Wei Shixiong, Zhang Yiyuan, Luo Feixiang, Duan Kexing, Li Mingqian, Lv Guoyue
Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center The First Hospital of Jilin University Changchun China.
Department of Thoracic Surgery The First Hospital of Jilin University Changchun China.
Bioeng Transl Med. 2024 Apr 22;9(4):e10671. doi: 10.1002/btm2.10671. eCollection 2024 Jul.
Restoration of extensive tracheal damage remains a significant challenge in respiratory medicine, particularly in instances stemming from conditions like infection, congenital anomalies, or stenosis. The trachea, an essential element of the lower respiratory tract, constitutes a fibrocartilaginous tube spanning approximately 10-12 cm in length. It is characterized by 18 ± 2 tracheal cartilages distributed anterolaterally with the dynamic trachealis muscle located posteriorly. While tracheotomy is a common approach for patients with short-length defects, situations requiring replacement arise when the extent of lesion exceeds 1/2 of the length in adults (or 1/3 in children). Tissue engineering (TE) holds promise in developing biocompatible airway grafts for addressing challenges in tracheal regeneration. Despite the potential, the extensive clinical application of tissue-engineered tracheal substitutes encounters obstacles, including insufficient revascularization, inadequate re-epithelialization, suboptimal mechanical properties, and insufficient durability. These limitations have led to limited success in implementing tissue-engineered tracheal implants in clinical settings. This review provides a comprehensive exploration of historical attempts and lessons learned in the field of tracheal TE, contextualizing the clinical prerequisites and vital criteria for effective tracheal grafts. The manufacturing approaches employed in TE, along with the clinical application of both tissue-engineered and non-tissue-engineered approaches for tracheal reconstruction, are discussed in detail. By offering a holistic view on TE substitutes and their implications for the clinical management of long-segment tracheal lesions, this review aims to contribute to the understanding and advancement of strategies in this critical area of respiratory medicine.
大面积气管损伤的修复仍是呼吸医学领域的一项重大挑战，尤其是在由感染、先天性异常或狭窄等情况引起的病例中。气管是下呼吸道的重要组成部分，是一根纤维软骨管，长度约为10 - 12厘米。其特征是有18±2个气管软骨，分布在气管前外侧，气管肌位于后方。虽然气管切开术是治疗短段缺损患者的常用方法，但当病变范围超过成人气管长度的1/2（儿童为1/3）时，就需要进行气管替代。组织工程有望开发出生物相容性气道移植物，以应对气管再生方面的挑战。尽管有潜力，但组织工程气管替代物的广泛临床应用仍面临障碍，包括血管化不足、再上皮化不充分、机械性能欠佳和耐久性不足。这些限制导致组织工程气管植入物在临床应用中取得的成功有限。本综述全面探讨了气管组织工程领域的历史尝试和经验教训，阐述了有效气管移植物的临床前提条件和关键标准。详细讨论了组织工程中采用的制造方法，以及组织工程和非组织工程方法在气管重建中的临床应用。通过对组织工程替代物及其对长段气管病变临床管理的影响提供全面视角，本综述旨在促进对这一呼吸医学关键领域策略的理解和推进。
