第二種再生医療等提供計画における培養脂肪幹細胞を用いた乳房再建

Breast Reconstruction Using Stem Cell Culture in the Second-Class Regenerative Medicine Provision Plan

はじめに

　脂肪の生着率を高めるとされる幹細胞付加脂肪移植術には術中に一部の脂肪から幹細胞を含む分画を抽出して，それ以外の脂肪細胞と混合して幹細胞の割合を高めた脂肪移植を行う方法と，術前に少量の脂肪細胞を採取し，幹細胞を分離して培養し増加させ，後日，改めて吸引した脂肪と混合して移植する方法の2種類がある。本稿では，第二種再生医療等提供計画に相当する後者について述べる。

　In grafting procedures that involve cultured adipose-derived stromal cell (ADSCs)-added fat, a small amount of fat cells is harvested preoperatively, the stem cells are isolated, cultured and increased, and the cells are then mixed with the aspirated fat again at a later date for transplantation. At our hospital, cultured ADSCs-added fat transplantation has been performed in seven cases to date, and two of the seven cases have been completed up to nipple reconstruction. Three fat injections were required in each of these two cases, and the postoperative MRI evaluations showed little fat necrosis. The average fat retention rate was 72%. Breast reconstruction using cultured ADSCs-added fat grafting is a technique that requires a longer culture period and a greater number of treatments, but it has potential for improved engraftment rates. In addition, compared to SVF-added fat grafting, the use of cultured ADSCs-added fat requires a smaller amount of fat and does not require special equipment.