Trakea Rekonstrüksiyonunda Ksifoid Kıkırdak, Tiroid ve Auriküla Kıkırdak Greftlerinin Histolojik Analizle Karşılaştırılması: Tavşan Modeli

Öz

Trakea ön duvar rezeksiyonunu takiben ksifoid kıkırdak, tiroid ala superior kıkırdağı ve auriküler kıkırdak otolog greft materyalleri ile yapılan rekonstrüksiyonların doku uyumu açısından histolojik analizle karşılaştırmasıdır. Araştırmada 15 haftalık 30 adet erkek Yeni Zelanda tavşanı kullanıldı. Tavşanların trakeasının anterior bölümünde yaklaşık 1 cm”lik defekt oluşturuldu. Bu defektlerin 10 tanesi ksifoid kıkırdak, 10 tanesi tiroid ala superior kıkırdağı ve geri kalan 10 tanesi ise auriküler kıkırdak otolog greftleri ile tamir edilerek üç grup oluşturuldu. Her gruptan beşer tavşan ameliyattan sonraki dördüncü ve sekizinci haftada sakrifıye edilerek, uygulanan greftlerin histolojik analizleri yapıldı. Her materyalde histolojik parametrelerden enflamasyon, kıkırdak prolife-rasyonu, kıkırdak rezorbsiyonu, greft canlılığı, epitelizasyon, çevre doku yabancı cisim reaksiyonu, mikroapse ve prolapsus gelişimi değerlendirildi. Her üç greft arasından kıkırdak proliferasyonu en az tiroid ala superior kıkırdağı greftinde olduğu gözlendi (p=0,032). Greft canlılığının en az ve kıkırdak rezorbsiyonunun ise maksimum olduğu kıkırdak grefti auriküler kıkırdak olarak saptandı (p=0,015). En iyi kıkırdak proliferasyonu ve greft canlılığının ksifoid kıkırdak otolog greftinde olduğu gözlendi (p<0,05). Enflamasyon auriküler kıkırdakta hiç yokken, ksifoid kıkırdak grefti ile tiroid ala superior kıkırdağı greftinde benzer orandaydı (p>0,05). Auriküler kıkırdak grefti uygulanan hiçbir tavşanda ise enflamasyon gözlenmedi. Tüm gruplarda epitelizasyon ve çeşitli derecelerde çevre doku yabancı cisim reaksiyonu gözlense de, tiroid ala superior kıkırdağı greftinde daha fazla çevre doku yabancı cisim reaksiyonu saptandı (p=0,016). Ksifoid kıkırdak greftinin canlılığını uzun süre koruması, kıkırdak proliferasyonunun diğer kıkırdak greftlerine göre daha fazla ve kıkırdak rezorbsiyonunun ise daha az olması gibi nedenlerle trakea rekonstrüksiyonlarında tiroid ala superior kıkırdağı ve auriküler kıkırdak greftlerine göre daha iyi bir seçenek olduğu kararına varıldı.

Anahtar Kelimeler

• Trakea
• rekonstrüksiyon
• auriküler kıkırdak
• tiroid kıkırdak
• ksifoid kıkırdak

Comparison of Xiphoid, Tyhroid and Auricular Cartilage Grafting in Tracheal Reconstruction for Histological Analysis: The Rabbit Model

Öz

Following the anterior tracheal wall resection, a histological analysis was made to compare the utility of xiphoid cartilage, thyroid ala superior cartilage and auricular cartilage as autologous graft materials with respect to tissue compatibility in tracheal reconstruction. The study included 30 male New Zealand white rabbits of 15 weeks of age. An anterior tracheal defect of approximately 1 cm2 was formed in all rabbits. The defect was repaired with xiphoid cartilage autolog grafts in a group of 10 rabbits, with thyroid ala superior cartilage autolog grafts in another group of 10 and with auricular cartilage autolog grafts in the remaining group of 10 rabbits to form 3 different study groups. Five from each group were sacrificed in the postoperative fourth and eighth weeks and the grafts applied were investigated with a histological analysis. Histological parameters for comparison included inflammation, cartilage proliferation, cartilage resorption, graft viability, epithelization, foreign body reaction in the peripheral tissues, microabcess formation and tendency for prolapsus. Among the three type of autologous graft materials, the thyroid ala superior cartilage was observed to show the lowest cartilage proliferation (p=0.032). The auricular cartilage was identified to yield the lowest graft viability and the highest cartilage resorption (p=0.015). The xiphoid cartilage was observed to have the best cartilage proliferation and graft viability (p<0.05). Although no inflammation was observed in auricular cartilage grafts, the rate of inflammation was similar in xiphoid cartilage and thyroid ala superior grafts (p>0.05). No evidence of inflammation was observed in rabbits with auricular grafting. Despite the fact that all groups showed epithelization and various degrees of foreign body reaction in the peripheral tissues, the thyroid ala superior cartilage grafting was found to have the highest degree of foreign body reaction in the peripheral tissues (p=0.016). Due to qualities of maintaining cartilage graft viability for an extended period of time and sustaining higher degrees of cartilage proliferation besides lower degrees of cartilage resorption, the xiphoid cartilage grafting was assessed to serve as a better option in the tracheal reconstruction in comparison to its thyroid ala superior and auricular cartilage counterparts.

Anahtar Kelimeler

• reconstruction
• auricular cartilage
• thyroid cartilage
• xiphoid cartilage

Kaynakça

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