De Filippo Roger E, Bishop Colin E, Filho Luiz Freitas, Yoo James J, Atala Anthony
Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Transplantation. 2008 Jul 27;86(2):208-14. doi: 10.1097/TP.0b013e31817f1686.
In women, a healthy, patent vagina is important for the maintenance of a good quality of life. Apart from congenital abnormalities, such as cloacal exstrophy, intersex disorders, and an absence of the posterior two thirds of the organ, individuals may also suffer from cancer, trauma, infection, inflammation, or iatrogenic injuries leading to tissue damage and loss -- all of which require vaginal repair or replacement. Of necessity, reconstruction is often performed with nonvaginal tissue substitutes, such as segments of large intestine or skin, which are not anatomically or functionally ideal (Hendren and Atala, J Urol 1994; 152: 752; Hendren and Atala, J Pediatr Surg 1995; 30: 91). Whenever such tissue is used additional complications often ensue, such as strictures, infection, hair growth, graft shrinkage, diverticuli, and even malignancy (Filipas et al., BJU Int 2000; 85: 715; Lai and Chang, Changgeng Yi Xue Za Zhi 1999; 22: 253; Parsons et al., J Pediatr Surg 2002; 37: 629; Seccia et al., Ann Plast Surg 2002; 49: 379; Filipas, Curr Opin Urol 2001; 11: 267).
Using a rabbit model, we report here the construction of a functional vagina using autologous cells expanded from a small vaginal biopsy. RESULTS.: Six months after total vaginal replacement, radiographic analysis of rabbits implanted with the neovagina demonstrated wide, patent vaginal calibers without strictures. Histologic analysis revealed well-organized epithelial and muscle cell layers. Physiologic studies showed normal-range responses to electrical stimulation or to an adrenergic agonist.
These data indicate that a tissue engineering approach to clinical vaginal reconstruction in women is now a realistic possibility.
对女性而言，健康、通畅的阴道对于维持良好生活质量至关重要。除了先天性异常，如泄殖腔外翻、两性畸形以及阴道后三分之二缺失外，个体还可能因癌症、创伤、感染、炎症或医源性损伤导致组织受损和缺失，所有这些情况都需要进行阴道修复或重建。通常，重建手术需使用非阴道组织替代物，如大肠段或皮肤，但这些组织在解剖结构或功能上并不理想（亨德伦和阿塔拉，《泌尿学杂志》1994年；152:752；亨德伦和阿塔拉，《小儿外科学杂志》1995年；30:91）。每当使用此类组织时，往往会引发额外的并发症，如狭窄、感染、毛发增生、移植物收缩、憩室形成，甚至恶性肿瘤（菲利帕斯等人，《英国泌尿学杂志》2000年；85:715；赖和张，《长庚医学杂志》1999年；22:253；帕森斯等人，《小儿外科学杂志》2002年；37:629；塞西亚等人，《整形外科学年鉴》2002年；49:379；菲利帕斯，《当前泌尿学观点》2001年；11:267）。
我们在此报告，利用兔模型，通过对小块阴道活检组织进行自体细胞扩增，构建了功能性阴道。结果：全阴道置换6个月后，对植入新阴道的兔子进行影像学分析，结果显示阴道管径宽大、通畅，无狭窄。组织学分析显示上皮和肌肉细胞层组织良好。生理学研究表明，对电刺激或肾上腺素能激动剂的反应在正常范围内。
这些数据表明，采用组织工程方法对女性进行临床阴道重建目前已成为一种现实的可能性。
