喉移植：从实验可行性到多学科临床现实。

文献信息

中文摘要

喉移植是血管化复合组织移植（VCA）中最复杂的形式之一，旨在恢复不可逆喉功能障碍患者的呼吸、发声和吞咽功能。过去几十年中，系统的临床前研究——包括大型动物和啮齿动物模型的改进、器官保存优化以及免疫学机制的阐明——为临床转化奠定了科学基础。静态冷保存的进展、新兴的机器灌注技术以及基于生物标志物的精准监测进一步提高了移植物活力和排斥监测。临床上，自1998年首例成功的人喉移植以来，全球约16例病例已证明长期移植物存活和有意义功能恢复的可行性。最近，适应证已从创伤相关缺损扩展到在严格免疫学和伦理监督下精心选择的肿瘤患者。手术进展集中在微血管重建、选择性神经再支配和气道稳定，而术后管理强调个体化免疫抑制、结构化康复、感染预防以及终身监测排斥和恶性肿瘤。尽管如此，重大挑战仍然存在，包括慢性排斥、功能结局的变异性、免疫抑制下的肿瘤安全性、供体短缺以及非救命移植背景下未解决的伦理问题。未来方向集中在整合多组学生物标志物、基于机器学习的监测、生物工程支架和个性化免疫调节，以增强长期移植物功能和安全性。总体而言，喉移植已从实验可行性演变为临床上现实的重建策略，但其更广泛的应用将取决于多学科创新和严格的伦理治理。

英文摘要

Laryngeal transplantation represents one of the most complex forms of vascularized composite allotransplantation (VCA), aiming to restore respiration, phonation, and swallowing in patients with irreversible laryngeal dysfunction. Over the past decades, systematic preclinical research-including refinement of large-animal and rodent models, organ preservation optimization, and elucidation of immunological mechanisms-has laid the scientific foundation for clinical translation. Advances in static cold storage, emerging machine perfusion technologies, and biomarker-based precision monitoring have further improved graft viability and rejection surveillance. Clinically, since the first successful human laryngeal transplantation in 1998, approximately 16 cases worldwide have demonstrated the feasibility of long-term graft survival and meaningful functional recovery. More recently, indications have expanded from trauma-related defects to carefully selected oncologic patients under rigorous immunological and ethical oversight. Surgical progress has focused on microvascular reconstruction, selective neural reinnervation, and airway stabilization, while postoperative management emphasizes individualized immunosuppression, structured rehabilitation, infection prophylaxis, and lifelong surveillance for rejection and malignancy. Nonetheless, major challenges persist, including chronic rejection, variability in functional outcomes, oncologic safety under immunosuppression, donor scarcity, and unresolved ethical issues in a non-life-saving transplant context. Future directions center on integrating multi-omics biomarkers, machine-learning-based monitoring, bioengineered scaffolds, and personalized immunomodulation to enhance long-term graft function and safety. Overall, laryngeal transplantation has evolved from experimental feasibility to a clinically realistic reconstructive strategy, yet its broader application will depend on multidisciplinary innovation and rigorous ethical governance.