利用“体内生物反应器”技术行人体组织工程隆突重建

Backgrounds 背景

Long-segment airway defect reconstruction, especially when carina is invaded, remains a challenge in clinical setting. Previous attempts at bioengineered carina reconstruction failed within 90 days due to delayed revascularization and recurrent infection.

长段气道缺损的重建，尤其是当隆突被侵犯时，仍是临床上的一个挑战。由于延迟血管再生和反复感染，以往的组织工程隆突重建尝试在90天内失败。

Methods 方法

To establish the feasibility of carina bioengineering use In-Vivo Bioreactor technique. Uncontrolled single-center cohort study including three patients with long-segment airway lesions invading carina. Radical resection of the lesions was performed using standard surgical techniques. After resection, In-Vivo Bioreactor airway reconstruction was performed using a nitinol stent wrapped in two layers of acellularized dermis matrix (ADM). Two Port-a-Cath catheters connected to two portable peristaltic pumps were inserted between the ADM layers. The implanted bioengineered airway was continuously perfused with an antibiotic solution via the pump system. Peripheral total nucleated cells (TNCs) were harvested and seeded into the airway substitute via a Port-a-Cath twice a week for 1 month. The patients were treated as a bioreactor for in situ regeneration of their own bioengineered airway substitute.

为了证实利用体内生物反应器技术进行隆突组织工程化的可行性。采用非对照单中心队列研究纳入了3例长段气道病变侵犯隆突的患者。采用标准手术技术进行病灶根治性切除。切除后，使用镍钛合金支架包裹于两层脱细胞真皮基质(ADM)内进行体内生物反应器气道重建。两个连接到便携式蠕动泵的Port-a-Cath导管被插入到ADM层之间。植入的组织工程气道通过泵系统持续灌注抗生素溶液。收集外周血有核细胞(TNCs)，并通过Port-a-Cath播种到气道替代物中，每周两次，持续1个月。这些患者自身作为生物反应器，原位再生他们自己的组织工程化气道替代物。

Results 结果

Three patients were included in the study (mean age, 54.7 years). The first patient underwent 8 cm long trachea and carina reconstruction, the second patient 6 cm long trachea, carina and main bronchus reconstruction. The third patient right main bronchus and carina reconstruction. Major morbidity included gastric retention and pneumonia. All three patients survived till last follow-up and bronchoscopy follow-up showed well-vascularized regenerated tissue without leakage.

3例患者被纳入研究(平均年龄54.7岁)。第1例行8cm气管及隆突重建，第2例行6cm气管、隆突及主支气管重建。第3例患者行右主支气管及隆突重建。术后主要发生胃潴留和肺炎。3例患者均存活至最后一次随访，支气管镜随访显示再生组织血管再生良好，没有渗漏。

Conclusions 结论

In this uncontrolled study, In-Vivo Bioreactor technique demonstrated potential to be applied for long-segment trachea, carina and bronchi reconstruction. Further research is needed to assess efficacy and safety.

在这项非对照研究中，体内生物反应器技术显示了应用于长段气管、隆突和支气管重建的潜力。还需要进一步的研究来评估疗效和安全性。

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