内皮祖细胞复合血管无细胞基质替代输尿管的可行性

Endothelial progenitor cells-seeding acellular matrix graft as a ureter substitute:Feasibility study

背景:临床治疗输尿管缺损,缺乏有效的输尿管替代物,而无细胞基质在体内单独作为支架,常引起替代段输尿管狭窄,但内皮祖细胞移植能改善缺血组织,参与血管新生。目的:初步探讨内皮祖细胞复合的血管无细胞基质替代输尿管的可行性。方法:将自体猪来源的内皮祖细胞以及平滑肌细胞一起种植在同种异体的颈动脉来源的血管无细胞基质中,体外孵育后进行猪长段输尿管的替代。结果与结论:移植后4周,无细胞基质替代物已经开始与输尿管融合,替代物内可以明显见到上皮细胞层,肌细胞层以及新生的血管。但在移除输尿管支架管后,也就是在移植后12周的替代物标本中,发现移植物的萎缩和管腔的明显狭窄,移植物周围出现严重的纤维化炎症反应。替代段上方输尿管明显扩张积水,同侧肾脏明显萎缩,而且已经失去功能。

BACKGROUND：There is lack of ureteral substitution for clinical application.Acellular matrix easily leads to ureteral stricture at the substitute segment.Endothelial progenitor cells（EPCs） can ameliorate ischemic tissue and participate in vascular angiogenesis.OBJECTIVE：To investigate the clinical possibility of substitution of ureter using EPCs-seeding acellular matrix graft.METHODS：Swine EPCs and smooth muscle cells were implanted carotid artery-derived vascular acellular matrix.And then,the swine ureteral defect was replaced by EPCs-seeding acellular matrix graft.RESULTS AND CONCLUSION：The acellular matrix graft fused with ureter at 4 weeks after transplantation,and smooth muscle cells,urinary epithelial cells and new blood vessels could be found in the replaced part.After 12 weeks,when the stand canal was removed,graft shrunk,and the lumen was clearly strictured.The upper urinary system was dilated,and the kidney lost its function due to severe hydronephrosis.