中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (53): 9943-9948.doi: 10.3969/j.issn.1673-8225.2011.53.016

• 细胞与组织移植 cell and tissue transplantation • 上一篇    下一篇

同种异体犬分期喉移植再造的可行性

姜  彦1，董  频2，李  娜1，李晓艳2，徐宏鸣2，张念凯1   

  1. 1青岛大学医学院附属医院耳鼻咽喉头颈外科，山东省青岛市  266003
    2上海交通大学附属上海市第一人民医院耳鼻咽喉头颈外科，上海市  200080
  • 收稿日期:2011-06-25 修回日期:2011-10-28 出版日期:2011-12-31 发布日期:2011-12-31
  • 作者简介:姜彦☆，男，1974年生，山东省兖州市人，汉族，2008年上海交通大学毕业，博士，主治医师，主要从事头颈部肿瘤/鼻科学研究。
  • 基金资助:

    上海市科委重点项目(0541195)“喉再造研究”；中国博士后科学基金(20110491558)“复合BMSCs的经等离子体处理PLGA导管修复大鼠喉返神经的研究”。

Feasibility of staged allogeneic larynx transplantation in dogs

Jiang Yan1, Dong Pin2, Li Na1, Li Xiao-yan2, Xu Hong-ming2, Zhang Nian-kai1   

  1. 1Department of Otolaryngology Head and Neck Surgery, the Affiliated Hospital of Medical College Qingdao University, Qingdao  266003, Shandong Province, China
    2Department of Otolaryngology Head and Neck Surgery, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai  200080, China
  • Received:2011-06-25 Revised:2011-10-28 Online:2011-12-31 Published:2011-12-31
  • About author:Jiang Yan☆, Doctor, Attending physician, Department of Otolaryngology Head and Neck Surgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, Shandong Province, China jiangyanoto@yahoo.com.cn
  • Supported by:

    the Key Project of Shanghai Science and Technical Committee, No. 0541195*; Science Foundation for Post Doctorate Research of China, No. 20110491558*

PDF

389

被引次数

2

摘要：

背景：控制感染是保证喉移植成功的关键。在实践中应探索如何最低限度地减少感染，使重建血运后的供体喉在免疫抑制状态下先成活，之后再恢复喉的呼吸、吞咽、发音功能。
目的：为减少感染，探讨采用分期移植方法进行同种异体喉移植的可行性。
方法：根据体质量、喉体大小将10只雄性同种比格犬配对成5组供受体，采用异体喉移植方式，埋置在受体犬颈部皮下，每日应用免疫抑制剂抗机体免疫排斥，待喉体成活后再将供体喉与受体分别行咽部、气管对位吻合，建立Ⅱ期喉移植动物模型。
结果与结论：Ⅰ期喉植入后，供喉生存良好，血运可。颈部纵切口的1号和颈部横切口的4，5号犬伤口生长良好，4，5号供喉未发生感染现象，最长可至4周后行Ⅱ期再植；U形切口的2，3号犬皮瓣坏死，供喉不同程度发生感染，2号喉坏死，3号经处理后喉存活。供喉在受体内生存最长可达4周。提示将喉移植分期进行，供喉摘除后预埋置法模式可以避免、减少移植后的喉体感染，受体犬耐受，供喉易成活，可以进行Ⅱ期的喉再造。移植后的主要组织学变化是黏膜上皮的改变，可以此作为观察免疫抑制反应的指标。需要处理的是埋置喉的腺体分泌问题，免疫抑制剂必须连续长期应用。

关键词: 喉肿瘤, 感染, 器官移植, 分期, 再植

Abstract:

BACKGROUND: The key to success in laryngeal transplantation is to control the infection. In practice, how to minimize the risk of infection should be considered first, so that the laryngeal allograft can survive after revascularization under the immunosuppressive state. Then the therapeutics methods should be focused on the functional recovery of respiratory, swallowing and phonation.
OBJECTIVE: To explore the feasibility of staged allogeneic larynx transplant for dogs in order to decrease the infection rate.
METHODS: Ten male conspecific Beagle dogs were assigned into five pairs of donor and receptor according to body mass and the size of larynx. The allogeneic larynx was embedded under the neck skin by allotransplantation. The dogs were treated with immunosuppressant daily to resist immnological rejection. The pharynx and trachea were contraposed after larynx survived to establishⅡstage laryngeal transplantation animal model.
RESULTS AND CONCLUSION: InⅠstage of laryngeal transplantation, the laryngeal allograft survived well, blood supply was passable. Receptor dog 1 with vertical midline incision in the neck, receptor dogs 4 and 5 with transverse incisions in the neck grew well. No infection phenomena was found in receptor dogs 4 and 5. The lastⅡstage laryngeal transplantation was performed in the 4th week afterⅠstage laryngeal transplantation. Skin flap necrosis occurred in receptor dogs 2 and 3 with U-shape incisions. The donor larynx had different degree infection. Laryngeal allograft of receptor dog 2 died; laryngeal allograft of receptor dog 3 survived after treatment. The survival period of donor larynx in receptors was as long as 4 weeks. These findings indicate that the larynx infection is avoid or reduced by staged larynx transplantation with pre-embed laryngeal allograft after total laryngectomy. The receptor dog is tolerant; the donor larynx is easy to survive. The main histological change occurs in the epithelial mucosae which can be used as an inspect index of immunosuppressive agents. However, glandular organ secretion is a troublesome problem and immunodepressant must be continuously administrated for a long time.

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