大鼠喉同种异种移植术后组织学观察

为探讨大鼠同种异体喉移植免疫排斥反应发生的时间和发展过程，其实施大鼠喉移植术３１只，其中对照组（ｎ＝１３）；供，受体均为封闭群ＳＤ大鼠，属同系喉移植术。实验组（ｎ＝１８）；供体为封闭群ＳＤ大鼠，受体为Ｗｉｓｔａｒ大鼠，属同种异体移植术。免疫排斥反应开始于术后第３天，表现为受体颈部皮肤肿胀，淋巴结肿大，７天后颈部皮肤硬肿显著，移植物组织水肿，逐渐被纤维结缔组织包裹。相应的组织学变化特点是：术后第３天     

同种异体大鼠喉异位移植模型急性排斥反应的研究

目的 动态观察Wistar大鼠喉异位移植至SD大鼠模型排斥反应的规律,探讨该模型对喉移植排斥反应的研究价值.方法选用Wistar和SD大鼠,根据Strome方法建立异位喉移植模型.依照术后环孢霉素A应用的不同,分为免疫抑制组和排斥观察组、每组供、受体大鼠各18只.于术后第3、7、11天取各组大鼠移植喉进行大体组织观察及病理学检查.观察急性排斥反应的程度.结果 ①免疫抑制组术后各时间点的临床表明及肉眼观察无明显差异,而术后第3天移植喉组织病理改变呈非特异性炎症反应.术后第7、11天移植喉与正常喉的组织学特征基本相同;②排斥观察组术后第3、7、11天移植喉的组织病理改变分别呈轻、中、重度排斥反应.移植喉不同组织层面排斥反应表现有序贯性,黏膜上皮及黏膜下层组织较肌肉及软骨组织排斥反应发生早,反应程度重.结论 喉黏膜组织具有较强烈的组织抗原性.wistar大鼠喉异位移植至SD大鼠模型轻、中、重三个层次排斥反应特点鲜明,适用于喉移植排斥反应免疫机制的研究.     

不同方法处理同种异体肋软骨的组织学改变

目的采用不同方法对家兔肋软骨进行处理,观察移植后的组织学改变,旨在比较几种方法的优劣.方法用60Co照射、酒精浸泡、冷冻等3种方法处理的同种肋软骨对40只家兔进行移植,12周后取软骨连续组织切片,光镜下观察并进行综合评价.结果组织学反应以炎细胞浸润、坏死、血管反应及纤维组织增生为主.经统计学处理,3种方法在坏死及炎细胞浸润两种组织学改变中的差异有显著意义（P＜0.05）.结论①本组实验60Co照射组软骨坏死的阳性率最低;②机体对同种异体肋软骨产生不同程度的排斥反应,且个体差异较大,与处理方法有关;③移植的同种异体肋软骨中伴纤维组织增生占50%左右,提示移植肋软骨在体内可能被宿主的纤维结缔组织所代替,可以维持形态.     

用组织培养的同种异体软骨进行喉重建的实验研究

目的　观察用组织培养法保存的兔活性甲状软骨进行同种异体喉软骨移植重建的效果。方法　先取大小约 5mm× 2mm× 1mm兔甲状软骨块 ,分别用RPMI - 1640培养液及 4 %甲醛保存 2 0d ,然后将两种方法保存的软骨块同时移植于同一兔甲状软骨板中线两侧缺损处 ,培养软骨置于左侧 ,甲醛保存软骨置于右侧 ,分别于 7d、14d、30d、60d、90d、12 0d、180d、2 0 0d及 30 0d时取标本观察移植重建效果。结果　用组织培养软骨进行喉移植后与受体组织相容性好 ,移植排斥反应小 ,喉重建修复效果明显优于甲醛保存软骨。结论　用组织培养法保存的活性软骨进行同种异体喉软骨移植其排斥反应小 ,喉重建修复效果满意。     

同种异体羊膜修补外伤性鼓膜穿孔

目的探讨采用同种异体羊膜对外伤性鼓膜穿孔进行鼓膜修补术的临床疗效。方法回顾性分析2003年7月至2008年2月间在我科住院的27例外伤性鼓膜穿孔患者使用同种异体羊膜行鼓膜修补术,鼓膜穿孔愈合情况及听力提高的临床资料。结果全部患者随访时间超过6个月,鼓膜穿孔总愈合率为96.3%（26/27）,平均听力改善（12±3.7）dB。结论使用同种异体羊膜修补鼓膜,具有取材方便且量大,操作简便,组织相容性好,损伤小,疗效好的优点。     

同种异体气管移植

气管移植目前仍处于动物实验阶段,影响气管移植应用于临床的主要因素在于移植气管的再血管化,有效的免疫抑制及供者气管的保存。本文就近年来如何解决这些问题的相关研究进行综述。     

同种异体气管移植

气管移植目前仍处于动物实验阶段,影响气管移植应用于临床的主要因素在于移植气管的再血管化,有效的免疫抑制及供者气管的保存。本文就近年来如何解决这些问题的相关研究进行综述。     

同种异体工程化软骨的构建和修复甲状软骨缺损的实验研究

目的探讨同种异体预定形态组织工程化软骨在有免疫功能动物体内构建的可行性及其对甲状软骨缺损的修复能力.方法利用组织工程技术制备同种异体片状和"C”型半管状工程化软骨;将4周形成的片状工程化软骨用于修复12只新西兰大白兔甲状软骨大片缺损;一定时间取材,分别对预定形态工程化软骨的构建情况及其修复效果进行大体和组织学评价.结果①构建4周形成的预定形态工程化软骨呈乳白色,有弹性和支撑力,8周时软骨呈瓷白色,镜下观察显示软骨组织特征;②甲状软骨缺损修复术后4、8、12周观察,修复区愈合良好,组织学检查修复区与正常软骨间的界面区可见软骨细胞生长及软骨基质生成,无免疫排斥迹象.结论在有免疫功能的动物体内可形成同种异体预定形态组织工程化软骨,获取的工程化软骨对甲状软骨缺损有良好的修复效果,无明显免疫排斥反应.     

同种异体软骨修复甲状软骨缺损的实验研究

目的　观察用不同类型的同种异体软骨修复喉软骨缺损的效果。方法　取新西兰白兔16只 ,平均分成两组。在每只兔的双侧甲状软骨切除 6mm× 3mm× 1mm全层软骨。一组动物将RPMI 16 4 0液和甲醛保存 30d的同种异体甲状软骨 (大小为 5mm× 2mm× 1mm)分别植入甲状软骨两侧缺损处 ,另一组动物于甲状软骨两侧缺损处分别植入新鲜的自体和异体软骨。分别于术后 7、30、180及 36 0d时处死取材 ,用大体观察、HE染色及免疫组织化学方法观察移植修复效果。结果经连续 1年观察 ,RPMI 16 4 0液保存的及新鲜的同种异体软骨与自体软骨移植排斥反应轻 ,均能较好修复甲状软骨缺损 ,而甲醛保存软骨早期有明显炎性细胞浸润 ,移植 180d至 36 0d时软骨基质明显吸收 ,软骨细胞退变 ,甲状软骨缺损区为纤维结缔组织修复。结论　RPMI 16 4 0液保存的及新鲜的同种异体软骨都具有活性 ,和自体软骨一样是软骨缺损修复的良好材料 ,可应用于临床     

去细胞全喉软骨支架的免疫学研究

目的 评价去细胞全喉软骨支架的免疫原性.方法 通过对兔离体喉行双侧颈总动脉顺行灌注去离子剂,构建去软组织细胞全喉支架12只.12只去细胞全喉软骨支架及12只新鲜喉分别埋植于24只青紫蓝兔喉旁肌内,于埋植后2、4、12、24周分别取材进行大体观察、组织学观察及淋巴细胞浸润计数比较.结果 去细胞全喉软骨支架颜色透明苍白,完整地保留了喉的去细胞组织结构及软骨活性.去细胞全喉软骨支架埋植于青紫蓝兔喉旁肌后,各观察时间点未出现明显的免疫排斥反应,4周后埋植喉体积逐渐缩小,但软骨结构仍存在.对照组新鲜喉埋植2周时即出现明显的免疫排斥反应,4周后喉的形状完全消失,喉大部分结构已被溶解,被纤维结缔组织取代,周围组织出现不同程度的溶解坏死.同一时间点,对照组淋巴细胞浸润程度明显高于实验组,差异有统计学意义(2周与4周的t值分别为15.11和13.91,P值均<0.01).结论 灌注法去细胞技术能够构建出具有低免疫原性的喉软骨支架,该支架有可能成为良好的喉修复材料.     

Intrinsic muscles and distribution of the recurrent laryngeal nerve in the pig larynx

To use the pig larynx in studies of laryngeal reinnervation, it is essential to have a clear understanding of its anatomy. We aimed to define the macroscopic anatomy of the intrinsic muscles and the course of the recurrent laryngeal nerve (RLN) in the pig larynx. Twelve large white pig larynges were used. Five larynges were preserved in formalin, then dissected to study the anatomy of the intrinsic muscles. Seven larynges were stained using the modified Sihlers staining technique, which results in nerves being stained dark purple while the remainder of the larynx is rendered translucent. The intrinsic muscles of the pig larynx were similar to those in the human. The RLN gives off a branch that enters the posterior cricoarytenoid muscle (PCA) on its deep surface and supplies the entire muscle, although the branching pattern of the nerve within the muscle varies considerably. These results facilitate detailed reinnervation studies in the pig laryngeal transplant model.     

Unusual case of laryngeal lipoma

Lipomas are benign tumors, composed of fat cells of the adult type. While lipomas on the trunk and limbs are common, they are rare in the upper aerodigestive tract. Here we report a case of laryngeal lipoma presented with a complaint of change of voice.     

成人喉乳头状瘤的治疗现状

喉乳头状瘤是耳鼻咽喉科最常见的良性肿瘤。近年来,关于成人喉乳头状瘤的治疗方式又有一些新观点。本文就成人喉乳头状瘤的治疗方式做一综述,以便对该病治疗有进一步了解。     

Autofluorescent diagnostics in laryngeal pathology

Autofluorescent diagnostics are based on the ability of oxidized flavin mononucleotide (FMN) in normal cells to emit green fluorescence when exposed to blue light. Neoplastic cells have significantly lower concentrations of FMN and do not emit green fluorescence. Autofluorescent endoscopy is designed for early, accurate and minimally invasive diagnostics for laryngeal pathology. This procedure has the ability to give information about the nature of laryngeal lesions without the devastation of tissue and has important advantages over standard biopsy. In our investigation we used the System of AutoFluorescent Endoscopy (SAFE 1000) designed by Pentax. We examined 38 patients using the SAFE 1000 system, and then all of the patients underwent laryngomicroscopy (LMS). In LMS, a biopsy was taken, and the diagnostic sensitivity of these two methods was compared according to the pathohistologic diagnosis. For statistical evaluation we used Fisher's exact test. We found that autofluorescent endoscopy has greater sensitivity in the detection of precancerous and malignant conditions in the larynx than standard laryngomicroscopy. We believe that autofluorescent endoscopy in addition to laryngomicroscopy gives a more accurate diagnosis of laryngeal pathology than laryngomicroscopy alone.     

Canine laryngeal transplantation: preliminary studies and a new heterotopic allotransplantation model

While transplantation of the larynx may eventually be useful in post-laryngectomy reconstruction, three criteria must first be met before human transplants can be attempted: transplant viability must be high, immunosuppression must be safe and effective and functional recovery of the larynx must occur. To study these first two criteria, a total of 11 canine larynx transplants were performed: 3 autografts, 6 orthotopic allografts and 2 heterotopic allografts. The rationale and technical performance of these different transplant procedures are reviewed in detail. Orthotopic transplant recipients received cyclosporin A (CsA) while the heterotopic allograft recipients received RS-61443 and methylprednisolone in addition to CsA. Overall, 9 of 11 of the transplants remained viable. In contrast, all 3 autografted animals developed esophageal-cutaneous fistulas; 2 developed sepsis and were sacrificed on post-operative days (POD) 5 and 28, respectively. The third survived for 91 days and demonstrated a high degree of regeneration in the recurrent and superior laryngeal nerves of the transplant. Orthotopically transplanted dogs also had a high morbidity and perioperative mortality (5 of 6 animals). The single long-term survivor was treated with CsA alone, but developed complete transplant rejection on POD 33. The two heterotopic transplant recipients had no perioperative morbidity and the combination of CsA, RS-61443 and methylprednisolone given these latter animals was effective in the longterm prevention of rejection. One of these heterotopic recipients died of sepsis on POD 68 while the other remained alive and well on POD 168. Our present findings show that currently available microsurgical techniques allow experimental canine laryngeal transplantation to be done with significantly high transplant viability rates. In the dog, CsA alone is inadequate for the long-term prevention of transplant rejection while combined therapy with CsA, RS-61443 and methylprednisolone can provide long-term rejection-free larynx transplant survival. The newly developed heterotopic larynx transplant model allows studies of transplant viability, rejection mechanisms and neural regeneration and functional recovery to be performed with minimal animal morbidity and lowered research costs.Presented at the combined meeting of the Society of Head and Neck Surgeons and the European Organization for Research and Treatment of Cancer (EORTC), Paris, France, 25–28 May, 1994