重建气管再上皮化的研究进展

Research progress of reconstructed tracheal re-epithelialization

背景:炎症、外伤、肿瘤或其他病变可导致气管大范围受损,需切除较长段气管并重建。但是当气管缺损长度超过自身气管长度一半以上时往往难以修复,必须置入气管假体重建气管连续性。目的:对气管假体的基础与临床应用研究进展进行综述,介绍重建气管再上皮化的类型及方法,分析目前在重建气管再上皮化研究方面存在的问题。方法:第一作者应用计算机检索PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及CNKI数据库(www.cnki.net/index.htm),在标题和摘要中以"气管缺损,气管重建,气管上皮化"或"tracheal defect reconstruction,tracheal epithelialization,re-epithelialization"为检索词进行检索。纳入标准:①具有原创性,论点论据可靠的文章。②观点明确,分析全面的文章。③文献主题内容与此课题联系紧密的文章。结果与结论:共检索到30篇符合标准的文献。生物材料科学和生物医学工程的迅速发展,为人类组织器官修复重建提供了必要的替代材料,用生物医学材料制成的人工气管由于其结构的完整性和可调节性,使其具备了置换气管的重要条件,为研制理想的人工气管开辟了广阔的途径。但仍然存在着很多问题,若用同种异体组织替代,难以避免免疫排斥反应;自体组织移植,则要以牺牲正常组织为代价。组织工程化气管的构建目前还只停留在裸鼠皮下水平,重建气管再上皮化的难题制约着人工气管的发展。

BACKGROUND： Inflammation, trauma, tumor or other lesions result in extensive damage to the trachea, which need to cut a long tracheal segment and reconstructed. It is hard to repair defects if the removal of the trachea was exceeding half length of the total trachea. Tracheal prosthesis is needed to reconstruct tracheal continuity. OBJECTIVE： To review the basis and clinical applications of tracheal prosthesis, introduce the type and method of tracheal reconstruction and re-epithelialization, and to analyze the problems exists in current re-epithelialization in the reconstructed trachea. METHODS： A computer-based online search of PubMed （http：//www.ncbi.nlm.nih.gov/PubMed） and CNKI （www.cnki.net/index.htm） was performed by the first author using Key words of ＂tracheal defect reconstruction, tracheal epithelialization, re-epithelialization＂. Articles with following features were included： ①With original and reliable evidence. ②With clear viewpoint and comprehensive analysis. ③Closely connected with this subject. RESULTS AND CONCLUSION： Totally 30 articles were included in this analysis. The rapid development of biomaterials science and biomedical science provide necessary substitute material for tissue and organ reconstruction. Artificial trachea made of biomedical have structural integrity and scalability, making it have an important condition for the replacement of the trachea, and showing excellent biocompatibility and stability of structural properties. Many scholars have made encouraging progress in tracheal reconstruction, but there are still many problems： If the use of allograft tissue replacement, it is difficult to avoid immune rejection; own body transplantation, they have to expense the cost of normal tissue. Construction of tissue-engineered trachea is still just stop at the level of nude mice. The puzzles of reconstructed tracheal re-epithelialization restrict the development of artificial trachea.