Objective To investigate effect of the removal of epithelium and mixed glands from the tracheal allografts on the graftimmunosuppression. Methods Fresh untreated tracheal allografts， cryopreserved tracheal allografts, and 10 off-epithelium tracheal allografts were obtained from 25 male SD rats. Fresh untreated tracheal allografts(40) were divided into 4 groups and dipped respectively in the solution of protease ⅩⅣ in 0, 0.1, 0.3 and 0.5 mg/ml at 4℃ for 12 hours. Thirty recipient male SD rats were randomly and equally divided into group A (fresh untreated tracheal allografts), group B(cryopreserved tracheal allografts), and group C(offepithelium tracheal allografts). The transplanted allografts were implanted into the abdominal cavity of other rats by being embedded in the greater omentum. Twenty-one days after transplantation, the tracheal graft segments were surgically removed, and then were initially fixed in cold 10% neutral buffered formalin solution for hematoxylineosin staining. Histological observation and lymphocyte infiltration were performed on the grafts to evaluate rejection. Results The 0.3 mg/ml protease ⅩⅣ could remove the epithelium and mixed glands of the grafts completely, but did no damage to cartilage. The cartilages of each group all survived and were revascularized. The lumens of group A were filled with granulation and necrosis tissue. In contrast, group B was filled with a few granulation tissues and group C was not at all. The number of lymphocyte infiltration in group A, B, and C was 29.16±2.69/HP, 15.17±2.19/HP, and 11.56±0.87/HP respectively. There was significant difference between group A and both group B and group C (Plt;0.05), and there was significant difference between group B and group C (Plt;0.05). Therefore, the grade of graftrejectionwas group Agt;group Bgt;group C. Conclusion The 0.3 mg/ml protease ⅩⅣ can completely remove the epithelium and mixed glands of grafts at 4℃ for 12 hours, and it preserves the normal structure of cartilage. The antigenicity of tracheal grafts can be greatly reduced by removing the epithelium and by the cryopreservation. The prior tracheal allograft in the omentum is feasible for the revascularization of the grafts.
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.
Objective To review the research advances of the tracheal prosthesis. Methods The articles concerned in recent years were extensively reviewed. Results There were still many arguments about the use of tracheal substitutes. Avariety of artificial trachea had been designed and assessed, but so far none of them had been satisfactory for clinical use. The failures were mainly due to their high mortality and incidence of complication such as prosthetic defluvium, granuloma formation, local infection, air leakage, anastomotic stenosis or obstruction. Conclusion The major causes of the poor effectiveness by the use of tracheal prosthesis are closely related to its biological compatibilities. The selected biomaterials and the design of prosthesis hold the key to a breakthrough in research and clinical use of tracheal prosthesis.
In tracheal resection and reconstruction, a technically demanding, complex, and high-risk procedure, management of the anastomotic site significantly impacts postoperative outcomes and long-term quality of life. However, comprehensive studies detailing perioperative anastomotic management strategies in tracheal reconstruction remain scarce. This review summarizes perioperative management strategies for tracheal reconstruction, covering preoperative assessment, surgical techniques, and other key aspects. It also highlights future research directions and challenges, aiming to provide clinicians with a systematic guide to perioperative management in tracheal reconstruction.
Objective To summarize our clinical experience of side-slide tracheoplasty in surgical management of bridging bronchus associated with congenital tracheal stenosis(CTS) and congenital heart disease (CHD). Method We retrospectively analyzed the clinical data of 8 bridging bronchus patients associated with CTS and CHD underwent tracheoplasty in our hospital from January 2010 through June 2015. There were 3 males and 5 females at age of 19.6±9.1 months and weight of 9.9±5.4 kg in our hospital. It was found that main tracheal associated with intermediate bronchus stenosis in 4 patients. Complete tracheal rings or bronchial rings were identified in all cases. Less than 50% normal tracheal size was found in all patients. Correction of CHD and tracheoplasty were done under cardiopulmonary bypass at the same stage. The technique of side-slide tracheoplasty was used in all patients. Results Average cardiopulmonary bypass time was 64.0±24.1 min. Average aortic clamp time was 14.0±18.1 min. No operative death occurred in hospital. The average duration of postoperative hospital stay was 20 d. Follow-up was completed in 8 patients. The duration of follow-up was 1 month to 5 years. Tracheal granulation occurred in one patient after six weeks of postoperation. The clinical symptoms improved significantly in the remaining patients. Conclusions Bridging bronchi has special anatomical features. The technique of side-slide tracheoplasty can be used to correct bridging bronchus associated with CTS with satisfactory outcomes.
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.
A variety of benign and malignant disorders affecting the trachea can theoretically be treated by simple resection and subsequent end-to-end anastomosis of remained trachea. Unfortunately, it is feasible only when the affected tracheal length does not exceed 50% of the entire length in adults and about 30% in children. Tracheal transplantation may be a treatment option for those patients, but still has many problems to be solved, such as immunological rejection, revascularization, infection and granulation tissue hyperplasia. This review focuses on how to use different methods to inhibit immunological rejection of tracheal transplantation, and current research progress of immunological rejection in tracheal allograft.
ObjectiveTo investigate that the TGF- beta/Smad signaling pathway mediated epithelial mesenchymal transition (EMT) in trachea stenosis after transplantation. Methods180-220 g male rats (n=50) were randomly divided into a control group and an experimental group. no surgical operation rats were in the control group. tracheal transplantation rats (Wistar-SD rat) were in the experimental group. Graft specimens were obtained in rats on 3,7,10,14,35,90 days after operation. HE staining is used to explain the fibrosis degree of tracheal stenosis. The fibrosis degree of tracheal stenosis was detected by calculating the fibrosis rate. Immunohistochemical staining was used to detect transplanted tracheal, such as EMT related molecules E-cadherin, vimentin, alpha-SMA expression, p-Smad2/3 expression and transcription factor ZEB1, Snail1 expression in tracheal graft specimens. ResultsHE staining showed that the tracheal fibrosis rate of the control group was 0.171±0.020, fibrosis rate was 0.537±0.013 (P < 0.01) on the third day after transplantation. The result of immunohistochemical staining showed that vimentin positive epithelial cells increased significantly (P < 0.05). E-cadherin expression significantly reduced (P < 0.05). Compared with the control group, TGF- beta expression increased (P < 0.05) in the experiment group. Compared with the control group, the expression of p-Smad2/3, the transcription factor ZEB1 and Snail1 significantly increased (P < 0.05) in the experiment group. ConclusionMechanism of tracheal stenosis may be due to EMT. At the same time, TGF- beta/Smad signaling pathway and transcription factor ZEB1, Snail1 may regulate the EMT.
Objective To investigate the efficacy and influential factors of interventional therapy for post-intubation tracheal stenosis. Methods The clinical data of 69 patients with tracheal stenosis after tracheal intubation in the First Affiliated Hospital of Guangzhou Medical University from February 2010 to March 2015 were retrospectively analyzed. The effects of interventional treatment for tracheal stenosis after intubation were evaluated by reviewing the medical records and telephone follow-up for more than 1 year. Multivariate logistic regression model was used to analyze the influential factors. Results The study recruited 69 patients with the median age of 44 years. After the interventional treatment, ATS dyspnea score decreased from (2.41±0.76) points to (0.65±0.62) points ( P<0.01), the diameter of airway lumen increased from (4.24±2.05)mm to (10.57±3.14)mm ( P<0.01). The short-term effective rate of interventional therapy was 92.8% (64/69) but the restenosis rate in 1 month, 3 months and 1 year after interventional treatment were 56.5%, 26.1% and 36.2%, respectively. Multivariate logistic regression analysis showed that diabetes (OR=2.819, 95%CI 1.973-4.062）, shortness of breath score >3 points (OR=13.816, 95%CI 5.848-32.641）, trachea stenosis diameter <4.5 mm (OR=7.482, 95%CI 4.015-13.943), tracheal stenosis grade ≥4 (OR=3.815, 95%CI 2.258-6.447), stenosis in the upper trachea (OR=5.173, 95%CI 3.218-8.316) were risk factors of interventional therapy for post-intubation tracheal stenosis. Conclusions The general efficacy of interventional treatment for tracheal stenosis after tracheal intubation is poor, and the recurrence rate is still high. The high degree of tracheal stenosis, diabetes mellitus and upper tracheal stenosis are important factors that affect the efficacy of respiratory interventional therapy.
Objective To evaluate the clinical features and complications of bedside tracheal intubation in intensive care unit ( ICU) , and explore the suitable strategy of intubation. Methods In this retrospective study,42 patients who underwent bedside tracheal intubation in ICU during September 2008 and March 2009 were divided into a schedule group ( n =24) and an emergency group ( n =18) . The time to successful intubation, number of intubation attempts, and complications were recorded. The schedule group was defined as those with indications for intubation and fully prepared, while the emergency group was defined as those undergoing emergency intubations without full preparation due to rapid progression of disease and accidental extubation. Results The success rate for all patients was only 57. 1% on the first attempt ofintubation. The main complications during and after induction were hypotension ( 45. 2% ) and hypoxemia ( 50. 0% ) . Compared with the emergency group, the schedule group had fewer attempts to successful intubation ( 1. 71 ±1. 12 vs. 2. 67 ±1. 75) , higher success rate on the second attempt ( 87. 5% vs.61. 1%) , and lower ypoxemia incidence ( 29. 1% vs. 77. 8%, P lt; 0. 05) . Conclusions The tracheal intubation in ICU is a difficult and high risk procedure with obvious complications. Early recognition ofpatients with indications and well preparation are critical to successful bedside intubation.