Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
Division of Medical Oncology of the Respiratory Tract, European Institute of Oncology, Milan, Italy.
Ann Thorac Surg. 2014 Feb;97(2):480-3. doi: 10.1016/j.athoracsur.2013.10.032. Epub 2013 Dec 25.
Bronchopleural fistula after lung resection still represents a challenging life-threatening complication for thoracic surgeons. Considering its extremely high mortality rate, an effective treatment is urgently required. Our project investigated the hypothesis of experimental bronchopleural fistula closure by bronchoscopic injection of autologous bone marrow-derived mesenchymal stem cells into the cavity of the fistula, evaluating its feasibility and safety in a large animal model.
An experimental bronchopleural fistula was created in 9 goats after right upper tracheal lobectomy. The animals were randomly assigned to two groups: one received autologous bone marrow-derived mesenchymal stem cell bronchoscopic transplantation; the other received standard bronchoscopic fibrin glue injection.
All animals receiving bronchoscopic stem cell transplantation presented fistula closure by extraluminal fibroblast proliferation and collagenous matrix development; none (0%) died during the study period. All animals receiving standard treatment still presented bronchopleural fistula; 2 of them (40%) died. Findings were confirmed by pathology examination, computed tomography, and magnetic resonance imaging.
Bronchoscopic transplantation of bone marrow-derived mesenchymal stem cells effectively closes experimental bronchopleural fistula by extraluminal fibroblast proliferation and collagenous matrix development. Stem cells may play a crucial role in the treatment of postresectional bronchopleural fistula after standard lung resection. Although these results provide a basis for the development of clinical therapeutic strategies, the exact mechanism by which they are obtained is not yet completely clear; further studies are required to understand exactly how stem cells work in this field.
肺切除术后支气管胸膜瘘仍然是胸外科医生面临的具有挑战性的致命并发症。鉴于其极高的死亡率，迫切需要有效的治疗方法。我们的项目假设通过支气管镜将自体骨髓间充质干细胞注射到瘘管腔内来闭合实验性支气管胸膜瘘，并在大型动物模型中评估其可行性和安全性。
在 9 只山羊中进行右上叶气管支气管切除术后建立实验性支气管胸膜瘘。动物随机分为两组：一组接受自体骨髓间充质干细胞支气管镜移植；另一组接受标准支气管镜纤维蛋白胶注射。
所有接受支气管镜干细胞移植的动物均通过腔外成纤维细胞增殖和胶原基质发育实现瘘管闭合；研究期间无动物（0%）死亡。所有接受标准治疗的动物仍存在支气管胸膜瘘；其中 2 只（40%）死亡。病理学检查、计算机断层扫描和磁共振成像证实了这些发现。
支气管镜下骨髓间充质干细胞移植通过腔外成纤维细胞增殖和胶原基质发育有效闭合实验性支气管胸膜瘘。干细胞可能在标准肺切除术后支气管胸膜瘘的治疗中发挥关键作用。尽管这些结果为开发临床治疗策略提供了依据，但它们的获得的确切机制尚不完全清楚；需要进一步研究以确切了解干细胞在该领域的作用机制。
