Patch Esophagoplasty: Esophageal Reconstruction Using Biologic Scaffolds
Patch Esophagoplasty: Esophageal Reconstruction Using Biologic Scaffolds
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DOI：
10.1016/j.athoracsur.2013.08.011
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发表时间：
2014-01-01
影响因子：
4.6
通讯作者：
Badaloni, Adolfo E.
中科院分区：
文献类型：
--
作者：
Nieponice, Alejandro;Ciotola, Franco F.;Badaloni, Adolfo E.
背景食管外科重建的标准技术仍不理想。患病或损伤食管的一期缝合与高发病率相关，主要是由于渗漏和狭窄，并且由于侵蚀和感染的高风险，合成材料是禁忌的。由细胞外基质（ECM）组成的可降解生物支架最近在临床前和临床环境中显示出有希望的结果，以防止扩大内镜粘膜切除术后狭窄。我们提出了一种新的手术技术，利用ECM支架作为重建补片，以增加食管直径在一期修复。4例需要食管重建的患者使用由猪膀胱ECM组成的ECM支架进行了补片食管成形术。用ECM补片代替食管的全层壁，将其缝合到剩余食管的边缘，类似于血管手术中进行的补片血管成形术。所有患者均获得了良好的临床结局，手术后立即恢复，并在7天后恢复口服。1例患者在第5天出现微漏，引流后2天自发闭合。包括吞钡和食管胃镜检查（EGD）在内的随访研究显示，所有患者的手术段均获得了充分的食管排空。EGD在2个月时显示完全的粘膜重塑，在贴片水平上约有20%的面积收缩。缺损区域与周围健康组织无法区分。贴片区域的活检显示正常鳞状上皮。其中1例患者存在单独的胸内狭窄，需要进一步手术。所有病例的临床结局均良好。提出了一种治疗食管狭窄的替代方法，该方法使用生物支架和创新的外科手术。还需要进一步的工作，包括前瞻性研究和长期随访，以充分评估这种基于生物支架的再生医学方法用于食管重建的潜力。(C)2014年由胸外科医师协会
Background. Standard techniques for surgical reconstruction of the esophagus remain suboptimal. Primary closure of diseased or injured esophagus has been associated with high morbidity, primarily due to leak and stricture, and synthetic materials are contraindicated due to the high risk of erosion and infection. Degradable bioscaffolds composed of extracellular matrix (ECM) have recently shown promising results in both preclinical and clinical settings to prevent stricture after extended endoscopic mucosal resection. We propose a novel surgical technique that utilizes an ECM scaffold as a reconstructive patch to augment the esophageal diameter during primary repair.Methods. Four patients requiring esophageal reconstruction underwent a patch esophagoplasty using an ECM scaffold composed of porcine urinary bladder ECM. The full thickness wall of the esophagus was replaced with an ECM patch that was sutured to the edges of the remaining esophagus, similar to the patch angioplasty performed in vascular procedures.Results. All patients had a favorable clinical outcome with immediate recovery from the procedure and reinstated oral intake after 7 days. One patient had a micro leak at day 5 that closed spontaneously 2 days after drainage. Follow-up studies including barium swallow and esophagogastroduodenoscopy (EGD) showed adequate esophageal emptying through the surgical segment in all patients. The EGD showed complete mucosal remodeling at 2 months, with approximately 20% area contraction at the patch level. The area of the defect was indistinguishable from surrounding healthy tissue. Biopsy of the patch area showed normal squamous epithelium. One of the patients had a separate intrathoracic stricture that required further surgery. Clinical outcomes were otherwise favorable in all cases.Conclusions. An alternative for the treatment of esophageal stenosis is presented which uses a biological scaffold and an innovative surgical procedure. Additional work, including prospective studies and long-term follow-up, is required to fully evaluate the potential of this bioscaffold-based regenerative medicine approach for esophageal reconstruction. (C) 2014 by The Society of Thoracic Surgeons