LONG-SEGMENTAL TRACHEA REPLACEMENT USING NICKEL-TITANIUM ALLOY STENT WRAPPED WITH AUTOLOGOUS PERICARDIUM_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUOYuekui ¹ , GUOPengming ¹ , LIBin ² , SONGTieniu ² , YULixin ³ ,  ZHANGJianhua ² , WANGCheng ² , JIANGPeng ²

1. The Second Clinical Medical College of Lanzhou University, Lanzhou Gansu, 730030, P. R. China;
2. Department of Thoracic Surgery, Lanzhou University Second Hospital;
3. Department of Anesthesia, Lanzhou University Second Hospital;

Corresponding author：

ZHANGJianhua, Email: 972659434@qq.com

Keywords：

Trachea injury; Pericardium; Nickel-titanium alloy stent; Tracheal reconstruction; Tracheal epithelium; Pig

DOI：

10.7507/1002-1892.20150304

Video：

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Objective To perfect the surgical process that trachea could be reconstructed by nickel-titanium (Ni-Ti) alloy stent wrapped with autologous pericardium, and to evaluate the effectiveness and observe the complications. Methods In the experiment, twelve healthy Bama suckling pigs with weight of 18-25 kg were selected. The pericardium was harvested to cover the Ni-Ti alloy stent. The compound artificial trachea was used to reconstruct long-segmental (6 cm) trachea defect. The effectiveness, complications, the properties, and growth rate of the new mucosa of the artificial trachea lumen were observed. Results Of 12 pigs, 2 died soon because of hemorrhage and infection, respectively; 7 died at 2-4 months after operation because of hyperplasia at the middle section and blockage of phlegm plug; 3 survived after 42 weeks postoperatively, but accompanied with dyspnea symptom. At 1, 2, 3, 4, and 5 months after operation, the average crawl length of the new trachea mucosa was 1, 3, 5, 7, and 10 mm, respectively; the occurrence rates of anastomotic stenosis were 0 (0/10), 0 (0/9), 0 (0/4), 33.3% (1/3), and 33.3% (1/3) respectively; and the occurrence rates of scar hyperplasia in the middle of lumen were 20% (2/10), 66.7% (6/9), 75.0% (3/4), 66.7% (2/3), and 100% (3/3), respectively. At 7 months postoperatively, the bronchoscopy examination showed that the scar in central part of artificial trachea had the trends of stagnation, softening, and narrowing, and respiratory symptom had the trend of slight ease. Hyperplasia tissue could be found in central part of artificial trachea by autopsy and was verified to be fiber cells and necrotic tissue by pathology examination. Conclusion Ni-Ti alloy stent with autologous pericardium can insure that the reconstructed tracheal lumen is unobstructed, and support the trachea epithelium regeneration; the main factors of the death of the experimental animals are the lumen hyperplasia of the artificial trachea and the blockage of the secondary phlegm plug.

Citation： LUOYuekui, GUOPengming, LIBin, SONGTieniu, YULixin, ZHANGJianhua, WANGCheng, JIANGPeng. LONG-SEGMENTAL TRACHEA REPLACEMENT USING NICKEL-TITANIUM ALLOY STENT WRAPPED WITH AUTOLOGOUS PERICARDIUM. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1419-1422. doi: 10.7507/1002-1892.20150304 Copy

1.	Bacon JL, Patterson CM, Madden BP. Indications and interventional options for non-resectable tracheal stenosis. J Thorac Dis, 2014, 6(3):258-270.
2.	Grillo HC. Tracheal replacement:a critical review. Ann Thorac Surg, 2002, 73(6):1995-2004.
3.	赵衍. 人工气管重建气管的研究进展. 中华心胸血管外科杂志, 2004, 20(2):65-66.
4.	王嵩, 史宏灿. 人工气管研究进展. 中国修复重建外科杂志, 2011, 25(3):365-368.
5.	Ch'ng S, Wong GL, Clark JR. Reconstruction of the trachea. J Reconstr Microsurg, 2014, 30(3):153-162.
6.	Chang JW, Park SA, Park JK, et al. Tissue-engineered tracheal reconstruction using three-dimensionally printed artificial tracheal graft:preliminary report. Artif Organs, 2014, 38(6):E95-E105.
7.	Serrano C, Lostalé F, Rodríguez-Panadero F, et al. Tracheal selfexpandable metallic stents:a comparative study of three different stents in a rabbit model. Arch Bronconeumol, 2015.[Epub ahead of print].
8.	Haykal S, Salna M, Waddell TK, et al. Advances in tracheal reconstruction. Plast Reconstr Surg Glob Open, 2014, 2(7):e178.
9.	王晓明, 许林海, 孙高忠, 等. 大鼠心包膜组织对其缺血心肌的保护和再生作用. 中华医学杂志, 2011, 91(42):3012-3015.
10.	姜格宁, 丁嘉安, 张鹏, 等. 心包加镍钛记忆合金支架气管置换术. 中华胸心血管外科杂志, 2005, 21(5):313.
11.	Nassiri N, Yu A, Statkus N, et al. Imaging of cardiac herniation in traumatic pericardial rupture. J Thorac Imaging, 2009, 24(1):69-72.
12.	Makris D, Holder-Espinasse M, Wurtz A, et al. Tracheal replacement with cryopreserved allogenic aorta. Chest, 2010, 137(1):60-67.
13.	Kim J, Suh SW, Shin JY, et al. Replacement of a tracheal defect with a tissue-engineered prosthesis:Early results from animal experiments. J Thorac Cardiovasc Surg, 2004, 128(1):124-129.
14.	Neville WE, Bolanowski JP, Kotia GG. Clinical experience with the silicone tracheal prosthesis. J Thorac Cardiovasc Surg, 1990, 99(4):604-613.
15.	刘文亮, 肖鹏, 梁恒星, 等. 新复合型人工气管移植实验研究. 中国修复重建外科杂志, 2013, 23(3):330-334.
16.	Bujia J, Wilmes E, Hammer C. Immunologic behavior of human tracheal transplants. Laryngorhinootologie, 1992, 71(7):353-358.
17.	Jacobs JP, Elliott MJ, Haw MP, et al. Pediatric tracheal homograft reconstruction:a novel approach to complex tracheal stenoses in children. J Thorac Cardiovasc Surg, 1996, 112(6):1549-1560.
18.	纪子钊, 陈刚, 张苏宁, 等. 记忆合金材料弹力金属支架在犬肺组织瓣重建气管缺损中的应用. 中国组织工程与临床康复, 2011, 15(51):9549-9552.
19.	赵雪柠, 从波, 刘大昱, 等. 聚丙烯网状材料与颈前皮瓣联合重建气管的实验研究. 中国耳鼻喉头颈外科杂志, 2008, 43(7):533-536.
20.	曹子昂, 顾旭东, 林海平, 等. 自体心包包裹人工气管修复气管缺损的组织相容性评估. 中国组织工程研究与临床康复, 2008, 12(14):2645-2647.
21.	Schultz P, Vautier D, Dupret-Bories A, et al. Replacement of the trachea using surgical reconstruction:current state of research. Ann Otolaryngol Chir Cervicofac, 2009, 126(5-6):272-277.
22.	郭启勇, 常钢, 刘兆玉, 等. 气管内留置螺旋状金属内支架的基础研究. 中华放射学杂志, 1997, 29(7):484-487.
23.	郝可可, 于力克. 经支气管镜冷冻治疗气管支架管腔内再狭窄. 临床肺科杂志, 2004, 10(1):101.
24.	刘兆玉, 郎旭, 卢再鸣, 等. 实验犬留置不同类型气管支架的基础研究. 介入放射学杂志, 2007, 16(7):485-488.

1. Bacon JL, Patterson CM, Madden BP. Indications and interventional options for non-resectable tracheal stenosis. J Thorac Dis, 2014, 6(3):258-270.
2. Grillo HC. Tracheal replacement:a critical review. Ann Thorac Surg, 2002, 73(6):1995-2004.
3. 赵衍. 人工气管重建气管的研究进展. 中华心胸血管外科杂志, 2004, 20(2):65-66.
4. 王嵩, 史宏灿. 人工气管研究进展. 中国修复重建外科杂志, 2011, 25(3):365-368.
5. Ch'ng S, Wong GL, Clark JR. Reconstruction of the trachea. J Reconstr Microsurg, 2014, 30(3):153-162.
6. Chang JW, Park SA, Park JK, et al. Tissue-engineered tracheal reconstruction using three-dimensionally printed artificial tracheal graft:preliminary report. Artif Organs, 2014, 38(6):E95-E105.
7. Serrano C, Lostalé F, Rodríguez-Panadero F, et al. Tracheal selfexpandable metallic stents:a comparative study of three different stents in a rabbit model. Arch Bronconeumol, 2015.[Epub ahead of print].
8. Haykal S, Salna M, Waddell TK, et al. Advances in tracheal reconstruction. Plast Reconstr Surg Glob Open, 2014, 2(7):e178.
9. 王晓明, 许林海, 孙高忠, 等. 大鼠心包膜组织对其缺血心肌的保护和再生作用. 中华医学杂志, 2011, 91(42):3012-3015.
10. 姜格宁, 丁嘉安, 张鹏, 等. 心包加镍钛记忆合金支架气管置换术. 中华胸心血管外科杂志, 2005, 21(5):313.
11. Nassiri N, Yu A, Statkus N, et al. Imaging of cardiac herniation in traumatic pericardial rupture. J Thorac Imaging, 2009, 24(1):69-72.
12. Makris D, Holder-Espinasse M, Wurtz A, et al. Tracheal replacement with cryopreserved allogenic aorta. Chest, 2010, 137(1):60-67.
13. Kim J, Suh SW, Shin JY, et al. Replacement of a tracheal defect with a tissue-engineered prosthesis:Early results from animal experiments. J Thorac Cardiovasc Surg, 2004, 128(1):124-129.
14. Neville WE, Bolanowski JP, Kotia GG. Clinical experience with the silicone tracheal prosthesis. J Thorac Cardiovasc Surg, 1990, 99(4):604-613.
15. 刘文亮, 肖鹏, 梁恒星, 等. 新复合型人工气管移植实验研究. 中国修复重建外科杂志, 2013, 23(3):330-334.
16. Bujia J, Wilmes E, Hammer C. Immunologic behavior of human tracheal transplants. Laryngorhinootologie, 1992, 71(7):353-358.
17. Jacobs JP, Elliott MJ, Haw MP, et al. Pediatric tracheal homograft reconstruction:a novel approach to complex tracheal stenoses in children. J Thorac Cardiovasc Surg, 1996, 112(6):1549-1560.
18. 纪子钊, 陈刚, 张苏宁, 等. 记忆合金材料弹力金属支架在犬肺组织瓣重建气管缺损中的应用. 中国组织工程与临床康复, 2011, 15(51):9549-9552.
19. 赵雪柠, 从波, 刘大昱, 等. 聚丙烯网状材料与颈前皮瓣联合重建气管的实验研究. 中国耳鼻喉头颈外科杂志, 2008, 43(7):533-536.
20. 曹子昂, 顾旭东, 林海平, 等. 自体心包包裹人工气管修复气管缺损的组织相容性评估. 中国组织工程研究与临床康复, 2008, 12(14):2645-2647.
21. Schultz P, Vautier D, Dupret-Bories A, et al. Replacement of the trachea using surgical reconstruction:current state of research. Ann Otolaryngol Chir Cervicofac, 2009, 126(5-6):272-277.
22. 郭启勇, 常钢, 刘兆玉, 等. 气管内留置螺旋状金属内支架的基础研究. 中华放射学杂志, 1997, 29(7):484-487.
23. 郝可可, 于力克. 经支气管镜冷冻治疗气管支架管腔内再狭窄. 临床肺科杂志, 2004, 10(1):101.
24. 刘兆玉, 郎旭, 卢再鸣, 等. 实验犬留置不同类型气管支架的基础研究. 介入放射学杂志, 2007, 16(7):485-488.

Chinese Journal of Reparative and Reconstructive Surgery

LONG-SEGMENTAL TRACHEA REPLACEMENT USING NICKEL-TITANIUM ALLOY STENT WRAPPED WITH AUTOLOGOUS PERICARDIUM

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