ステントされた大動脈マトリクスを使用して,バイオエンジニアリングによる呼吸器および支氣管の再構築の実現可能性
Emmanuel Martinod1,2, Kader Chouahnia3, Dana M Radu1,2
1Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France.
JAMA
|May 26, 2018
まとめ
大動脈のマトリクスを使った呼吸器のバイオエンジニアリングは,気管と支氣管の再構築には可能である. この革新的な技術は 複雑な呼吸道疾患の患者にとって 長期的な生存と呼吸道機能の有望性を示しています
科学分野:
- 再生医療
- 胸部 外科
- バイオ材料工学
背景:
- 呼吸道移植は近親肺腫瘍や末期気管支柱疾患の患者にとって潜在的な選択肢です.
- 呼吸道移植の現在の方法は論争の的であり,新しいアプローチが必要である.
研究 の 目的:
- 呼吸道再建のためのステントされた大動脈マトリックスを使用した呼吸道生物工学の可行性を評価する.
- 呼吸管または支氣管の複合置換を必要とする患者におけるこの技術の可能性を評価する.
主な方法:
- 末期気管損傷または近隣肺腫瘍を有する20人の患者を対象としたコホート研究.
- 凍結保存されたヒト大動脈アロプラントと オーダーメイドのステントを用いた呼吸道再構築
- 特定のケースでは肺を節約する 支氣管移植
主要な成果:
- 13人の患者は呼吸道移植 (気管,気管管,体管) を受けた.
- 90日間の全死亡率は5%であったが,気管/気管管の再建患者では死亡率は発生しなかった.
- 3年11ヶ月の追跡期間中,移植患者の76. 9%が生存し,80%がステントの除去後に正常に呼吸していた.
- 大動脈のマトリックス内での表皮再生とデノボ軟骨の形成の証拠が観察されました.
結論:
- ステント付き大動脈マトリックスによる呼吸道バイオエンジニアリングは 複雑な呼吸道を再建する可能性を証明しました
- このテクニックは,重度の呼吸道障害のある患者の治療結果を改善する可能性があることを示しています.
- 確固たる有効性と安全性を確立するには,さらなる研究が必要である.
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