Clinical Experience Of Slide Tracheoplasty In Patients With Tracheal Stenosis And Exploration On Alternative Strategy

Objective: To analyze the present effectiveness of the clinical treatment for long segmental tracheal stenosis,and against the limitation of Slide tracheoplasty,proposing the procedure of using tissue-engineered trachea to replace normal trachea,and further demonstrated the feasibility of this procedure by basic experiment.Methods: Data were analyzed retrospectively from January 2010 to December 2016 at the Shanghai Children's Medical Center for tracheal Slide tracheoplasty.SPSS software was used for statistic analysis.Then through the 3D printing technology,prepared a tracheal scaffold,combined with tissue engineering technology,to build a tissue engineering trachea.And verify the feasibility of replacing the normal trachea by in vivo transplant experiments.Results: A total of 113 patients underwent Slide operation.The early postoperative mortality rate was 17.70%.Preoperative dyspnea was an independent risk factor of early postoperative death.Length of stenotic segment has a certain significance on the prognosis of Slide surgery.Stenotic segment more than 50% of total trachea length prompted the morbidity of early postoperative complications,the duration of ICU time and hospitalization time,indicating a poor prognosis.In patients appeared granulation tissue fromation,ventilator dependence,airway inflammation,pneumonia,low cardiac output and cerebrovascular accident,there were statistically significant differences in the survival rate and mortality rate(P <0.05).During follow-up,no long-term death happened half year later postoperatively.1 year and 5-year estimated survival rates were 77.28 ± 4.01%,the majority of children achieved complete remission or close to complete remission.Then,we 3D printed a biodegradable material scaffold with morphology similar to native rabbit trachea.It presented favorable biocompatibility and cell adhesion abilities,and provided appropriated support.After seeding of chondrocytes,we constructed a cells-scaffold compound with certain thickness of neo-tissue.Then,after implantation of dorsal subcutaneous spaces of nude mice,tissue-engineered trachea presented mature regenerative cartilage tissue similar to native trachea.By animal experiments of trachea transplantation,experimental animals underwent tissue-engineered trachea transplantation survived 2-10 weeks postoperatively.The main complication of surgery was granulation tissue formation.Conclusion: Slide surgery has created surgical conditions for many children with long segmental tracheal stenosis.However,the overall mortality rate is high,the morbidity of postoperative complications,such as granulation tissue formation,ventilator dependence,tracheomalacia,is high.Currently,there are no reliable treatment for these severe complications,indicating there are thill some limitations of this procedure.To further improve the surgical approach,we combined with 3D printing technology and tissue engineering methods to build a tissue-engineered trachea with morphology similar to the native trachea.By animal experiments of trachea transplantation,we demonstrated the feasibility of autologous trachea transplantation and TET transplantation.