点击显示 收起
【摘 要】 目的：为带血供的骨膜肋间肌瓣食管成型术提供解剖学和形态学基础。方法：取10条犬的肋骨膜肌瓣标本，将其上的第7肋间血管灌注后观察分布情况。手术先切除部分第7肋骨，然后将保留的骨膜和上下肋间肌修整成一个带血管蒂的骨膜肌瓣。瓣长8.5～12.5 cm，宽4.5 cm，以此肌瓣修复1/2直径4 cm长的食管缺损。结果：带蒂的骨膜肌瓣由肋间动脉的两条主干分支供血，具有良好的血运。尽管处死犬检查手术修复部位轻度狭窄，但术后实验犬与正常犬在进食与活动上相同。结论：带血供的肋骨膜肌瓣是胸段食管成型的良好组织材料。
Applied anatomy and experimental study of esophagoplasty with osteoperio-intercostal muscle flap in dog
Zhang Xu, Wang Xiaoru, Zhang Chaoman, et al.
Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Chengde Medicle College, Chengde 067000
Objective: To provide anatomical and morphologic basis for the esophagoplasty with vascularized osteoperio-intercostal muscle flap in dogs.Methods: The seventh intercostal vessels of the pedicled flap was fixed and observed on 10 dog specimens.After a segment of the seventh rib on the right chest was removed, the left osteoperiost with connective muscles was cut into a pedicled flap, 8.5～12.5 cm long and 4.5 cm wide, which was used to repair the esophageal defect with 1/2 diameter and 4 cm long.Results: The pedicled flaps were supplied with rich vessels from two main branches of the seventh intercostal artery.The experimental animals were as same as the normal animals in diet and action although a little stricture was formed in the repaired region after operation.Conclusion: Ostoperio-intercostal muscle flap is a feasible donor for esophagoplasty in thorax.
Key words Esophagoplasty Osteoperio-intercostal muscle flap Surgical flap Canine
对于先天性食管狭窄、食管破裂、食管良性肿瘤等食管疾病，目前采用的治疗方法主要是食管成型。在保留部分食管壁的基础上进行的食管成型手术有数种，但其术式仍不完善，有必要进一步探讨。作者在郑和平等［1］人体带肋间血管肋骨瓣应用解剖研究的基础上，设计了骨膜肋间肌瓣食管成型术，实验取得了满意结果，报道如下：
1 材料和方法
1.1 骨膜肋间肌瓣的解剖学观察 采用成年杂种犬10条，处死后立即切开第7肋骨骨膜，完整剥离10 cm长，连同上下肋骨及肋间肌在胸椎关节处离断，将该骨肌瓣上的肋间动脉与静脉用10%赛璐璐加不同染料灌注，而后在手术显微镜下解剖并观察其血管分布。
1.2 骨膜肋间肌瓣食管成型术 实验1(垂直式)：右侧胸部侧方切口，显露第7肋骨。仔细完整地剥离骨膜，接近肋角处切除部分肋骨。沿第6肋下缘、第8肋上缘平行离断肋间肌，前方横断后形成一个带血管蒂的骨膜肌瓣，瓣长8.5 cm，平均宽度(4.5±0.2)cm。游离骨肌瓣对应部位食管，去除4 cm长，1/2周径的食管壁。将肋骨膜肌瓣与食管缺损部位对应，用1号丝线全层吻合。吻合后骨肌瓣与食管走行呈垂直相交状态。实验2(水平式)：肌瓣长12.5 cm，宽度、修复缺损范围同实验1(图1)。术后禁食5 d，2周后吃普食，进食后去除胸腔引流管。
A B C
A.修整的肋骨膜肌瓣 B.垂直式吻合 C.水平式吻合