Department of Pediatric Surgery, Saitama Medical University, Saitama, Japan; Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Pediatric Surgery, Saitama Medical University, Saitama, Japan; Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Division of Tissue engineering, The University of Tokyo Hospital, Tokyo, Japan.
J Pediatr Surg. 2021 Jul;56(7):1186-1191. doi: 10.1016/j.jpedsurg.2021.03.025. Epub 2021 Mar 26.
Tissue engineering of esophagus is required for management of long-gap esophageal atresia (LGEA). Collagenous connective tissue membranes fabricated by in-body tissue architecture (iBTA), called biosheets, can repair esophageal defects and generate tissues similar to native esophagus. However, iBTA requires second-stage surgery because of heterotopic preparation of biosheets. Our aim was to develop orthotopic iBTA for primary engineering of the esophagus by interposing a tubular mold to the esophageal defect.
The cervical esophagus of six rats was transected. An acrylic tube (internal diameter 2.6 mm, length 7.0 mm) was inserted and fixed between the ends of the upper and lower esophagus, and a 3 mm-long esophageal defect was created. Four weeks later, the rats were sacrificed for histological analysis.
Postoperatively the rats could intake liquid food. After four weeks, the esophageal defects were filled with regenerated tissues. Histologically the new esophageal walls stained positive for collagen type I. The inner surfaces were covered with stratified squamous epithelium that expressed pan-cytokeratin. In only one of six rats, regeneration of muscular-like tissue was suggested by positive immunohistochemical staining for desmin.
Orthotopic iBTA can regenerate a substitute esophagus with esophageal epithelium and collagenous wall. This technique may be a novel treatment for esophageal atresia with gaps of various lengths including LGEA.
长段食管闭锁（LGEA）的治疗需要进行食管组织工程。通过体内组织架构（iBTA）制造的胶原结缔组织膜，称为生物片，可以修复食管缺损并生成类似于天然食管的组织。然而，iBTA 由于生物片的异位准备需要进行二期手术。我们的目的是通过在食管缺损处插入管状模具来开发用于食管初级工程的原位 iBTA。
将六只大鼠的颈段食管横断。插入一个丙烯酸管（内径 2.6mm，长 7.0mm）并固定在上、下食管的两端之间，创建一个 3mm 长的食管缺损。四周后，处死大鼠进行组织学分析。
术后大鼠可以摄入液体食物。四周后，食管缺损被再生组织填充。组织学上，新的食管壁对 I 型胶原呈阳性染色。内表面被复层鳞状上皮覆盖，表达广谱细胞角蛋白。在六只大鼠中，只有一只通过肌样组织的免疫组织化学染色阳性表达 desmin 提示有再生。
原位 iBTA 可以再生具有食管上皮和胶原壁的替代食管。该技术可能是治疗各种长度的食管闭锁，包括 LGEA 的一种新的治疗方法。
