Alvarez P Díaz-Agero, García-Arranz M, Georgiev-Hristov T, García-Olmo D
Thoracic Surgery Unit, Residencia General, Hospital Universitario "La Paz", Paseo de la Castellana 261, 28046 Madrid, Spain.
Thorax. 2008 Apr;63(4):374-6. doi: 10.1136/thx.2007.083857.
Tracheal fistulas represent a challenging management problem. The standard treatment in most cases is based on surgical procedures. Various endoscopic treatment modalities have been proposed in patients at high surgical risk but the results are often unsatisfactory. The fistulas frequently recur with additional complications and sometimes death. The case history is reported of a patient with a tracheomediastinal fistula resulting from laser treatment of tracheal cancer. The fistula was treated by bronchoscopic injection of autologous adipose-derived stem cells (ASC) suspended in fibrin glue. The patient's stem cells were isolated from lipoaspirate according to a standard-ised procedure. No complications due to treatment with ASC occurred during the follow-up period and no fistula-related symptoms were detected. Postoperative bronchoscopic examination of the wall and base of the fistula revealed re-epithelialisation and neovascularisation that led to successful closure. To our knowledge, this is the first report of treatment of tracheal fistula by autologous cell therapy. Further studies are needed to confirm whether this new method should become routine practice.
气管瘘是一个具有挑战性的治疗难题。大多数情况下的标准治疗方法是基于外科手术。对于手术风险高的患者，已经提出了各种内镜治疗方式，但结果往往不尽人意。瘘管经常复发并伴有其他并发症，有时甚至导致死亡。本文报告了一例因气管癌激光治疗导致气管纵隔瘘的患者病例。通过支气管镜注射悬浮在纤维蛋白胶中的自体脂肪来源干细胞（ASC）对瘘管进行治疗。患者的干细胞按照标准化程序从抽脂物中分离出来。在随访期间未发生因ASC治疗引起的并发症，也未检测到与瘘管相关的症状。术后对瘘管壁和底部进行支气管镜检查发现重新上皮化和新血管形成，从而成功闭合。据我们所知，这是自体细胞疗法治疗气管瘘的首例报告。需要进一步研究以确认这种新方法是否应成为常规治疗方法。
