Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Transplantation. 2023 Aug 1;107(8):1698-1705. doi: 10.1097/TP.0000000000004509. Epub 2023 Jul 20.
Long-segment tracheal airway defects may be congenital or result from burns, trauma, iatrogenic intubation damage, or tumor invasion. Although airway defects <6 cm in length may be reconstructed using existing end-to-end reconstructive techniques, defects >6 cm continue to challenge surgeons worldwide. The reconstruction of long-segment tracheal defects has long been a reconstructive dilemma, and these defects are associated with significant morbidity and mortality. Many of these defects are not compatible with life or require a permanent extended-length tracheostomy that is fraught with complications including mucus plugging and tracheoesophageal fistula. Extensive circumferential tracheal defects require a reconstructive technique that provides a rigid structure able to withstand the inspiratory pressures, a structure that will biologically integrate, and contain functional ciliated epithelium to allow for normal mucociliary clearance. Tracheal transplantation has been considered the reconstructive "Holy Grail;" however, there has been a long-held scientific dogma that revascularization of the trachea was not possible. This dogma stifled research to achieve single-staged vascularized tracheal transplantation and prompted the introduction of many creative and inventive alternatives. Throughout history, alloplastic material, nonvascularized allografts, and homografts have been used to address this dilemma. However, these techniques have largely been unsuccessful. The recent introduction of a technique for single-staged vascularized tracheal transplantation may offer a solution to this dilemma and potentially a solution to management of the fatal tracheoesophageal fistula.
长段气管气道缺损可能是先天性的，也可能由烧伤、创伤、医源性插管损伤或肿瘤侵犯引起。虽然长度<6cm的气道缺损可以使用现有的端端重建技术进行重建，但长度>6cm的缺损仍然是全球外科医生面临的挑战。长段气管缺损的重建一直是一个重建难题，这些缺损与显著的发病率和死亡率相关。许多这类缺损无法维持生命，或者需要永久性的长段气管造口术，而这伴随着包括黏液堵塞和气管食管瘘在内的并发症。广泛的环状气管缺损需要一种能够承受吸气压力的刚性结构，一种能够实现生物整合的结构，并包含有功能的纤毛上皮，以允许正常的黏液清除。气管移植一直被认为是重建的“圣杯”；然而，长期以来一直存在一种科学教条，即气管的再血管化是不可能的。这种教条抑制了实现单阶段血管化气管移植的研究，并促使人们提出了许多富有创意和创新性的替代方案。在历史上，所有的材料、非血管化同种异体移植物和同种移植物都被用来解决这个难题。然而，这些技术在很大程度上都没有成功。最近引入的一种单阶段血管化气管移植技术可能为解决这一难题提供了一种解决方案，并可能为致命性气管食管瘘的处理提供一种解决方案。
