실험적 기관 재건술에 대한 고찰

성숙환,김용희 대한기관식도과학회 2001 大韓氣管食道科學會誌 Vol.7 No.2

The purpose of this study was to review the literatures of experimental tracheal reconstruction. Although there have been significant advancements in the surgical treatment of the long circumferential tracheal injuries, there still has been a difficult problem with high morbidity and mortality. The method for tracheal reconstruction after circumferential resection is preferred end-to-end anastomosis for defects up to 6 cm in length, but larger tracheal defects require the use of tracheal allograft, various artificial prosthesis or autogenous organs. The tracheal allotransplantation has been widely used as there was significantly improved the method of surgical technique, preservation and immunosuppression. But it has been limited by a number of factors such as few donor, limited use of immunosuppressant, delayed revascularization and re-epitheliazation. Experimental studies on the tracheal prosthesis have a long history and they tried to use silicone, polytetrafluoroethylene, polypropylene mesh, Dacron, Marlex mesh, external or internal stents. Other experimental studies were reported the use of autogenous tissues that were cartilage. jejunum, aorta, skin, muscle, periostium or esophagus. But a great variety of these protheses have been resulted unsatisfactory in a significant Proportion of cases. Alternatively, the tissue-engineering technique has showed a new approach to reconstruct trachea and much progress in tissue-engineering bas been made recently. In conclusion, although the tracheal allotransplantation and the use of prosthesis and allograft have been reported a lot of limitation to overcome, we could sooner expect good result of ideal tracheal prosthesis.

A rational tissue engineering strategy based on three-dimensional (3D) printing for extensive circumferential tracheal reconstruction

Park, Jeong Hun,Park, Ju Young,Nam, Inn-Chul,Ahn, Minjun,Lee, Jae Yeon,Choi, Seok Hwa,Kim, Sung Won,Cho, Dong-Woo Elsevier 2018 Biomaterials Vol.185 No.-

<P><B>Abstract</B></P> <P>Extensive circumferential tracheal defects remain a major challenging problem in the field of tracheal reconstruction. In this study, a tissue-engineered tracheal graft based on three-dimensional (3D) printing was developed for extensive circumferential tracheal reconstruction. A native trachea-mimetic bellows scaffold, a framework for a tissue-engineered tracheal graft, was indirectly 3D printed and reinforced with ring-shaped bands made from medical grade silicone rubber. A tissue-engineered tracheal graft was then created by stratifying tracheal mucosa decellularized extracellular matrix (tmdECM) hydrogel on the luminal surface of the scaffold and transferring human inferior turbinate mesenchymal stromal cell (hTMSC) sheets onto the tmdECM hydrogel layer. The tissue-engineered tracheal graft with critical length was anastomosed end-to-end to the native trachea and complete re-epithelialization was achieved on the entire luminal surface within 2 months in a rabbit model with no post-operative complications. With this successful result, the present study reports the preliminary potential of the tissue-engineered tracheal graft as a rational tissue engineering strategy for extensive circumferential tracheal reconstruction.</P>

토끼 기관의 재건에 이용된 혈행성 연골막 피판의 연골생성능

김은서,최은창,김영호,홍원표,김영덕 대한기관식도과학회 1996 大韓氣管食道科學會誌 Vol.2 No.1

Perichondrium is generally used for reconstruction of airway and successful regeneration of cartilage framework using perichondrium are reported by several authors. It has many advantages for airway reconstruction. It can maintain the stable framework and it has higher flexibility so it's easy to design according to the shape of defects. It resist strongly against infection process. Its airtightness and rapid mucosalization enables to predict good postoperative recovery and results. To investigate the differences in cartilage regeneration between avascular and vascularized perichondrial flap, this study was designed with vascularized flaps composed of vascularized perichondrium and central auricular artery and vein. Morphologic study was performed to determine the fate of the grafted perichondrium at regular intervals using light microscopy with H & E stain. Chondrogenic potential and formation of cartilaginous plate of experimental group was superior than in the control group. Grafted perichondrium was fed by consistent feeding vessel. At 6 weeks, the regenerated cartilage could hardly be distinguished form the normal cartilage framework but in control group, regenerated cartilaginous tissue was generally immature in same period. In conclusion, this study indicated that consistent vasculature to grafed tissue is the essential factor for successful reconstruction of cartilaginous framework.

기관 재건을 위한 밸로우즈 인공지지체의 개발

박정훈(Jeong Hun Park),이정섭(Jung Seob Lee),주영훈(Young Hoon Joo),강현욱(Hyun-Wook Kang),조동우(Dong-Woo Cho) 대한기계학회 2010 대한기계학회 춘추학술대회 Vol.2010 No.11

For patients with tracheal resection, various composite scaffolds have been developed and applied for tracheal defect repair in animal models. And artificial prostheses consisting of a polypropylene mesh tube reinforced with a polypropylene spiral have been developed and applied clinically. In this study, a novel three-dimensional (3D) bellows scaffold with high flexibility and biodegradability was developed for tracheal reconstruction. And the flexibility of the bellows scaffold against compression was evaluated using finite element method (FEM) simulation. The bellows scaffold was fabricated by indirect micro-stereolithography technology that combines projection based micro-stereolithography and sacrificial molding process using polycaprolactone (PCL).

갑상선 편평상피세포암종 환자에서 요전완유리피판을 이용한 후두기관재건술 1예

정재훈,이주은,김소현,주영훈 대한이비인후과학회 2023 대한이비인후과학회지 두경부외과학 Vol.66 No.3

Primary squamous cell carcinomas arising from the thyroid is an extremely rare malignancy,which clinically can invade the larynx and trachea. In such an event, thyroidectomy with enbloc resection and reconstruction is the treatment of choice. However, laryngotracheal recon-struction remains a challenge and no ideal reconstruction has yet been established. Herein, wereport a case of a thyroid squamous cell carcinoma invading the laryngotrachea. The tumorwas completely resected surgically, including the laryngotrachea wall, which was reconstruct-ed with a radial forearm free flap. The patient was decannulated one year after surgery and noevidence of disease was detected two years after surgery.

피부이식과 흉쇄유돌근 피판을 이용한 기관 결손의 재건 1례

장수경(Soo Kyung Jang),서강현(Gang Hyeon Seo),최선(Sun Choi),박석현(Seok Hyun Park),김진환(Jin Hwan Kim),이동진(Dong Jin Lee) 대한두경부종양학회 2021 대한두경부 종양학회지 Vol.37 No.1

Supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) involves the removal of the whole thyroid cartilage, both true and false vocal cords, the ventricles, and the paraglottic spaces, sparing the cricoid cartilage, hyoid bone, and at least one functional and mobile cricoarytenoid unit. Reconstruction is performed by suturing of the cricoid cartilage up tightly to the hyoid bone, so trachea-releasing procedures are needed to prevent leakage at anastomosis site. In case of advanced tranglottic cancer invading tracheal tracheal wall, we need to perform additional circumferentrial circumferential tracheal wall resection. However, when we perform SCPL, circumferential resection of tracheal wall is limited because SCPL procedure itself needs releasing of tracheal length. We report a case of advanced transglottic cancer involving tracheal wall treated with induction chemotherapy and SCPL including tracheal wall resection with reconstruction of tracheal defect by sternocleidomastoid muscle flap covered with skin graft.

암 침윤 기관협착에 대한 외과적 치료

박재길,전해명,전진영 대한기관식도과학회 2002 大韓氣管食道科學會誌 Vol.8 No.1

Advanced or recurrent thyroid cancer, and metastatic paratracheal lymph nodes may directly invade the trachea and lead to tracheal stenosis. In these cases the stenosis is not circumferential and it would be possible to reconstruct the trachea after partial resection of the stenotic trachea. We experienced five cases of tracheal reconstruction after partial resection of the tracheal wall in four Patients of advanced thyroid cancer, and in one Patient of malignant paratracheal lymphadenopathy.

갑상선 암 환장서 기관지 편이 정도를 평가하는 방법의 연구

유영삼,Yoo, Young-Sam 대한기관식도과학회 2010 大韓氣管食道科學會誌 Vol.16 No.2

Background: Tracheal deviations are encountered frequently in head and neck tumors especially in thyroid cancer. Dyspnea and stridor are symptom calling for surgery. The method of evaluation in tracheal deviation is not well established yet. This paper is aimed to suggest objective tools to evaluate tracheal deviation in relation to cervical vertebra. Material and Method: Ten cases of thyroid cancers were recruited retrospectively. Tracheal inner shadow and shape of cervical vertebra were reconstructed three dimensionally using 3D-doctor to compare position of trachea in relation to vertebral body. Extent of deviation was scored in relation to both lateral borders of vertebral body. Angles between trachea and spinous process were measured in axial CT and compared between study group and control group. Results: Deviation scores were statistically significant between study group (mean=1.1) and control group (mean=0) (p=0.0008). Deviation angles at maximal tumor size in study group (mean=160.3 Degrees) and deviation angles of control group (mean=177.1 Degrees) were statistically significant (p=0.0007). Angles at maximal deviation of three dimensional images ages in study group (mean=162.6 Degrees) and deviation angles of control group (mean=177.1 Degrees) were statistically significant (p=0.0089). Conclusion: Tracheal deviation can be evaluated using scoring of three dimensional images and measuring angle between trachea and vertebral spine.

A Case of Tracheal Defect Reconstruction Using Anterolateral Thigh Free Flap in Patients with Papillary Thyroid Carcinoma Invading Tracheal Cartilage

이영호,김지훈,김원식 대한이비인후과학회 2017 대한이비인후과학회지 두경부외과학 Vol.60 No.6

When a well-differentiated thyroid carcinoma invades the adjacent organ, the treatment of choice is en bloc surgical resection. After tracheal resection, the tracheal defect can be repaired in various ways. Depending on the invasion depth of the tumor or the defect circumference of the trachea, primary closure, reconstruction of surrounding muscles, or end-to-end anastomosis can be used. A 70-year-old man was diagnosed with papillary thyroid cancer with tracheal invasion. The patient was treated by total thyroidectomy with tracheal window resection of the invading trachea. The defect was reconstructed with an anterolateral thigh free flap. At 12 months after surgery, the patient leads a social life without any discomfort and has an acceptable voice. This case is reported along with associated techniques and reviews of related articles.

기관을 침범한 유두상 갑상선 암 환자에서 흉설골근을 통한 기관재건술 1예

우희원(Hee Won Wu),김연수(Yeon Soo Kim),신유섭(YooSeob Shin),김철호(Chul-Ho Kim) 대한두경부종양학회 2014 대한두경부 종양학회지 Vol.30 No.2

Papillary thyroid carcinoma is known as its relatively high cure rate after surgical treatment. But invasion of the trachea by thyroid carcinoma is poor prognostic factor and the best management is en bloc surgical resection of the tumor invading the trachea. A 55-year-old man was diagnosed as papillary thyroid cancer with tracheal in-vasion. We treated the patient by total thyroidectomy with window resection of invading trachea followed by im- mediate reconstruction with sternohyoid muscle flap and tracheostomy. At 48 days after surgery, tracheostoma was closed and the patient had no functional complication by the surgical process. Until 10 months after surgery, there was no sign of recurrence and the patient led social life without any discomfort. We present this case with a review of the related literatures.