Effect Of Feeding Regulation Measures For Construction Of Esophageal Channel Function In Neo-esophagus

Objective: To observe the effect of feeding regulation measures for construction of esophageal channel function in Neo-esophagus postoperative, the animal models is established by applying Nitinol alloy composite artificial esophagus to replacing thoracic esophagus.Methods: Took 6 Panamanian pigs as objects of study and set up 2 groups of animal model (3 for each group) by surgical operation .Beginning on the 2nd postoperative day, enteral nutrition was carried out for 28 days after the operation with feeding tube. Beginning on the 30th postoperative day, on the experimental group was fed with semi-liquid soft food and the control group was fed with mixed pig feed continued to the end of the experiment. After implantation of the artificial esophagus, eating condition according to Bown′s grade and body weight change were recorded. The site of artificial esophagus was observed and the time which artificial esophagus was sloughed out was recorded by the chest X-ray every month. At the 2nd,the 4th and 6th month postoperative, one pig was executed with euthanasia for the extraction of thoracic esophagus including the Neo-esophagus section each group. Then it is to measure the gross specimen and to perform the histological big section of specimens which is to make HE and Masson staining for histiocytic observation. With spss13.0 statistical software used, experimental data were analyzed statistically between groups. (student t test, Mean±standard deviation).Results: There were no death, anastomotic leakage. In experiment group, no artificial esophagus was sloughed out, until the experiment ended .The experimental animal had not dysphagia and the growth status was well. Macroscopically, the grafted artificial esophagus was in situ. And it is surrounded by an airtight tube which connects the normal esophagus each stump (named neo-esophagus).By light microscopic examination neo-esophagus had formed with cutaneous and subcutaneous layers including mucous glands, subcutaneous muscular, collagenous fibers and inflammatory corpuscle. With the time going, changes could be observed. But no regeneration of esophageal muscularis propria was observed. In control group, the grafted artificial esophagus was sloughed out from 1 to 4 month. And Neo-esophagus occurred different degrees narrow resulting in eating difficulty. Macroscopically neo-esophagus showed different degrees stenosis. By light microscopic examination the tissue structure of neo-esophagus in control group was the same as the experiment group. The thickness of neo-esophageal tube wall in middle area of experiment group was 0.27±0.03cm ,and the thickness of neo-esophageal tube wall in narrow area of control group was 0.25±0.03cm .There was not significantly deviation between two groups (P>0.05).The width of proximal stoma was 3.17±0.13cm in experiment group and was 4.68±0.49cm in control group. There was significantly deviation between two groups (P<0.05). The width of distal stoma was 3.18±0.13cm in experiment group and was 3.98±0.45cm in control group. There was significantly deviation between two groups (P<0.05).Conclusion: 1.After the replacement of thoracic esophagus with nitinol alloy composite artificial esophagus, the measure of feeding regulation not only could effectively delay the time of artificial esophageal shedding, but also could provide the supporting time of three-dimensional space which was needed by constructing function of esophageal channel in neo-esophagus, furthermore, it played a role in prevention the neo-esophagus from stenosis. 2. The measure of feeding regulation could not change the histological structure of neo-esophageal tube wall fundamentally.