Ponad 7000 publikacji medycznych!
Statystyki za 2021 rok:
odsłony: 8 805 378
Artykuły w Czytelni Medycznej o SARS-CoV-2/Covid-19

Poniżej zamieściliśmy fragment artykułu. Informacja nt. dostępu do pełnej treści artykułu
© Borgis - Postępy Nauk Medycznych s1/2011, s. 23-28
Paweł Lampe, Beata Jabłońska*
Krótka historia sztucznego przełyku
A brief history of the artificial oesophagus
Katedra i Klinika Chirurgii Przewodu Pokarmowego SUM w Katowicach
Kierownik: prof. dr hab. med. Paweł Lampe
Pomimo postępów w diagnostyce rak przełyku jest często rozpoznawany w późnym stadium. Ze względu na zaawansowane stadium, w którym zazwyczaj się znajduje, leczenie raka przełyku jest tylko paliatywne u ponad 70% pacjentów. Chorzy po resekcji przełyku wymagają rekonstrukcji. Zabiegi chirurgiczne składające się z przeniesienia lub wszczepienia nieuszypułowanego odcinka przewodu pokarmowego są bardzo inwazyjne. W piśmiennictwie istnieje wiele doniesień na temat ulepszeń sztucznego przełyku przy użyciu różnych materiałów biologicznych i syntetycznych. Celem niniejszej pracy było przedstawienie krótkiej historii sztucznego przełyku powołując się na najważniejsze publikacje na ten temat.
Despite the progress in diagnostics procedures, oesophageal cancer is often diagnosed in its late stages. Because of the advanced stage at which it usually presents, treatment of carcinoma of the oesophagus is just palliative in over 70% of patients The surgical treatment of the esophageal cancer is associated in the esophagectomy. Patients following esophagectomy require the esophageal reconstruction. Procedures consisting of translocation or implantation of a pedunculated segment of the alimentary canal are extremely invasive. There are numerous reports regarding improvements of the artificial esophageal using different synthetic and biological materials in the literature. The aim of this paper was to present a short history of the artificial esophagus by citing the most important publications on this topic.

Despite the progress in diagnostics procedures, oesophageal cancer is often diagnosed in its late stages. The disease is characterized by a malignant course: early infiltration of the muscular coat, and metastases to the regional lymph nodes. Because of the advanced stage at which it usually presents, treatment of carcinoma of the oesophagus is just palliative in over 70% of patients (1-4).
Nutritional gastric and enteral fistulas and oesophageal tubes have multiple disadvantages. Different sophisticated methods, i.e. cutting through the neoplasm using laser followed by irradiation and chemotherapy, cause discomfort to the patient, and do not seem to improve the quality of survival (5-7).
However, palliative procedures consisting of translocation or implantation of a pedunculated segment of the alimentary canal are extremely invasive. Besides, the intended purpose, which is enabling the patient to eat naturally and to prevent the bronchial tree from being flooded with saliva and food, is not always achieved. In the 1940s, numerous studies were carried out in order to develop alloplastic oesophageal prostheses. The tubes were easily available and convenient to use for a surgeon. The duration of the operatio was cut down, and intra- and perioperative mortality rates lowered. However, despite numerous improvements of the tube structure over the years as well as various materials and methods of anastomosing the prosthesis to the oesophagus being used, fusion between the tissues and the implant was not achieved. The attempts to use biological, usually cell-rich, implants were unsuccessful.
Non-preserved connective tissue fibrous membranes were later considered as potential material for the development of an oesophageal prosthesis. The results of those investigations were not encouranging, and thus the prostheses were not widely used.
In search of an effective palliation, which would additionally maximize the quality of survival experimental and clinical studies were launched aimed at the development of an artificial oesophageal prosthesis. In 1922, Neuhoff and Ziegler (8) used rubber tubes as experimental oesophageal prostheses in dogs. In 1947, Grindlay (9) suggested that polyethylene tubes could be used as bilairy, tracheal and colonic prostheses. In 1952, Berman (10) selected metacrylic and polyethylene tubes. Out of 20 dogs operated on with the use of the above mentioned tubes. 6 died for various reasons. However, the condition of the surviving 14 dogs was satisfactory. In the same year, Berman reported his results on 28 operations in humans. He used polyethylene tubes for thr formation of an artificial oesophagus. In 1954, Berman (11) operated on 60 patients using the same prosthetic material; mortality rate was below 10%. According to Berman, the success of the procedure might be accounted for by the elimination of the trauma resulting from the mobilized stomach being advanced upwards.
In 1952, Ruffo (12) published the results of his investigations concerning the use of plastic tubes as oesophageal prostheses. However, out of 15 dogs that were operated on, 11 died (74%) in the perioperative period. Chalnot at al. (13) replaced the thoracic segment of the oesophagus in 16 dogs. Having excised a 2-4 cm segment of the thoracic oesophagus, they implanted much longer polyvinyl tubes; the results were encouraging.
In 1953, Roth et al. (14) used metacrylic and PVC tubes as the prostheses of the thoracic oesophagus in 5 dogs, and cervical oesophagus in 15 dogs. Following the procedures they found prosthesis displacement, stomach wall perforation by a PVC prosthesis, and anastomotic leakage. Similar observations were made by Razemon at al. (15).
Shackelford and Sparkuhl (16) reported on a patient who survived 183 day with a plastic prosthesis following a plalliative surgical treatment fo oesopahgeal cancer. In 1954, More et al (17) published the results of their studies which had carried out on 36 rabbits since 1949. Like Berman, they used plastic prostheses; the results, however, were unsatisfactory. The rabbits were dying, most frequently, of suppurative inflammation within the thoracic cavity.
Although, in 1954, Battersby and King (18) submitted a paper describing advantageous features of the prosthetic tube proposed by Berman, they als pointed out some of its shortcoming, i.e. the standard size and the fact that the prosthesis could not be anastomosed to the oesophagus using standard suture technique. They developed a multi-layer prosthesis which consisted of polyethylene sheeting and nylon mesh fused together in an autoclave. The prosthesis was anastomosed to the oesophagus; various anastomoses were used for the purpose. Out of 22 dogs which were operated on using this method, 14 died. During endoscopic procedures performed 3-4 months following the operation, Battersby and King found that the prosthesis and tissues were separated. The high risk was, however, attributed to the oesophageal surgery rather to the above mentioned technique of prosthesis implantation.
In 1956, Maynard et al. (19) reported on the use of a plastic tube as and endoprosthesis for palliative treatment of oesophageal cancer, and for the replacement of an oesophageal segment in a group consisting of 5 patients (Group I) and 9 patients (group II) respectively. The endoprosthesis functioned satisfactorily in 4 patients from Group I. In 8 patients from Group II, the results were poor p the prosthesis and the oesophagel tissues did not fuse together.
In 1956, Ebner (20) described the use of Berman’s prosthesis for palliative treatment of cancer of the oesophagu.
In 1963, bearing in mind that organ pullup was too risky in the case of patients presenting with cancer cachexia, Fryfogle et al. (2) used an alloplastic oesophageal prosthesis. The prosthesis was made of rubber with silicone lining. The outer surface was covered with Dacron. In order for anastomosis not to cause ischaemia of the margins of the oesophasus, the authors suggested a complex technique. The function of the prosthesis and possible methods of anastomosing the tube to the oesophagus were first studied in experiments on dogs; afterwards the prosthesis was used in1 patient with a good result. After 6 weeks, however, the patient started complaining of dry hacking cough, most probably caused by tracheal compression by the prosthesis.
In 1968, La Guerre et al. (21) used tubed made of new material, hydron (Hadron Laboratories New Brunswick, N.J.), in a teflon or Dacron cuff, as oesophageal prostheses in 24 dogs. In the first 7 dogs died due to leakage from the upper anastomosis; two others died after about 3 weeks. The survival period of the remaining 13 dogs ranged between 1.5 and 9 months. The authors warned surgeons not to divide the vagus nerve while excising oesophageal segments. Three dogs, in which the nerve was damaged during the operative procedure, developed considerable weight loss. One dog vomited the prosthesis, and very soon stricture developed within the prosthesis canal. Microscopic examination did not reveal any ingrowth of the oesophageal wall tissuses into the prosthesis. Epithelial growth was not found either.
Stuart (22, 23) reported on 5 patients with a plastic tube as a prosthesis of a rubber segment of the oesophagus. He considered the immediate result satisfactory, and the method accepatable for palliative treatment of cancer of the oesophagus.
In 1973, Goldsmith et al. (24) described a marlex mesh prosthesis. The mesh pores were sealed up with collodion, and the whole prosthesis wrapped up in pedunculated omentum. Out od 12 dogs, 7 survived for a long period of time. The remaining 5 died of complications.

Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
  • Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
  • Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
  • Aby kupić kod proszę skorzystać z jednej z poniższych opcji.

Opcja #1


  • dostęp do tego artykułu
  • dostęp na 7 dni

uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony

Opcja #2


  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 30 dni
  • najpopularniejsza opcja

Opcja #3


  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 90 dni
  • oszczędzasz 28 zł
1. Bernat M: Problemy taktyki operacyjnej w zabiegach wytwórczych przełyku. Pol Przegl Chir 1984; 56: 653-658.
2. Fryfogle JD, Cyrowski GA, Rothwell D et al.: Replacement of the middle third of the esophagus with a silicone rubber prosthesis. An experiment and clinical study. Dis Chest 1963; 43: 464-475.
3. Guo Jun Huang, Wu K’ai (Ed.): Carcinoma of the oesophagus and gastric cardia. Springer Berlin 1984.
4. Tytgat GN, den Hartog Jager FC: Palliation of malignant obstruction with endoprosthesis. Acta Gastroenterol Belg 1984; 47: 188-194.
5. Mathus-Vliegen EM, Tytgat GN: Laser photocoagulation in the palliative treatment of upper digestive tract tumours. Cancer 1986; 57: 369-399.
6. Moses FM, Peura DA, Wong RK et al.: Palliative dilation of esophageal carcinoma. Gastrointest Endosc. 1985; 31: 61-63.
7. Semler P, Koch K, Schumacher W: Eine neue Moglichkeit zur Behandlung stenosierender Tumoren im obseren Gastrointestinaltrakt. Dtsch Med Wochenschr 1985; 110: 1731-1732.
8. Sons HU: Aortic rupture in manual dissection of the esophagus: a rare complication during palliative esophagectomy performed on account of radiated esophageal cancer. A pathologic-anatomic view. J Surg Oncol 1986; 31: 13-20.
9. Grindlay JH: Method of making tubes of polyethylene film for use in anastomosis of the common bile duct, trachea, and pelvic colon. Surgery 1948; 24: 22-29.
10. Berman EF: The experimental replacement of portions of the esophagus by a plastic tube. Ann Surg 1952; 135: 337.
11. Berman EF: Carcinoma of the esophagus: a new concept in therapy; sixty collected cases, using the polyethylene tube; report of ten (selected). Surgery 1954; 35: 822-835.
12. Ruffo A: Resezione dell’esofago toracico alto e sostituzione con tubi di material plastic. Minerva Chir 1952; 7: 336-343.
13. Chalnot P, Benichoux R, Gille P: Prothese de l’oesophage en matier plastique. Press Med 1952; 60: 1742-1744.
14. Roth M, HarkanyiI I, Toth J: Experimental repair of the oesophagus with a plastic tube. Acta Med Acad Sci Hung 1954; 6: 167-176.
15. Razemon F, Razemon JP, Laniez C et al.: Prosthese oesophagienne experimentale survie aprés neuf mois (1). Lile-Chir 1954; 9: 70-71.
16. Shackelford RT, Sparkuhl K: Palliative resection of the esophagus with use of a plastic tube; a case report with autopsy findings. Ann Surg 1953; 138:791-794.
17. Moore HD: The replacement of segments of the thoracic esophagus by polythene tubes. Surg Gynecol Obstet 1954; 98: 619-624.
18. Battersby JS, King H: Esophageal replacement with plastic tubes; experimental study. AMA Arch Surg 1954; 69:400-409.
19. Maynard AL, Rothman B, Naclerio EA: Experiences with the polyethylene tube in oesophageal surgery. Arch Surg 1956; 73: 142-153.
20. Ebner E: Zur Frage des Ersatzes der resezierten Speiserohre durch eine Polyathylenprothese. Wien Klin Wochenschr 1956; 68: 59-62.
21. LaGuerre JN, Schoanfeld BS, Calem W et al.: Prosthetic replacement of esophageal segments. H Thorac Cardiovascular Surg 1968; 56: 674-682.
22. Stuart DW: Post-cricoid carcinoma: end results of treatment by radical surgery and plastic tube repair. J R Soc Med 1979; 72: 724-728.
23. Stuart DW: Surgery in cancer of cervical oesophagus: plastic tube replacement. J Laryngol Otol 1966; 80: 328-396.
24. Goldsmith HS, Alday ES, Mikoshiba Y: Esophageal graft protection with intact omentum. Surg Gynecol Obstet 1973; 137: 231-234.
25. Skinner H, Conn J, Oesterle J: Experimental study on the use of homonymous transplants of esophagus in dogs. Public Health Reports 1951; 66: 29.
26. Fiaccavento W: Su un nuovo metodo di plastic esofagen con omoinnesti conservati. Minerva Chir 1952; 7: 824-827.
27. Ruffo A: Resezione dell’esofago toracico alto e sostituzione con innesto omologo fresco di esofago e con innesto fissato. Minerva Chir 1952; 7: 343-352.
28. Pate JW, Sawyer PN: Failure of freeze-dired esophageal grafts. Am J Surg 1953; 86: 152-153.
29. Pataky Z, Molnar L, Jakob T: Erfahrungen aus Ezperimenten mit lyophilisierten Speiserohrentranplanten. Zentralbl Chir 1985; 83: 2071-2077.
30. Giudice PA, Tavano C: Resezione dell’esofago cervical e sostituzione mediante transposizione di trachea. Minerva Chir 1956; 11: 475-480.
31. Galente N, Haller J, Shumacker H et al.: Experimental study of heterologus aortic and homologous tracheal grafts to bridge oesophageal defects. The American Surgeon 1958; 24: 521.
32. Roux G, Negre E, Loubatieres R et al. Etude experimentale des plasties oesophagiennes par homograffes et heterograffes vasculaires. J Int Chir 1953; 13: 34-47.
33. Sadliński C: Badania nad wartością liofilizowanych przeszczepów obcogatunkowej aorty w zabiegach plastycznych przełyku. Własna odmiana sposobu zespolenia. ŚlAM 1960.
34. Smith RA, Raison JCA: Excision of a carcinoma of the middle third of the oesophagus with aortic graft replacement; preliminary report. Br J Surg 1957; 44: 566-569.
35. Rogers FA: Restoration of the thoracic oesophagus with aortic homograft following palliative subtotal esophagectomy. Am J Surg 1958; 96: 38-42.
36. Frederickson JM, Wagenfeld DJH, Pearson G: Sastric pullup vs deltopectoral flap for reconstruction of the cervical esophagus. Arch Otolaryngol 1981; 107: 613-616.
37. Klopp C, Alford C, Pierpont H: The use of polyethylene film and split-thickness skin graft in reconstruction of cervical oesophageal and pharyngeal defects. Surgery 1951; 29: 231.
38. Edgerton MT: One stage reconstruction of the cervical esophagus or trachea. Surgery 1952; 31: 239-250.
39. Dumm JB, Macmanus JE, Anderson AA et al.: Esophageal reconstruction by means of prosthesis. Experimental and clinical experience. J Thorac Surg 1955; 30: 368-376.
40. Forster E, Campo A: Oesophagoplastic intrathoracique chez l’homme par prothese cutance libre. Poumon Coeur 1955; 11: 337-346.
41. Connar RG, Campbell FH, Pickreal KL et al.: Esophageal reconstruction with free autogenous dermal grafts. An experimental study. Surgery 1956; 39: 459-469.
42. Cenna C, Ferrero FF: Riconstruzione dell’esofago cervical con lembi autoplasticti liberi di cute. Minerva Chir 1956; 11: 767-775.
43. Kaplan I, Markowicz H: One stage primary reconstruction of the cervical esophagus by means of free tubular graft of penile skin. Br J Plast Surg 1963; 16: 314-319.
44. Neuhoff H: Fastial transplantation into visceral defects. Gynec Obstet 1917; 24: 383.
45. Rob CG, Bateman GH: Reconstruction of the trachea and the cervical esophagus. Preliminary report. Br J Surg 1949; 37: 202-205.
46. Baronofsky ID, Hilger J: Fascia lata transplants for resected cervical esophagus. Surgery 1951; 30: 355-360.
47. Henry E, Ottavioli P, Inglesakis J et al.: Utilisation de sereuses intrathoraciques comme material de plastie perietale en chirurgie oesophagienne. Press Med 1956; 64: 952-955.
48. Kawamura L, Sato H, Ogoshi S et al.: Experimental studies on an artificial esophagus using a collagen – silicone copolymer. Jpn J Surg 1983; 13: 358-367.
49. Lampe P: Badania nad biostatyczną protezą przełyku. Annales Academiae Silesiensis. 1989.
50. Takimoto Y, Nakamura T, Yamamoto Y et al.: The experimental replacement of a cervical esophageal segment with an artificial prosthesis with the use of collagen matrix and a silicone stent. J Thorac Cardiovasc Surg 1998; 116: 98-106.
51. Yamamoto Y, Nakamura T, Shimizu Y et al.: Intrathoracic esophageal replacement in the dog with the use of an artificial esophagus composed of a collagen sponge with a double-layered silicone tube. J Thorac Cardiovasc Surg 1999; 118: 276-286.
52. Qin X, Xu ZF, Shi HC et al.: (Experimental study on a novel esophageal prosthesis made of composite biomaterials). Zhonghua Wai Ke Za Zh. 2003; 41: 541-544.
53. Watanabe M, Sekine K, Hori Y et al.: Artificial esophagus with peristaltic movement. ASAIO J 2005; 51:158-561.
54. Marzaro M, Vigolo S, Oselladore B et al.: In vitro and in vivo propos al of an artificial esophagus. J Biomed Mater Res A 2006; 77: 795-801.
55. Liang JH, Zhou X, Peng PX et al.: (Experimental study of replacement of an esophageal segment with an nitinol alloy composite artificial esophagus). Zhonghua Wai Ke Za Zhi. 2006; 44: 952-955.
56. Liang JH, Zhou X, Zheng ZB et al.: Polyester connecting ring improves outcome in nitinol composite artificial esophagus. ASAIO J 2009; 55: 514-518.
57. Juhász A, Szilágyi A, Mikó I et al.: Esophageal replacement using cryopreserved tracheal graft. Dis Esophagus 2008; 21: 468-472.
otrzymano: 2011-07-20
zaakceptowano do druku: 2011-08-17

Adres do korespondencji:
*Beata Jabłońska
Katedra i Klinika Chirurgii Przewodu Pokarmowego Śląskiego Uniwersytetu Medycznego w Katowicach
40-752 Katowice, ul. Medyków 14
tel. 32 789-42-52

Postępy Nauk Medycznych s1/2011
Strona internetowa czasopisma Postępy Nauk Medycznych