Abstract：
Full Circumferential Tracheal Replacement (FCTR) is a surgical challenge, indicated in rare cases of extensive tracheal resection, with no consensus on surgical technique or materials. A systematic review according to PRISMA guidelines was carried out from 2000 to 2022 to identify cases of FCTR, to compare surgical indications, the nature of the tracheal substitutes and their immunological characteristics, surgical replacement techniques and vascularization. Thirty-seven patients, including five children, underwent FCTR surgery using 4 different techniques: thyrotracheal complex allograft (n = 2), aorta (n = 12), autologous surgical reconstruction (n = 19), tissue-engineered decellularized trachea (n = 4). The mean follow-up was 4 years. Of the 15 deceased patients, 10 died of the progression of the initial pathology. For the majority of the teams, particular care was given to the vascularization of the substitute, in order to guarantee long-term biointegration. This included either direct vascularization via vascular anastomosis, or an indirect technique involving envelopment of the avascular substitute in a richly vascularized tissue. Stent placement was standard, except for autologous surgical reconstructions where tracheal caliber was stable. Internal stents were frequently complicated by granulation and stenosis. Although epithelial coverage is essential to limit endoluminal proliferation and act as a barrier, fully functional ciliated airway epithelium did not seem to be necessary. In order to facilitate future comparisons, a standardized clinical trial, respecting regulatory constraints, including routine follow-up with tracheal biomechanics assessment and scheduled biopsies could be proposed. It would help collecting information such as dynamics and mechanisms of tracheal bio-integration and regeneration.
摘要：
全圆周气管置换术（FCTR）是一项手术挑战，在罕见的广泛气管切除术中，在手术技术或材料上没有共识。从2000年到2022年，根据PRISMA指南进行了系统审查，以确定FCTR病例。为了比较手术适应症，气管替代物的性质及其免疫学特征，手术替代技术和血管化。三十七个病人,包括五个孩子,使用4种不同的技术进行FCTR手术：甲状腺气管复合体同种异体移植（n=2），主动脉（n=12），自体手术重建（n=19），组织工程化脱细胞气管（n=4）。平均随访时间为4年。在15名死者中,10死于初始病理的进展。对于大多数团队来说，特别注意替代品的血管化，以保证长期的生物整合。这包括通过血管吻合直接血管化，或涉及将无血管替代物包裹在富含血管的组织中的间接技术。支架放置是标准的，除了气管口径稳定的自体手术重建。内部支架经常因肉芽和狭窄而复杂化。尽管上皮覆盖对于限制腔内增殖和作为屏障是必不可少的，功能齐全的纤毛气道上皮似乎不是必需的。为了便于将来的比较，标准化的临床试验,尊重监管约束，包括常规随访与气管生物力学评估和计划活检。这将有助于收集诸如气管生物整合和再生的动力学和机制之类的信息。
