Перспективы реконструктивной хирургии пищевода: тканевая инженерия или протезирование?
https://doi.org/10.23873/2074-0506-2025-17-4-504-514
Аннотация
Введение. При заболеваниях пищевода часто выполняют операции по его резекции или полному удалению с пластическим восстановлением желудком или кишечником, что сопряжено с различными осложнениями непосредственно после операции и в отдаленном периоде (некроз трансплантата, стенозы, анастомозит, рецидивы и т.д.). Замена собственного пищевода на имплантат – перспективный метод решения актуальной проблемы хирургии пищевода.
Цель данного обзора – обобщение знаний и описание текущего состояния исследований по созданию искусственного пищевода.
Материал и методы. В обзор включены иностранные и отечественные публикации по данной теме. Были проанализированы научные работы, найденные в электронных библиотеках eLIBRARY, Elektronische Zeitschriftenbibliothek, the Cochrane Library и PubMed на трех языках: русском, английском и немецком.
Заключение. Анализируемые публикации отражают два основных пути решения проблемы: разработка протезов на основе искусственных тканей и биоинженерное восстановление пищевода. Создание биоинженерного пищеводного трансплантата возможно за счет объединения каркаса и клеточного компонента. Чтобы использование биоинженерного неоэзофагуса стало эффективным методом при лечении заболеваний пищевода, необходимо решить вопросы, связанные с его подвижностью, васкуляризацией, межклеточным взаимодействием и взаимодействием клеток с каркасом. В этом отношении создание бионического протеза пищевода с контролируемой двигательной функцией – возможный путь решения проблемы. Современные синтетические материалы и технологии позволяют создать все компоненты стенки пищевода. В настоящее время обозначенная проблема все еще находится на стадии разработки и экспериментов.
Об авторе
А. С. Аллахвердян
ФГБОУ ВО «Российский университет медицины» МЗ РФ
Россия
Россия
Аллахвердян Александр Сергеевич - проф., д-р мед. наук, заведующий кафедрой торакальной хирургии и руководитель университетской клиники торакальной хирургии.
127006, Москва, Долгоруковская ул., д. 4
Список литературы
1. Allum WH, Blazeby JM, Griffin SM, Cunningham D, Jankowski JA, Wong R. Guidelines for the management of oesophageal and gastric cancer. Gut. 2011;60(11):1449–1472. PMID: 21705456 https://doi.org/10.1136/gut.2010.228254
2. Аллахвердян А.С., Анипченко А.Н., Анипченко Н.Н. Эффективность видеоэндохирургических операций при прогрессировании и рецидивах ахалазии кардии. Эндоскопическая хирургия. 2023;29(1):13–19. https://doi.org/10.17116/endoskop20232901113
3. Годжелло Э.А., Галлингер Ю.И., Хрусталева М.В., Евдокимова Е.В., Ходаковская Ю.А. Современная концепция эндоскопического лечения рубцовых стриктур пищевода и пищеводных анастомозов. Хирургия. Журнал им. Н.И. Пирогова. 2013;(2):97–104.
4. Шестаков А.Л., Черноусов Ф.А., Пастухов Д.В. Хирургическое лечение доброкачественных заболеваний пищевода. Хирургия. Журнал им. Н.И. Пирогова. 2013;5:36–39.
5. Spitz L, Kiely E, Pierro A. Gastric transposition in children--a 21-year experience. J Pediatr Surg. 2004;39(3):276–281. PMID: 15017537 https://doi.org/10.1016/j.jpedsurg.2003.11.032
6. Deurloo JA, Ekkelkamp S, Hartman EE, Sprangers MA, Aronson DC. Quality of life in adult survivors of correction of esophageal atresia. Arch Surg. 2005;140(10):976–980. PMID: 16230548 https://doi.org/10.1001/arch-surg.140.10.976
7. van Vilsteren FG, Pouw RE, Herrero LA, Peters FP, Bisschops R, Houben M, et al. Learning to perform endoscopic resection of esophageal neoplasia is associated with significant complications even within a structured training program. Endoscopy. 2012;44(1):4–12. PMID: 22109651 https://doi.org/10.1055/s-0031-1291384
8. Salama FD. Prosthetic replacement of the esophagus. J Thorac Cardiovasc Surg. 1975;70(4):739–746. PMID: 126337
9. Orlando G, Wood KJ, De Coppi P, Baptista PM, Binder KW, Bitar KN, et al. Regenerative medicine as applied to general surgery. Ann Surg. 2012;255(5):867-880. PMID: 22330032 https://doi.org/10.1097/SLA.0b013e318243a4db
10. Zani A, Pierro A, Elvassore N, De Coppi P. Tissue engineering: an option for esophageal replacement? /emin Pediatr Surg. 2009;18(1):57–62. PMID: 19103424 https://doi.org/10.1053/j.sem-pedsurg.2008.10.011
11. Kemp P. History of regenerative medicine: looking backwards to move forwards. Regen Med. 2006;1(5):653–669. PMID: 17465733 https://doi.org/10.2217/17460751.1.5.653
12. Macchiarini P, Walles T, Biancosino C, Mertsching H. First human transplantation of a bioengineered airway tissue. J Thorac Cardiovasc Surg. 2004;128(4):638–641. PMID: 15457176 https://doi.org/10.1016/j.jtcvs.2004.02.042
13. Orlando G, Wood KJ, Stratta RJ, Yoo JJ, Atala A, Soker S. Regenerative medicine and organ transplantation: past, present, and future. Transplantation. 2011;91(12):1310–1317. PMID: 21505379 https://doi.org/10.1097/TP.0b013e318219ebb5
14. Atala A, Guzman L, Retik AB. A novel inert collagen matrix for hypospadias repair. J Urol. 1999;162(3 Pt 2):1148– 1151. PMID: 10458452 https://doi.org/10.1016/S0022-5347(01)68105-9
15. Chalmers RL, Smock E, Geh JL. Experience of Integra(®) in cancer reconstructive surgery. J Plast Reconstr Aesthet Surg. 2010;63(12):2081–2090. PMID: 20335086 https://doi.org/10.1016/j.bjps.2010.02.025
16. Berman EF. The experimental replacement of portions of the esophagus by a plastic tube. Ann Surg. 1952;135(3):337–343. PMID: 14903864 https://doi.org/10.1097/00000658-195203000-00007
17. Fryfogle JD, Cyrowski GA, Rothwell D, Rheault G, Clark T. Replacement of the middle third of the esophagus with a silicone rubber prosthesis. An experiment and clinical study. Dis Chest. 1963;43:464–475. PMID: 7176957 https://doi.org/10.1378/chest.43.5.464
18. Lynen Jansen P, Klinge U, Anurov M, Titkova S, Mertens PR, Jansen M. Surgical mesh as a scaffold for tissue regeneration in the esophagus. Eur Surg Res. 2004;36(2):104–111. PMID: 15007263 https://doi.org/10.1159/000076650
19. Shinhar D, Finaly R, Niska A, Mares AJ. The use of collagen-coated vicryl mesh for reconstruction of the canine cervical esophagus. Pediatr Surg Int. 1998;13(2–3):84–87. PMID: 9563014 https://doi.org/10.1007/s003830050254
20. Jungebluth P, Alici E, Baiguera S, Blomberg P, Bozóky B, Crowley C, et al. Tracheobronchial transplantation with a stem-cell-seeded bioartificial nanocomposite: a proof-of-concept study. Lancet. 2011;378(9808):1997–2004. PMID: 22119609 https://doi.org/10.1016/S0140-6736(11)61715-7
21. Takimoto Y, Okumura N, Nakamura T, Natsume T, Shimizu Y. Long-term follow-up of the experimental replacement of the esophagus with a collagen-silicone composite tube. A/AIO J. 1993;39(3):M736–M739. PMID: 8268635
22. Takimoto Y, Nakamura T, Yamamoto Y, Kiyotani T, Teramachi M, Shimizu Y. The experimental replacement of a cervical esophageal segment with an artificial prosthesis with the use of collagen matrix and a silicone stent. J Thorac Cardiovasc Surg. 1998;116(1):98–106. PMID: 9671903 https://doi.org/10.1016/S0022-5223(98)70247-8
23. Yamamoto Y, Nakamura T, Shimizu Y, Matsumoto K, Takimoto Y, Liu Y, et al. Intrathoracic esophageal replacement with a collagen sponge-silicone double layer tube: evaluation of omental-pedicle wrapping and prolonged placement of an inner stent. A/AIO J. 2000;46(6):734–739. PMID: 11110272 https://doi.org/10.1097/00002480-200011000-00015
24. Takimoto Y, Nakamura T, Teramachi M, Kiyotani T, Shimizu Y. Replacement of long segments of the esophagus with a collagen-silicone composite tube. A/AIO J. 1995;41(3):M605– M608. PMID: 8573876 https://doi.org/10.1097/00002480-199507000-00082
25. Elliott MJ, De Coppi P, Speggiorin S, Roebuck D, Butler CR, Samuel E, et al. Stem-cell-based, tissue engineered tracheal replacement in a child: a 2-year follow-up study. Lancet. 2012;380(9846):994–1000. PMID: 22841419 https://doi.org/10.1016/S0140-6736(12)60737-5
26. Badylak SF, Weiss DJ, Caplan A, Macchiarini P. Engineered whole organs and complex tissues. Lancet. 2012;379(9819):943–952 PMID: 22405797 https://doi.org/10.1016/S0140-6736(12)60073-7
27. Totonelli G, Maghsoudlou P, Garriboli M, Riegler J, Orlando G, Burns AJ, et al. A rat decellularized small bowel scaffold that preserves villus-crypt architecture for intestinal regeneration. Biomaterials. 2012;33(12):3401–3410. PMID: 22305104 https://doi.org/10.1016/j.biomaterials.2012.01.012
28. Tan JY, Chua CK, Leong KF, Chian KS, Leong WS, Tan LP. Esophageal tissue engineering: an in-depth review on scaffold design. Biotechnol Bioeng. 2012;109(1):1–15. PMID: 21915849 https://doi.org/10.1002/bit.23323
29. Freud E, Efrati I, Kidron D, Finally R, Mares AJ. Comparative experimental study of esophageal wall regeneration after prosthetic replacement. J Biomed Mater Res. 1999;45(2):84–91. PMID: 10397961 https://doi.org/10.1002/(sici)1097-4636(199905)45:2<84::aid-jbm2>3.0.co;2-o
30. Gilbert TW, Sellaro TL, Badylak SF. Decellularization of tissues and organs. Biomaterials. 2006;27(19):3675–3683. PMID: 16519932 https://doi.org/10.1016/j.biomaterials.2006.02.014
31. Kajitani M, Wadia Y, Hinds MT, Teach J, Swartz KR, Gregory KW. Successful repair of esophageal injury using an elastin based biomaterial patch. A/AIO J. 2001;47(4):342–345. PMID: 11482483 https://doi.org/10.1097/00002480-200107000-00009
32. Badylak SF, Hoppo T, Nieponice A, Gilbert TW, Davison JM, Jobe BA. Esophageal preservation in five male patients after endoscopic inner-layer circumferential resection in the setting of superficial cancer: a regenerative medicine approach with a biologic scaffold. Tissue Eng Part A. 2011;17(11– 12):1643–1650. PMID: 21306292 https://doi.org/10.1089/ten.TEA.2010.0739
33. Clough A, Ball J, Smith GS, Leibman S. Porcine small intestine submucosa matrix (Surgisis) for esophageal perforation. Ann Thorac Surg. 2011;91(2):e15– e16. PMID: 21256256 https://doi.org/10.1016/j.athoracsur.2010.10.011
34. Badylak S, Meurling S, Chen M, Spievack A, Simmons-Byrd A. Resorbable bioscaffold for esophageal repair in a dog model. J Pediatr Surg. 2000;35(7):1097– 1103. PMID: 10917304 https://doi.org/10.1053/jpsu.2000.7834
35. Urita Y, Komuro H, Chen G, Shinya M, Kaneko S, Kaneko M, et al. Regeneration of the esophagus using gastric acellular matrix: an experimental study in a rat model. Pediatr Surg Int. 2007;23(1):21–26. PMID: 17004093 https://doi.org/10.1007/s00383-006-1799-0
36. Doede T, Bondartschuk M, Joerck C, Schulze E, Goernig M. Unsuccessful alloplastic esophageal replacement with porcine small intestinal submucosa. Artif Organs. 2009;33(4):328–333. PMID: 19335409 https://doi.org/10.1111/j.1525-1594.2009.00727.x
37. Lopes MF, Cabrita A, Ilharco J, Pessa P, Patrício J. Grafts of porcine intestinal submucosa for repair of cervical and abdominal esophageal defects in the rat. J Invest Surg. 2006;19(2):105–111. PMID: 16531368 https://doi.org/10.1080/08941930600569621
38. Ozeki M, Narita Y, Kagami H, Ohmiya N, Itoh A, Hirooka Y, et al. Evaluation of decellularized esophagus as a scaffold for cultured esophageal epithelial cells. J Biomed Mater Res A. 2006;79(4):771–778. PMID: 16871513 https://doi.org/10.1002/jbm.a.30885
39. Bhrany AD, Beckstead BL, Lang TC, Farwell DG, Giachelli CM, Ratner BD. Development of an esophagus acellular matrix tissue scaffold. Tissue Eng. 2006;12(2):319–330. PMID: 16548690 https://doi.org/10.1089/ten.2006.12.319
40. Totonelli G, Maghsoudlou P, Georgiades F, Garriboli M, Koshy K, Turmaine M, et al. Detergent enzymatic treatment for the development of a natural acellular matrix for oesophageal regeneration. Pediatr Surg Int. 2013;29(1):87–95. PMID: 23124129 https://doi.org/10.1007/s00383-012-3194-3
41. Beckstead BL, Pan S, Bhrany AD, Bratt-Leal AM, Ratner BD, Giachelli CM. Esophageal epithelial cell interaction with synthetic and natural scaffolds for tissue engineering. Biomaterials. 2005;26(31):6217–6228. PMID: 15913763 https://doi.org/10.1016/j.biomaterials.2005.04.010
42. Green N, Huang Q, Khan L, Battaglia G, Corfe B, MacNeil S, et al. The development and characterization of an organotypic tissue-engineered human esophageal mucosal model. Tissue Eng Part A. 2010;16(3):1053–1064. PMID: 19845463 https://doi.org/10.1089/ten.TEA.2009.0217
43. Saxena AK, Ainoedhofer H, Höllwarth ME. Culture of ovine esophageal epithelial cells and in vitro esophagus tissue engineering. Tissue Eng Part C Methods. 2010;16(1):109–114. PMID: 19374530 https://doi.org/10.1089/ten.TEC.2009.0145
44. Saxena AK, Baumgart H, Komann C, Ainoedhofer H, Soltysiak P, Kofler K, et al. Esophagus tissue engineering: in situ generation of rudimentary tubular vascularized esophageal conduit using the ovine model. J Pediatr Surg. 2010;45(5):859–864. PMID: 20438914 https://doi.org/10.1016/j.jped-surg.2010.02.005
45. Kofler K, Ainoedhofer H, Höllwarth ME, Saxena AK. Fluorescence-activated cell sorting of PCK-26 antigen-positive cells enables selection of ovine esophageal epithelial cells with improved viability on scaffolds for esophagus tissue engineering. Pediatr Surg Int. 2010;26(1):97–104. PMID: 19855980 https://doi.org/10.1007/s00383-009-2512-x
46. Ohki T, Yamato M, Murakami D, Takagi R, Yang J, Namiki H, et al. Treatment of oesophageal ulcerations using endoscopic transplantation of tissue-engineered autologous oral mucosal epithelial cell sheets in a canine model. Gut. 2006;55(12):1704–1710. PMID: 16709659 https://doi.org/10.1136/gut.2005.088518
47. Wei RQ, Tan B, Tan MY, Luo J-C, Deng L, Chen X-H, et al. Grafts of porcine small intestinal submucosa with cultured autologous oral mucosal epithelial cells for esophageal repair in a canine model. Exp Biol Med (Maywood). 2009;234(4):453–461. PMID: 19176869 https://doi.org/10.3181/0901-RM-5
48. Orlando G, García-Arrarás JE, Soker T, Booth C, Sanders B, CL Ross, et al. Regeneration and bioengineering of the gastrointestinal tract: current status and future perspectives. Dig Liver Dis. 2012;44(9):714–720. PMID: 22622201 https://doi.org/10.1016/j.dld.2012.04.005
49. Poghosyan T, Sfeir R, Michaud L, Bruneval P, Domet T, Vanneaux V, et al. Circumferential esophageal replacement using a tube-shaped tissue-engineered substitute: An experimental study in minipigs. Surgery. 2015;158(1):266–277. PMID: 25796416 https://doi.org/10.1016/j.surg.2015.01.020
50. Ahmed M, Ghanbari H, Cousins BG, Hamilton G, Seifalian AM. Small calibre polyhedral oligomeric silsesquioxane nanocomposite cardiovascular grafts: influence of porosity on the structure, haemocompatibility and mechanical properties. Acta Biomater. 2011;7(11):3857–3867. PMID: 21763798 https://doi.org/10.1016/j.act-bio.2011.06.051
51. Ritchie AC, Wijaya S, Ong WF, Zhong SP, Chian KS. Dependence of alignment direction on magnitude of strain in esophageal smooth muscle cells. Biotechnol Bioeng. 2009;102(6):1703–1711. PMID: 19170241 https://doi.org/10.1002/bit.22190
52. Watanabe M, Sekine K, Hori Y, Shiraishi Y, Maeda T, Honma D, et al. Artificial esophagus with peristaltic movement. A/AIO J. 2005;51(2):158–161. PMID: 15839441 https://doi.org/10.1097/01.mat.0000154644.44891.f1
53. Nakase Y, Nakamura T, Kin S, Nakashima S, Yoshikawa T, Kuriu Y, et al. Intrathoracic esophageal replacement by in situ tissue-engineered esophagus. J Thorac Cardiovasc Surg. 2008;136(4):850–859. PMID: 18954622 https://doi.org/10.1016/j.jtcvs.2008.05.027
54. Vondrys D, Elliott MJ, McLaren CA, Noctor C, Roebuck DJ. First experience with biodegradable airway stents in children. Ann Thorac Surg. 2011;92(5):1870– 1874. PMID: 22051281 https://doi.org/10.1016/j.athoracsur.2011.07.042
55. Yekrang J, Semnani D, Karbasi S. Optimizing the mechanical properties of a bi-layered knitted/nanofibrous esophageal prosthesis using artificial intelligence. e-Polymers. 2016;16(5):359–371. https://doi.org/10.1515/epoly-2016-0146
56. Liu H, Zhang Y, Ma S, Alsaid Y, Pei X, Cai M, et al. Esophagus-Inspired Actuator for Solid Transportation via the Synergy of Lubrication and Contractile Deformation. Adv /ci (Weinh). 2021;8(24):e2102800. PMID: 34708584 https://doi.org/10.1002/advs.202102800
57. Wang Y, Huang W, Wang Y, Mu X, Ling S, Yu H, et al. Stimuli-responsive composite biopolymer actuators with selective spatial deformation behavior. Proc Natl Acad /ci U/A. 2020;117(25):14602–14608. PMID: 32522869 https://doi.org/10.1073/pnas.2002996117
58. Jiao D, Zhu QL, Li CY, Zheng Q, Wu ZL. Programmable Morphing Hydrogels for Soft Actuators and Robots: From Structure Designs to Active Functions. Acc Chem Res. 2022;55(11):1533– 1545. PMID: 35413187 https://doi.org/10.1021/acs.accounts.2c00046
Рецензия
Для цитирования:
Аллахвердян А.С. Перспективы реконструктивной хирургии пищевода: тканевая инженерия или протезирование? Трансплантология. 2025;17(4):504-514. https://doi.org/10.23873/2074-0506-2025-17-4-504-514
For citation:
Allakhverdyan A.S. Perspectives for esophageal reconstructive surgery: tissue engineering or prosthetics? Transplantologiya. The Russian Journal of Transplantation. 2025;17(4):504-514. (In Russ.) https://doi.org/10.23873/2074-0506-2025-17-4-504-514
Просмотров:
33
Послать статью по эл. почте 