脂肪源性干细胞预防吻合口渗漏：猪缺血性食管切除术模型。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-01-01 DOI:10.1016/j.jss.2024.10.054

Jennifer Williams MD , Kristen Knapp MD , Brian Zilberman MD , Andrew Lin MD , Vincent Verchio MD , Zeus Antonello PhD , Ping Zhang PhD , Drew Delong VMD , Francis Spitz MD , Julieta E. Barroeta MD , Xiaoxin Chen MD , David Shersher MD

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引用次数: 0

摘要

导言食管切除术是一种挽救生命的手术，但吻合口漏率高达 11%-35% 。缺血被广泛认为是造成吻合口漏的最主要风险因素。我们假设，向缺血食管胃吻合口注射脂肪源性干细胞（ASCs）可防止吻合口漏：方法：我们利用吲哚菁绿和Elevision设备在猪身上建立了缺血性食管胃吻合口渗漏模型，以量化灌注。与非缺血对照组（n = 3）相比，使用相对灌注量为 50%-60% 的胃导管创建的吻合口产生持续渗漏（n = 3）。然后，我们在缺血吻合口周围注射人（n = 2）或猪（n = 2）ASCs。我们分析了临床结果，包括术后败血症、体重下降、吻合口中断、组织病理学以及免疫组化：结果：所有缺血对照组（3/3，100%）和注射异种人类 ASC 的实验组（2/2，100%）术后均出现败血症，尸检时发现吻合口破裂或断裂。然而，在猪异体ASC注射实验组中，动物表现良好，无一术后出现败血症，解剖时也未发现吻合口中断。组织病理学显示，与缺血组和人源ASC组相比，猪源ASC组的吻合口粘连有所改善，免疫组化显示猪源ASC组的上皮化和粘膜下纤维化有所改善：结论：在猪缺血性食管切除术模型中，异基因间充质干细胞可防止食管胃吻合口漏。

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Adipose-Derived Stem Cells Prevent Anastomotic Leak: A Porcine Ischemic Esophagectomy Model

Introduction

Esophagectomy is a lifesaving procedure plagued by an anastomotic leak rate of 11%-35%. Ischemia is widely accepted to be the most significant risk factor for anastomotic leak. We hypothesized that the injection of adipose-derived stem cells (ASCs) into an ischemic esophagogastric anastomosis would prevent leakage.

Methods

We developed a leaking ischemic esophagogastric anastomosis model in pigs using indocyanine green and the Elevision device to quantify perfusion. Anastomoses created using a gastric conduit with a relative perfusion of 50%-60% produced an anastomosis that consistently leaked (n = 3) compared to nonischemic controls (n = 3). We then injected either human (n = 2) or porcine (n = 2) ASCs around an ischemic anastomosis. We analyzed clinical outcomes including postoperative sepsis, weight loss, and disruption of the anastomosis and histopathology as well as immunohistochemistry.

Results

All of the ischemic controls (3/3, 100%), as well as the xenograft human ASC-injected experimental group (2/2, 100%), became septic postoperatively and were found to have an anastomotic breakdown or disruption on necropsy. However, in the porcine allograft ASC-injected experimental group, the animals did well, with none of the subjects experiencing postoperative sepsis, and none were found to have disrupted anastomoses on necropsy. Histopathology revealed improved apposition of the anastomosis and immunohistochemistry revealed improved epithelization and submucosal fibrosis of the porcine ASC group compared to ischemic and human ASC groups.

Conclusions

Allogenic ASCs prevented anastomotic leakage of esophagogastric anastomosis in a porcine ischemic esophagectomy model.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.