Abstract： Objective To investigate the change of tissue structure and epithelial barrier function of excluded esophagus after esophageal exclusion surgery for tracheoesophageal fistula (TEF). Methods Twentyeight hybrid dogs were divided into 3 groups with random number method. For group A (n=12), fistula was excluded; for group B (n=12), only the esophagus was excluded; and group C (n=4) was the control group. The normal and excluded esophagus of the three groups were observed through general sampling, HE staining, transmission electron microscope (TEM), scanning electron microscope (SEM) and Lanthanum trace labeling. The interstitial space dilation (ISD) of the cells on the esophageal mucosa was measured and the number of desmosome in the intercellular space was calculated. Results The changes of tissue structure and epithelial barrier function of the excluded esophagus were similar between group A and group B. Compared with group C, group A and B showed the following changes: esophageal structure changed, submucous glandular tissues reduced or disappeared; the interstitial space increased, the number of desmosome decreased, and the epithelial barrier function attenuated, but the basal lamina did not changed and lanthanum did not break through it. For the dogs in group C, esophageal mucosa could be observed, submucosa was complete and a large number of gland tissues and micrangiums could be seen in it. The number of desmosome for group A, B and C was 0.21±0.03 entries/μm2, 0.22±0.05 entries/μm2, and 0.32±0.03 entries/μm2 respectively, which showed a significant difference between group A, B and group C (Plt;0.05), while there was no significant difference between group A and group B (Plt;0.05). The average interstitial space for group A, B and C was 2.11±0.56 μm, 2.04±0.77 μm, and 1.84±0.49 μm respectively. There was no significant difference between group A and B, while there was significant difference between group A, B and group C. Conclusion The esophageal exclusion surgery for refractory TEF is safe, feasible, and effective with few complications, and deserved to be popularized.
Objective To investigate the application value of spiral CT postprocessing technique in the airway stent implantation technology. Methods Twenty-three patients with malignant airway stenosis or malignant tracheoesophageal fistula who needed the treatment of airway stent implantation from May 2012 to April 2016 were collected, including 19 males and 4 females with an average age of (61.6±10.0) years. Bronchoscopy and spiral CT with three-dimensional airway reconstruction were proceeded for the same patients before and after stent implantation, and the relevant data about narrow airway was measured by volume rendering, multiplanar reformation (MPR) and CT virtual endoscopy (CTVE) in a variety of ways, to confirm the location and size of narrow airway and fistulas, the degree and length of airway stenosis, as well as the distal end of the situation, and evaluate the patency of airway, the position and shape of stents, adjacent airway and complications after stenting. The positive forecast outcomes of the two inspections wascompared. Results Airway stents were placed successfully according to the data from the spiral CT airway three-dimensional reconstruction. Thirty stents were implantated in the 23 patients, including 21 column-type stents, 3 L-type stents, and 6 Y-type stents. All stents stayed in situ, with patency and no deformation.The fistulas were closed and the airways were reopened. Symptoms of cough after eating and drinking and dyspnea were relieved. The positive rates of bronchoscopy and CT examination on diagnosis of airway stenosis were both 100% (23/23). Complications: MRP showed tumor growth leading to stenosis again in 3 patients, and CTVE displayed mucous congestion in 2 patients. Conclusions The technique of 64-layer spiral CT postprocessing technique can measure the relate data of airway stricture or fistulas as a kind of convenient, quick, accurate, and noninvasive method in patients with malignant airway stenosis or tracheoesophageal fistula who need the treatment of airway stenting. It is of high reference value both to airway stent implanting and postoperative observation, and is worthy of application.