Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
J Tissue Eng Regen Med. 2020 Jun;14(6):855-868. doi: 10.1002/term.3045. Epub 2020 Apr 23.
The gastroesophageal junction has been of clinical interest for some time due to its important role in preventing reflux of caustic stomach contents upward into the esophagus. Failure of this role has been identified as a key driver in gastroesophageal reflux disease, cancer of the lower esophagus, and aspiration-induced lung complications. Due to the large population burden and significant morbidity and mortality related to reflux barrier dysfunction, there is a pressing need to develop tissue engineering solutions which can replace diseased junctions. While good progress has been made in engineering the bodies of the esophagus and stomach, little has been done for the junction between the two. In this review, we discuss pertinent topics which should be considered as tissue engineers begin to address this anatomical region. The embryological development and adult anatomy and histology are discussed to provide context about the native structures which must be replicated. The roles of smooth muscle structures in the esophagus and stomach, as well as the contribution of the diaphragm to normal anti-reflux function are then examined. Finally, engineering considerations including mechanics and current progress in the field of tissue engineering are presented.
胃食管连接部由于其在防止腐蚀性胃内容物向上反流进入食管方面的重要作用，一直受到临床关注。该功能的失效已被确定为胃食管反流病、食管下段癌和吸入性肺并发症的关键驱动因素。由于与反流屏障功能障碍相关的庞大的人群负担和显著的发病率及死亡率，因此迫切需要开发能够替代患病连接部的组织工程解决方案。虽然在工程学上已经在食管和胃体方面取得了良好的进展，但对于两者之间的连接部却几乎没有做任何工作。在这篇综述中，我们讨论了组织工程师开始解决这个解剖区域时应考虑的相关主题。讨论了胚胎发育和成人解剖学和组织学，为必须复制的天然结构提供了背景。然后检查了食管和胃中的平滑肌结构的作用，以及膈对正常抗反流功能的贡献。最后，介绍了工程学方面的考虑因素，包括力学和组织工程领域的当前进展。
