Tissue reaction and injury after nitinol artificial esophagus replacement

doi:10.3969/j.issn.2095-4344.2013.51.017

Abstract

Abstract:

BACKGROUND: Previous experiment has confirmed that the nitinol artificial esophagus is an artificial succedaneum which can be used for replacing an esophagus resected and rebuilding esophageal tube.
OBJECTIVE: To observe the tissue reaction of the neo-esophagus and the adjacent organs injury contacted with the nitinol artificial esophagus after replacement.
METHODS: Eight miniature pigs were selected and modeled by resection of a 70 mm segment of the thoracic esophagus. After modeling, the nitinol artificial esophagus was inserted into the proximal and distal end of the thoracic esophagus at an insert distance of about 10 mm. After that, the nitinol artificial esophagus with polyester connecting ring was sewed into the thoracic esophagus in a manner of full-thickness anastomosis. After operation, the pigs were subjected to feeding regulation measures to control the shedding time of the artificial esophagus. Two model pigs were sacrificed for anatomical observation at 1, 2, 3, 4 months postoperatively, respectively. The tissue reaction during the neo-esophagus formed procedure and adjacent organs injury contacted with the nitinol artificial esophagus were observed.
RESULTS AND CONCLUSION: All pigs survived without complications such as thoracic hemorrhage, pneumothorax, pyothorax, esophageal perforation and anastomotic leakage. The experimental animals with the nitinol artificial esophagus fixed in situ had no dysphagia for eating semisolids food (Bown’SⅡ). Autopsy findings showed that there was slight membrane-like adhesion between partial pleura and lung. No hydrothorax was found. The nitinol artificial esophagus was wrapped up by the neo-esophagus. There was slight membrane-like adhesion between the neo-esophagus and the adjacent organs such as the lung, aorta and esophageal mucosa. The esophageal mucosa covered the neo-esophageal entocoele from esophageal stumps to intermedius of neo-esophagus until completely covered. Histological findings of the neo-esophagus showed that in imbed cycle of the nitinol artificial esophagus the tissue reaction showed aseprtic inflammation reaction and foreign body reaction around the implant. These tissue reactions were most severe at 1 month after operation and thereafter relieved gradually.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: biocompatible materials, alloys, esophagus, soft tissue injuries

CLC Number:

R318

Liang Xian-liang, Liang Jian-hui, Xue Ping, Lin Jing-tai, Zhou Xing. Tissue reaction and injury after nitinol artificial esophagus replacement[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(51): 8887-8893.

Figures/Tables 4

大体解剖：在解剖观察各个时间点的解剖差异没有本质上的不同，仅是壁层胸膜与肺等邻近器管粘连紧密程度，分离粘连难易和新生食管管壁的厚薄有些差异，如术后时间越早，粘连越轻，分离粘连越容易，新生食管管壁越薄；术后时间越晚，粘连越重，分离粘连越困难，新生食管管壁越厚。新生食管腔内黏膜生长及覆盖情况：新生食管腔内术后1个月，正常食管残端两側食管黏膜终止于两端的涤纶连接环平面处，镍钛合金人工食管插入部分与正常食管残端黏膜接触部位未见黏膜糜烂、溃疡，两端涤纶连接环中间管体与新生食管管体肉芽组织紧密相嵌连接。新生食管腔内术后2个月，明显可见再生的食管黏膜从正常食管残端两側向新生食管中央呈片段性生长延伸，部分覆盖新生食管管腔。术后3个月，新生食管片段性再生黏膜相互融合连接，覆盖大部分新生食管，黏膜覆盖区新生食管管壁与植入管体呈现逐步分离。术后4个月，新生食管腔内几乎被再生食管黏膜完全覆盖。植入管体与新生食管管壁也呈现完全分离，见图3。镍钛合金人工食管替代食管植入周期内的新生食管组织反应表现为炎症反应，以术后1个月组织反应最为严重，新生食管组织由炎症细胞，主要以异物巨细胞、单核/巨噬细胞为主，伴有淋巴细胞、嗜中性粒细胞浸润，构成异物炎性肉芽组织组成。随后在术后2，3，4个月组织炎症反应逐步减轻，第4个月炎症反应的淋巴细胞、中性粒细胞基本消失，但异物巨细胞、巨噬细胞、单核细胞却伴随着植入体的存在而一直持续存在；在这过程中伴随有成纤维细胞出现，产生越来越多的胶原纤维和成纤维细胞转变为少量纤维细胞，异物炎性肉芽组织转变为包裹植入体的纤维结缔组织层，见图4，5。"

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