Martinod Emmanuel, Seguin Agathe, Holder-Espinasse Muriel, Kambouchner Marianne, Duterque-Coquillaud Martine, Azorin Jacques F, Carpentier Alain F
Laboratoire d'Etude des Greffes et Prothèses Cardiaques, Hôpital Broussais, Université Paris 6, Paris, France.
Ann Thorac Surg. 2005 Mar;79(3):942-8; discussion 949. doi: 10.1016/j.athoracsur.2004.08.035.
Tracheal replacement remains an unsolved surgical problem. Attempts to use tracheal substitutes have failed to achieve reliable results. In this study, tracheal regeneration was obtained after tracheal replacement with an allogenic aorta.
Twenty female sheep underwent a 8-cm tracheal replacement with a fresh aortic allograft. In the six last animals, aortic grafts came from male sheep. A stent prevented airway collapse. No immunosuppressive therapy was used. Aortic segments were retrieved at regular intervals up to 16 months. A polymerase chain reaction for the SRY gene was performed in specimens with aortic grafts from male sheep.
All animals but one survived the operation without complications. Clearly identified between the suture lines, the aortic segments were completely transformed into a tracheal structure. Histology showed initially an inflammatory reaction with proliferation of a squamous epithelium followed by mucociliary epithelium and newly formed cartilage rings. SRY gene was not found in newly formed cartilage rings showing that the regeneration originated from recipient cells.
This study presents a new type of tissue regeneration and brings hopes to the treatment of extensive tracheal lesions.
气管置换仍然是一个尚未解决的外科问题。使用气管替代物的尝试未能取得可靠的结果。在本研究中，用同种异体主动脉进行气管置换后实现了气管再生。
20只雌性绵羊接受了用新鲜主动脉同种异体移植物置换8厘米气管的手术。在最后6只动物中，主动脉移植物来自雄性绵羊。一个支架防止气道塌陷。未使用免疫抑制疗法。每隔一定时间取出主动脉段，最长至16个月。对来自雄性绵羊的带有主动脉移植物的标本进行SRY基因的聚合酶链反应。
除一只动物外，所有动物均存活且无并发症。在缝合线之间可清楚识别，主动脉段完全转变为气管结构。组织学显示最初有炎症反应，伴有鳞状上皮增生，随后是黏液纤毛上皮和新形成的软骨环。在新形成的软骨环中未发现SRY基因，表明再生起源于受体细胞。
本研究提出了一种新型的组织再生方式，并为广泛气管病变的治疗带来了希望。
