Polymere Implantatmaterialen zur trachealen und pharyngealen Schleimhautrekonstruktion in der Kopf-Hals-Chirurgie

Zusammenfassung

Es werden therapeutische Ansätze zur Rekonstruktion von Trachea und Pharynx mit Implantatmaterialien beschrieben. Trotz vielfältiger methodischer Ansätze mit unterschiedlichsten Materialien zur Trachealrekonstruktion hat es bisher keine Methode zur erfolgreichen klinischen Anwendung gebracht. Zu den wesentlichen Problemen gehörten u. a. Nahtinsuffizienzen, Stenosen, fehlende mukoziliäre Clearance und Vaskularisation. Erst die Entwicklung des Tissue Engineerings führte zu neuen Impulsen und neuartigen therapeutischen Optionen auch in der rekonstruktiven Trachealchirurgie. In der Pharynxrekonstruktion sind derzeit noch keine weiterreichenden Ansätze erkennbar, aus denen klinische Anwendung und Erfolg abschätzbar wären. In eigenen Arbeiten wurde ein neues polymeres Implantatmaterial bestehend aus Multiblock-Copolymeren verwendet, das aufgrund seiner physikochemischen Eigenschaften zur Rekonstruktion des oberen Aerodigestivtraktes (ADT) erfolgreich erschien. Um das Material für den Einsatz im ADT unter extremen chemischen, enzymatischen, bakteriellen und mechanischen Bedingungen zu testen, wurde es zur Rekonstruktion eines durchgreifenden Magenwanddefektes im Tiermodell (n = 42) eingesetzt. Gastrointestinale Komplikationen sowie negative systemische Auswirkungen traten bei keinem Versuchstier auf, und es kam zur mehrschichtigen Regeneration der Magenwand u. a. mit Aufbau einer regelrechten Mukosa. Durch die Stammzelltechnologie werden in Zukunft weitere Fortschritte in der Rekonstruktion von Geweben nach Prinzipien des Tissue Engineerings auch in der Kopf-Hals-Chirurgie erwartet.

Abstract

The existing therapeutical options for the tracheal and pharyngeal reconstruction by use of implant materials are described. Inspite of a multitude of options and the availability of very different materials none of these methods applied for tracheal reconstruction were successfully introduced into the clinical routine. Essential problems are insufficiencies of anastomoses, stenoses, lack of mucociliary clearance and vascularisation. The advances in Tissue Engineering (TE) offer new therapeutical options also in the field of the reconstructive surgery of the trachea. In pharyngeal reconstruction far reaching developments cannot be recognized at the moment which would allow to give a prognosis of their success in clinical application. A new polymeric implant material consisting of multiblock copolymers was applied in our own work which was regarded as a promising material for the reconstruction of the upper aerodigestive tract (ADT) due to its physicochemical characteristics. In order to test this material for applications in the ADT under extreme chemical, enzymatical, bacterial and mechanical conditions we applied it for the reconstruction of a complete defect of the gastric wall in an animal model. In none of the animals tested either gastrointestinal complications or negative systemic events occurred, however, there was a multilayered regeneration of the gastric wall implying a regular structured mucosa.

In future the advanced stem cell technology will allow further progress in the reconstruction of different kind of tissues also in the field of head and neck surgery following the principles of Tissue Engineering.

Schlüsselwörter

oberer Aerodigestivtrakt - multifunktionale, polymere Implantatmaterialien - Pharynxrekonstruktion - Trachearekonstruktion - Tissue Engineering - Magenwandregeneration

Key words

upper aerodigestive tract - multifunctional polymer implant materials - pharynx reconstruction - tracheal reconstruction - tissue engineering - gastric wall regeneration

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