Restoration of extensive tracheal damage remains a significant challenge in respiratory medicine, particularly in instances stemming from conditions like infection, congenital anomalies, or stenosis. The trachea, an essential element of the lower respiratory tract, constitutes a fibrocartilaginous tube spanning approximately 10–12 cm in length. It is characterized by 18 ± 2 tracheal cartilages distributed anterolaterally with the dynamic trachealis muscle located posteriorly. While tracheotomy is a common approach for patients with short‐length defects, situations requiring replacement arise when the extent of lesion exceeds 1/2 of the length in adults (or 1/3 in children). Tissue engineering (TE) holds promise in developing biocompatible airway grafts for addressing challenges in tracheal regeneration. Despite the potential, the extensive clinical application of tissue‐engineered tracheal substitutes encounters obstacles, including insufficient revascularization, inadequate re‐epithelialization, suboptimal mechanical properties, and insufficient durability. These limitations have led to limited success in implementing tissue‐engineered tracheal implants in clinical settings. This review provides a comprehensive exploration of historical attempts and lessons learned in the field of tracheal TE, contextualizing the clinical prerequisites and vital criteria for effective tracheal grafts. The manufacturing approaches employed in TE, along with the clinical application of both tissue‐engineered and non‐tissue‐engineered approaches for tracheal reconstruction, are discussed in detail. By offering a holistic view on TE substitutes and their implications for the clinical management of long‐segment tracheal lesions, this review aims to contribute to the understanding and advancement of strategies in this critical area of respiratory medicine.

中文翻译：

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组织工程气管植入物：进展、挑战和临床考虑

大面积气管损伤的恢复仍然是呼吸医学领域的一项重大挑战，特别是在感染、先天性异常或狭窄等情况下。气管是下呼吸道的重要组成部分，由纤维软骨管组成，长度约为 10-12 厘米。其特征是18±2个气管软骨分布在前外侧，动态气管肌位于后方。虽然气管切开术是治疗短长度缺陷患者的常见方法，但当病变范围超过成人长度的 1/2（或儿童长度的 1/3）时，就会出现需要更换的情况。组织工程 (TE) 有望开发生物相容性气道移植物，以应对气管再生的挑战。尽管具有潜力，但组织工程气管替代物的广泛临床应用遇到了障碍，包括血运重建不足、上皮再形成不足、机械性能欠佳和耐久性不足。这些限制导致在临床环境中实施组织工程气管植入物的成功有限。本综述对气管 TE 领域的历史尝试和经验教训进行了全面探索，结合了有效气管移植的临床先决条件和重要标准。详细讨论了 TE 中采用的制造方法，以及组织工程和非组织工程方法在气管重建中的临床应用。通过对 TE 替代品及其对长段气管病变临床管理的影响提供整体看法，本综述旨在促进呼吸医学这一关键领域策略的理解和进步。