OBJECTIVE: To compare the effect of several types of rib rings with intercostal muscles for the replacement of trachea in thorax. METHODS: The surface layer of the third rib of dogs were ripped off and curved into triangular, quadrilateral and polygonal form. These three types of rib rings with intercostal muscles were used to replace a segment of trachea in thorax. RESULTS: The stability of triangular rib ring was very well, but stricture of ring were often happened because of its smaller internal diameter. These stability of quadrilateral rib ring was the worst. The polygonal rib ring presented the biggest diameter and good stability compared to the other two kinds of rings. If silicone tube was supplemented in the polygonal rib ring, the quality of artificial trachea was excellent. CONCLUSION: The rib rings with intercostal muscles are successfully used for replacing the defect of trachea in canine thorax. The polygonal rib rings have the best quality in the three types of rib ring for tracheal replacement.
Tissue engineering trachea is an artificial trachea with biological activity, which is constructed in vitro by using tissue engineered principle and technology, and is a tracheal prosthesis for replacing large circumferential defect of the trachea. The course of its construction is as follows. First, seeding cells are cultured and expanded in vitro. Then they are collected, counted and seeded onto the biomaterial scaffold of tissue consistent and biodegradation. Finally, the biomaterial-cells construction is implanted into bio-reaction device or one’s subcutaneous layer. The tissue engineering trachea could be constructed after cultured certain times. Compared with other artificial trachea, the tissue engineering trachea has more advantages, such as nonimmunogenicity, no side-effects related to foreign graft materials, and biologic activity. This will bring some hope to look for an appropriate graft material. However, the study about it is still faced with some difficult problems, such as vascularized trachea, culturing in vitro, and prevention of infection in trachea prosthesia. So there will be long time for tissue engineering trachea to apply clinical tracheal transplantation successfully. This assay has reviewed the study about tissue engineering trachea from three sides——the source of seeding cells, the research about biomaterial scaffold, and the construction of tissue engineering trachea.
Objective To investigate the feasibility of bacterial cellulose patch to repair and reconstruct rabbit tracheal defect, so as to lay the foundation for the development of bacterial cellulose artificial trachea. Methods Thirty adult rabbits (weighing, 2.5-3.5 kg) were selected to establish full-thickness defect of the cervical trachea (1.0 cm×0.6 cm in size) which involved the anterior and side walls and 2-3 rings. Defect was repaired with sheet bacterial cellulose (1.2 cm in diameter and 6 layers) in experimental group (n=15), and with autologous cervical fascia in control group (n=15). The general condition of the animals was observed after operation; after 4, 8, and 12 weeks, the samples were obtained for measuring the tracheal stenosis degree, counting new microvessels, and observing lumen reconstruction situation by scanning electron microscope. Results Three rabbits died of infection, tracheal stenosis, or asphyxia caused by airway secretions retention in 2 groups respectively, and the other rabbits survived to the end of experiment. Gross observation showed that reconstruction materials gradually adhered to adjacent tissue and were enwrapped by connective tissue, small blood vessels like nutrient vessel were seen in 2 groups; no significant difference was found in the tracheal lumen stenosis degree between 2 groups (P > 0.05). Histological observation showed that the continuous growth of mucosal epithelial cells was observed near patch and anastomosis site with time, and cell morphology gradually turned mature in experimental group; while mucosal epithelial cells arranged loosely in control group. At each time point, new capillaries of experimental group were significantly more than those of control group (P < 0.05). Scanning electron microscope observation showed the continuous epithelioid cells were observed at anastomosis site with time, and gradually grew into the middle of the patch in experimental group; while less and discontinuous epithelioid cells were observed in control group. Conclusion Bacterial cellulose patch is feasible to reconstruct cervical tracheal defect in rabbits, and the new mucosa is formed early and completely, so it is expected to be used as artificial trachea material.
ObjectiveTo evaluate the difference between the tracheal intubation connected to conventional ventilation (TI-CV) and rigid bronchoscopy connected to high frequency ventilation (RB-HFV) under general anesthesia on patients with transbronchial cryobiopsy (TBCB).MethodA prospective, randomized, controlled trial was conducted in interstitial lung disease patients with TBCB from August 2018 to February 2019 in the First Affiliated Hospital of Guangzhou Medical University. According to the different methods of intubation, the patients were divided to a TI-CV group and a RB-HFV group randomly. The operating duration, extubation duration, total anesthesia time, heart rate, blood pressure and arterial blood gas analysis were collected and analyzed.ResultsSixty-five patients were enrolled. There were 33 patients with an average age of (48.0±15.0) years in TI-CV group and 32 patients with an average age of (48.8±10.8) years in RB-HFV group. The basic line of body mass index, pulmonary function (FEV1, FVC and DLCO), arterial blood gas (pH, PaO2 and PaCO2) and heart rate (HR), mean arterial pressure (MAP) had no significant differences between two groups. At the first 5 minutes of operation, the pH was (7.34±0.06) and (7.26±0.06), and the PaCO2 was (48.82±9.53) and (62.76±9.80) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P=0.000). At the end of operation, the pH was (7.33±0.06) and (7.21±0.08), the PaCO2 was (48.91±10.49) and (70.93±14.83) mm Hg, the HR were (79.6±21.1) and (93.8±18.7) bpm, the MAP were (72.15±13.03) and (82.63±15.65) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P<0.05). There were no differences in the operating duration and extubation duration between two groups. The total anesthesia time was (47.4±8.8) and (53.3±11.6) min with significant difference (P=0.017). Five minutes after the extubation, there were no significant difference in the pH, PaO2, PaCO2, HR and MAP between two groups. No serious complications occurred in either group.ConclusionsCompared with rigid bronchoscopy, TI-CV under general anesthesia is more conducive to maintain effective ventilation, and maintain the HR and MAP stable during the TBCB procedure. TBCB procedure should be performed by TI-CV under general anesthesia in patients with poor cardiopulmonary function.
ObjectiveTo investigate the clinical features of primary tracheal or pulmonary malignant glomus tumor (MGT).MethodsA patient with primary tracheal MGT was reported. Wanfang, CNKI, Embase, Ovid, Cochrance and PubMed databases were searched with key words "tracheal malignant glomus tumor" and " pulmonary malignant glomus tumor” both in English and in Chinese for literature of primary tracheal or pulmonary MGT. Their clinical manifestations, imaging findings, bronchoscopic findings, pathological findings, especially immunohistochemical characteristics, diagnosis and differential diagnosis, treatment, and prognosis of primary tracheal or pulmonary MGT were summarized.ResultsThis male patient who manifested as cough, chest tightness, shortness of breath and dyspnea was diagnosed as tracheal MGT and received a treatment of radiofrequency ablation and cryotherapy under bronchoscopy. He refused to receive the chemotherapy and died after two months with a lung metastases. A total of 17 cases of primary tracheal or pulmonary MGT were retrieved in 16 articles, of which 5 were primary in the trachea and 12 were primary in the lung. Their clinical manifestations, imaging findings, and bronchoscopic findings were non-specific. The diagnosis relied on pathology, especially immunohistochemical staining. The preferred treatment of tracheal MGT may be surgical resection, the prognosis was acceptable. Treatment of lung MGT included lobectomy or airway interventional treatment and its prognosis was poor. The treatment of primary tracheal or pulmonary MGT needed early treatment. Because the curative effect of airway interventional treatment and chemotherapy was dubious, surgical plan should be first considered.ConclusionsBoth of primary tracheal and primary pulmonary MGT are rare. They usually lack specific clinical manifestations, laboratory tests, and imaging, and are easy to be misdiagnosis or miss diagnosis. The diagnosis can be confirmed by the results of biopsy for pathological analysis, especially by the immunohistochemical staining analysis. The treatment of tracheal and pulmonary MGT need further study.
Objective To summarize the clinical experiences in treating primary tracheal tumors by surgery, so as to improve the results of surgical treatment. Methods The clinical data concerning 22 surgically treated patients were retrospectively analyzed. Four patients tumor were benign and eighteen cases’s tumor was malignant. Tracheal resections and end to end anastomosis were performed in 14 cases, carinal resection was performed in 4 cases, lateral tracheal wall resection was performed in 1 case, local scrape were performed in 2 cases, tumor was resected transfiberoptic bronchoscopy in 1 case. Tracheal resectable length was from 2.0cm to 5.2cm，and the average resectable length was 3.8cm in operation. Results 17 cases had been misdiagnosised ( 77.3%) in outpatient department. It was easy to be misdiagnosised as asthma. One case died of respiratory failure after operation in 30 days. The complication rate was 31.8%, complications consist of pneumonia in 4 cases, anastomosis leakage in 1 case and chylothorax in 2 cases. Anastomosis stenosis was found in 3 cases, the syndromes were improved after treatment.Twenty cases were followed up from 1 month to 8 years. Four cases with benign tumors were still alive. Among 16 cases with malignant tumors, 6 cases had survived more than 5 years， 3 cases died of brain, liver, bone metastasis of malignant tumors. Conclusion Surgical resection is the most effective treatment of tracheal tumors. Tracheal resection and reconstruction is the main choice of primary tracheal tumors treatment. Benign tumors can be resected conservatively. The reductions of operative complications are the key points of good surgical results. To know the characteristic of primary tracheal tumors well can reduce the misdiagnosis rate.
Objective To investigate change of bispectral index(BIS) and hemodynamic index during induction and orotracheal intubation of sevoflurane anesthesia. Methods This study was a prospective before-after study in the same patients. A total of 30 ASA physical status I and II adult patients without airway abnormalities were enrolled to receive inhalation induction of anesthesia with 8% sevoflurane. Mean arterial pressure(MAP),heart rate(HR) and BIS were recorded before anesthesia(T1),when patients loss of consciousness(T2), before intubation (T3),at 1 min(T4) and 3 min(T5) after intubation. Results BIS at T1-T5 were 96.8±1.7,70.4±8.8,39.2±8.4,43.6±12.9 and 41.6±9.3 respectively, the measurements at T2-T5 were all markedly lower than at T1(Plt;0.05). HR at T3-T5 were all markedly higher than at T1(Plt;0.05). MAP at T2 and T3 were markedly lower than at T1, but at T4 was higher than at T1(Plt;0.05), and recovered to the level at T1 at T5(Pgt;0.05).BIS,HR and MAP at T4 were all significantly higher than T3(Plt;0.05). Conclusion Anesthesia induction with sevoflurane and small dose of succinylchoiline we used can provide adequate depth of general anesthesia,but can not prevent cardiovascular adverse reactions to intubation.
Patients with pathological tracheal loss more than a certain length may need tracheal transplantation.Traditional natural tissue and autologous tissue have failed to produce satisfactory clinical outcomes to replace the trachea because of local infection，tracheal stenosis，tracheomalacia，immune rejection et al. In recent years，the emergence oftissue engineering trachea provides a new idea for tracheal transplantation. But scientists have not yet reached a consensus about how to choose ideal extracellular matrix to construct tissue engineering trachea. At present research and applicationof tissue engineering trachea，extracellular matrices mainly include allogenic trachea，allogenic aorta and biologicalcomposite materials. Each allogenic matrix or biological composite material has its own advantages and disadvantages. Therefore，this article mainly summarizes recent application and research progress of extracellular matrix in long segmental tracheal defect and its future perspective.
ObjectiveTo improve the knowledge of primary tracheobronchial lymphoma.MethodsTwo patients with primary tracheobronchial lymphoma admitted to First Affiliated Hospital Guangxi Medical University in 2013 and in 2016 were analyzed retrospectively, and related literatures were reviewed. Chinese National Knowledge Infrastructure, Wanfang database and VIP database were searched by using " trachea lymphoma” or " bronchus lymphoma” as keywords. Meanwhile, databases including PubMed, Ovid Medline and Embase database were retrieved with " Trachea” or " Bronchus” AND " Lymphoma” as keywords. Seventy-two cases of primary tracheobronchial lymphoma were reported, the clinical feature, imaging feature, pathological feature, treatment and prognosis of 72 cases were analyzed.ResultsThe two patients were both females. The chief complaints included cough and dyspnea. The tissue biopsy under bronchoscope was the main diagnostic method. On histopathology, one case was diagnosed grade B cell lymphoma, another was diagnosed mantle cell lymphomas. After chemotherapy, the symptoms were relieved and never relapsed in the follow-up period until October 2016. Literature review found 72 patients with primary tracheobronchial lymphoma with women being the majority (47 cases, 65.28%). The patients aged from16 to 82 years with a median age of 51 years, and nine cases (12.5%) of the patients aged from 16 to 30 years. The specific clinical symptoms were cough and dyspnea. Pulmonary function prompted obstructive dysfunction of pulmonary ventilation. The chest CT scan showed consolidation shadow in trachea and bronchus with or without pulmonary atelectasis. Neoplasms could be found by bronchoscopy. Mucosa-associated lymphoid tissue (MALT) lymphoma was the most common pathological characteristic (36.11%). Mantle cell lymphomas has not been reported currently.ConclusionsPrimary tracheobronchial lymphoma is one of the rare airway tumors. Its clinical features, imaging examinations and bronchoscopic characteristics are not specific, which can be easily confused with lung cancer. It also can cause life-threatening airway obstruction. The bronchoscopy play an important role in diagnosis of primary tracheobronchial lymphoma, while the diagnosis is confirmed by histopathological examination. The main pathology type is MALT lymphoma. The prognosis is good.
In vivo transplantation of tracheal grafts utilizes natural environment in vivo to improve cell adhesion, growth and scaffold properties, which can not only promote graft revascularization, but also induce immune tolerance and increase postoperative survival rate. Decellularized trachea with stem cells covering the outside layer and airway epithelial cells covering the inside layer can achieve complete mucosa re-epithelialization, cartilage cell growth and revascularization, using own body as a natural bioreactor to boost the maturity of tissue engineered trachea. Then transplantation at a normotopic in situ positioning is performed. This transplantation strategy provides a promising approach for the treatment of long-segment tracheal defects. This review focuses on the significance and research progress of constructing tissue engineered trachea in vivo.