목적: Diverse tracheal tissue engineering approaches with artificial graft have been attempted to reconstruct the circumferential tracheal defects. It is well known that long-segment circumferential defects still represent a major reconstructive problem that needs much time for tracheal epithelial regeneration on the luminal surface. 방법:For long-segment circumferential tracheal reconstruction, a novel tissue- engineered tracheal graft was developed. Native trachea-mimetic bellows scaffold, a framework of the tissue-engineered tracheal graft, was designed and its mechanical behavior under three-point bending and radial compression was analyzed using FEM analysis. Bellows scaffold was then fabricated by indirect 3D printing technique. Tracheal epithelial decellularized extracellular matrix (tedECM) hydrogel was stratified on the luminal surface of the bellows scaffold reinforced with silicon rings and human inferior turbinate mesenchymal stem cell (hTMSC) sheets were transferred to the tedECM hydrogel layer to facilitate tracheal epithelial regeneration. Tissue-engineered tracheal grafts were cultured in vitro for 3 days and implanted into the circumferential tracheal defect in a rabbit model. Tracheal epithelial regeneration was then assessed by bronchoscopy, x-ray, macroscopic, histological and immunohistochemical examinations at 2 months after implantation. 결과:The mature tracheal epithelium with predominant ciliated cells was completely regenerated on the entire luminal surface of the tissue- engineered tracheal graft within 2 months after implantation. 결론:Long-segment circumferential tracheal reconstruction using a tissue- engineered tracheal graft was successfully performed. A tissue-engineered tracheal graft with tedECM and hTMSC sheets might be a novel concept of clinically applicable tracheal substitute for tracheal reconstruction.