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中华胸部外科电子杂志 ›› 2021, Vol. 08 ›› Issue (03) : 164 -173. doi: 10.3877/cma.j.issn.2095-8773.2021.03.06

综述

关于气管替代物研究的进展与展望
许可1, 杨海堂2, 仲晨曦2, 赵珩2, 姚烽2,()   
  1. 1. 200030 上海,上海交通大学附属胸科医院胸外科
    2. 200030 上海,上海交通大学附属胸科医院胸外科;200030 上海,上海市胸科医院胸外科
  • 收稿日期:2021-06-18 修回日期:2021-07-21 接受日期:2021-07-29 出版日期:2021-08-28
  • 通信作者: 姚烽
  • 基金资助:
    上海市科学技术委员会(19411963900)

Progress and prospect of studies on tracheal substitute

Ke Xu1, Haitang Yang2, Chenxi Zhong2, Heng Zhao2, Feng Yao2,()   

  1. 1. Department of Thoracic Surgery, Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China
    2. Department of Thoracic Surgery, Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China; Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Received:2021-06-18 Revised:2021-07-21 Accepted:2021-07-29 Published:2021-08-28
  • Corresponding author: Feng Yao
引用本文:

许可, 杨海堂, 仲晨曦, 赵珩, 姚烽. 关于气管替代物研究的进展与展望[J]. 中华胸部外科电子杂志, 2021, 08(03): 164-173.

Ke Xu, Haitang Yang, Chenxi Zhong, Heng Zhao, Feng Yao. Progress and prospect of studies on tracheal substitute[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2021, 08(03): 164-173.

目前,广泛切除后气管重建仍然是胸外科领域的一大挑战。对于长度>6 cm的气管缺损,常需要气管替代物移植进行重建。气管替代物包括人工合成假体、自体组织气管、同种异体移植、异种移植和组织工程气管。理想的气管替代物尚不清楚,但一些技术已在动物或临床应用中显示出较好效果。本文回顾了过去几十年间气管替代物在应用中的成果与不足。其中,自体组织气管和同种异体主动脉移植展现出良好的应用前景。对于干细胞、组织工程气管的研究近年来引起人们的极大兴趣,但目前这种方法的长期结果欠佳,尚需要进一步的研究与优化。

To date, tracheal reconstruction after extensive resection remains a major challenge in the field of thoracic surgery. Tracheal replacement with a substitute is needed for reconstruction when the length of tracheal defect is more than 6 cm. Tracheal substitutes include synthetic prosthesis, autologous tissue composite, allograft, xenograft, and tissue-engineered trachea. At present, the ideal trachea substitute is still unclear, but some substitutes have shown good results in animal or clinical applications. This article reviews the achievements and limitations of each tracheal substitute over the past decades. Autologous tissue composite and alloaortic transplantation have shown promises in clinical application. The research on stem cells and tissue-engineered trachea has aroused great interest in recent years, but the poor long-term results of this approach right now highlight that there is still a long way to go in this research field.

表1 主流气管替代物临床应用代表文献
类型 文献 年份 例数 并发症 随访时间 内容
自体组织气管 Spaggiari等[24] 2005 1 ARDS,气管狭窄 24个月 尝试胸壁皮瓣替代气管,获得良好短期疗效
Yu等[31] 2006 1 6个月 使用前臂筋膜瓣联合人工刚性支撑物能够获得良好短期效果,且不需要支架植入
Fabre等[33] 2013 12 肺部感染 4~101个月 使用前臂游离筋膜瓣构建导管,并横向插入肋骨软骨加强,避免了支架相关的并发症
Zhang等[32] 2015 5 咯血 14~84个月 使用带弹性金属支架的自体肺组织瓣重建气道是一种可行的选择
同种异体气管 Rose等[35] 1979 1 9周 第一次成功将该方法应用于临床,获得良好的短期疗效,但缺乏长期疗效及随访信息。
Zhao等[37] 1999 2 60个月 摸索出合适的气管低温保存方法
Xu等[39] 2014 3 6个月 采用大网膜包裹异体气管进行分期移植,能为气管建立良好血供
Delaere等[40] 2010 1 12个月 在二阶段移植技术的基础上尝试撤退免疫抑制剂方案
Delaere等[25] 2012 5 黏膜坏死,气管环软化 6个月 在软骨间韧带做部分切口,并用受体黏膜替换部分供体黏膜有利于促进免疫抑制剂撤退,为气管替代提供更详尽的临床经验
同种异体主动脉 Hoffman等[43] 2001 1 3 d 主动脉被用作临时的气管替代物修复缺损
Azorin等[44] 2006 1 双侧肺炎 6个月 自体主动脉首次被作为替代物对气管进行长期的替代
Wurtz等[47] 2010 6 吻合口开裂胸骨开裂真菌感染 26~42个月 使用同种异体主动脉结合内支撑支架和外支撑肌瓣进行气管替代,血管化良好并有局部呼吸道上皮衬里,但所有患者均不能脱离支架
Martinod等[49] 2017 2 急性喉水肿支架细菌感染,支架肉芽肿 55~67个月 开发了使用低温保存(-80 ℃)的同种异体主动脉移植物作为生物基质的体内生物工程气管替代物的技术,发现主动脉内有软骨再生
Martinod等[50] 2018 13 喉水肿,急性肺水肿,ARDS,心房颤动 18~85个月 证明使用带支架的主动脉基质进行复杂气管和支气管重建的可行性,患者能够获得长期生存
组织工程气管 Elliott等[6] 2012 1 气道塌陷 24个月 以干细胞为基础的组织工程化移植物具有良好的上皮化、血管化潜能。但目前尚不清楚植入的工程气道是否具有生长能力,以及移植后的长期结果
Hamilton等[64] 2015 1 肉芽组织形成远端气管狭窄 48个月 尽管需要多个支架及多次支气管镜检查及干预,但脱细胞组织工程气管在儿童体内具有长期存活能力
Elliott等[65] 2017 1 急性气道压迫胸腔出血可能 15 d 总结出接种自体细胞的脱细胞气管支架移植的标准操作程序,并建议至少在移植后的最初几个月内使用气管支架
Tan等[75] 2017 1 4个月 通过体外灌注培养系统促进体内的组织工程气管原位再生,随访证实替代物完全血管化、再上皮化,且在接受放化疗后无相关并发症发生
Xu等[76] 2020 3 胃潴留肺炎 18~25个月 将体外灌注的体内生物反应器技术应用于侵犯隆凸的长段气管病变,再生组织血管化良好,无渗漏
表2 气管替代主要方法的优缺点
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