma. The IMVR is narrow.4 The whole ribs pleura and intercostal muscle pedicle skin flap valve ring histopathology changeThe histopathology examination show that the IMVR is edema obviously, the muscle cell denaturationin, depauperation and the chronic inflammation cell infiltration. The rib structure is integrity and no absorption phenomenon in the thirtieth day. In the sixtieth day, the chronic inflammation cell is more, reduction in vascularity and the vessel wall thickening in the muscle tissue. The rib structure still is integrity and no absorption phenomenon. After 100 days, we see the granulation tissue formed by generous neoformative blood capillary, the migratory columnar epithelium in the junctional zone and the pseudostratified ciliated columnar epithelium squamous metaplasia in the partly zone. The rib structure still no absorption phenomenon and it has the neoformative bone tissue.Conclusions:1 The mixed mode whole ribs pleura and intercostal muscle pedicle skin flap valve ring stability is better and blood supply is better. The ID and section area of the RT is bigger. The function of the RT is preferable matching the SGP in the trachea.2 The mixed mode whole ribs pleura and intercostal muscle pedicle skin flap valve ring achieve the tracheal piping shape and the RT tissue can survive.3 The mixed mode whole ribs pleura and intercostal muscle pedicle skin flap valve ring can replace the partly trachea in the thoracic cavity. 4 The generous growing of the granulation tissue and the scarring lead to the RT narrow still is the difficulty which need to solve the next step.
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