Xu Lin, Zhang Shijie, Li Jian, Liu Jingwei, Liu Haibo, Huang Weiming, Shang Xueqian
From the Department of Thoracic Surgery, The First Hospital of Peking University, Beijing, China.
Exp Clin Transplant. 2014 Oct;12(5):448-53.
Human tracheal allotransplant is an option for treating long-segment tracheal defects, but no reliable and satisfactory tracheal transplant procedure has been developed. The purpose of this study is to review the results of 2-stage tracheal reconstruction in human tracheal allotransplant for tracheal defects > 5 cm with the use of greater omentum for revascularization.
There were 3 patients who had tracheal allograft. In stage 1, a segment of donor trachea (6 cm) was excised and wrapped in the recipient greater omentum. In stage 2, at 3 to 5 weeks after stage 1, the tracheal allograft and omental pedicle were orthotopically transplanted to the cervical part of the trachea. All patients received immunosuppression with tacrolimus, mycophenolate mofetil, and methylprednisolone. Fiberoptic bronchoscopy was performed monthly during the 6 months after stage 2.
In all 3 patients, no major postoperative complication was observed. Transverse section of the donor trachea showed a mechanically stable chondral framework. Histologic sections stained with hematoxylin-eosin showed complete cartilage rings covered by intact respiratory epithelium.
A 2-stage procedure for human tracheal transplant with greater omentum is a safe and effective technique for tracheal reconstruction.
人气管同种异体移植是治疗长段气管缺损的一种选择，但尚未开发出可靠且令人满意的气管移植手术方法。本研究的目的是回顾使用大网膜进行血管重建的两阶段气管重建术在人气管同种异体移植治疗5cm以上气管缺损中的结果。
有3例接受气管同种异体移植的患者。在第一阶段，切除一段供体气管（6cm）并包裹在受体大网膜中。在第二阶段，在第一阶段后3至5周，将气管同种异体移植物和网膜蒂原位移植到气管颈部。所有患者均接受他克莫司、霉酚酸酯和甲泼尼龙免疫抑制治疗。在第二阶段后的6个月内每月进行一次纤维支气管镜检查。
所有3例患者均未观察到重大术后并发症。供体气管横切面显示软骨框架机械稳定。苏木精-伊红染色的组织学切片显示完整的软骨环被完整的呼吸道上皮覆盖。
使用大网膜的两阶段人气管移植手术是一种安全有效的气管重建技术。
