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Ke hana ʻia nei nā haʻawina preclinical like ʻole o ka stent Eustachian tube (ET) i hoʻomohala ʻia, akā ʻaʻole i hoʻohana ʻia i ka hana lapaʻau. I nā haʻawina preclinical, ua kaupalena ʻia nā scaffolds ET i ka hoʻonui ʻana o nā ʻiʻo i hoʻokumu ʻia e scaffold. Ua aʻo ʻia ka pono o ka cobalt-chromium sirolimus-eluting stent (SES) i ka pale ʻana i ka hoʻonui ʻana o nā ʻiʻo i hoʻokumu ʻia e ka stent ma hope o ke kau ʻana o ka stent i loko o kahi kumu hoʻohālike ET puaʻa. Ua māhele ʻia nā puaʻa ʻeono i ʻelua mau pūʻulu (ʻo ia hoʻi ka hui kaohi a me ka hui SES) me ʻekolu puaʻa i kēlā me kēia hui. Ua loaʻa i ka hui kaohi kahi stent cobalt-chromium i uhi ʻole ʻia (n = 6), a ua loaʻa i ka hui SES kahi stent cobalt-chromium me kahi uhi sirolimus-eluting (n = 6). Ua pepehi ʻia nā hui āpau 4 mau pule ma hope o ke kau ʻana o ka stent. Ua holomua ke kau ʻana o ka stent ma nā ET āpau me ka ʻole o nā pilikia e pili ana i ke ʻoki kino. ʻAʻohe o nā stents i hiki ke mālama i ko lākou ʻano poepoe mua, a ua ʻike ʻia ka hōʻiliʻili mucus i loko a puni nā stents ma nā hui ʻelua. Ua hōʻike ʻia ka loiloi histological ua haʻahaʻa loa ka wahi o ka hoʻonui ʻana o nā ʻiʻo a me ka mānoanoa o ka fibrosis submucosal i loko o ka hui SES ma mua o ka hui kaohi. ʻIke ʻia he pono ka SES i ka pale ʻana i ka hoʻonui ʻana o nā ʻiʻo i hoʻokumu ʻia e ka scaffold i loko o nā puaʻa ET. Eia nō naʻe, pono nā haʻawina hou aʻe e hōʻoia i nā mea kūpono no nā stent a me nā lāʻau antiproliferative.
He mau hana koʻikoʻi ko ka ʻōmole Eustachian (ET) ma ka pepeiao waena (e laʻa, ka hoʻoulu ʻana i ka ea, ka pale ʻana i ka hoʻoili ʻana o nā pathogens a me nā mea huna i ka nasopharynx)1. Hoʻokomo pū ʻia ka pale ʻana i nā leo nasopharyngeal a me ka regurgitation2. Hoʻopaʻa pinepine ʻia ka ET, akā wehe ʻia me ka moni ʻana, ka yawning, a i ʻole ka nau ʻana. Eia nō naʻe, hiki ke hana ʻia ka hana hewa o ka ET inā ʻaʻole wehe a pani pono paha ka ʻōmole3,4. Hoʻopilikia ka hana hewa dilated (obstructive) o ka ET i ka hana ET a, inā ʻaʻole mālama ʻia kēia mau hana, hiki ke ulu i loko o ka otitis media acute a mau paha, kekahi o nā maʻi maʻamau i ka hana ENT. Hoʻohana ʻia nā lāʻau lapaʻau o kēia manawa no ka hana hewa o ka ET (e laʻa, ke ʻoki ʻana i ka ihu, ke kau ʻana o ka ʻōmole ventilation, a me ka lāʻau lapaʻau) i nā maʻi. Eia nō naʻe, he palena ka hopena o kēia mau lāʻau lapaʻau a hiki ke alakaʻi i ka pale ʻana o ka ET, ka maʻi, a me ka perforation tympanic membrane irreversible3,6,7. Ua hoʻolauna ʻia ka Eustachian tube balloon angioplasty ma ke ʻano he lāʻau ʻē aʻe no ka hana hewa dilated ET8. ʻOiai ua hōʻike ʻia kekahi mau noiʻi mai ka makahiki 2010 he ʻoi aku ka maikaʻi o ka hoʻoponopono ʻana i ka balloon tube Eustachian ma mua o ka lāʻau maʻamau no ka hana ʻole o ka ET, ʻaʻole pane kekahi mau maʻi i ka dilatation8,9,10,11. No laila, hiki i ka stenting ke lilo i koho lapaʻau kūpono12,13. ʻOiai he nui nā noiʻi preclinical e loiloi ana i ka hiki ke hana loea a me ka pane ʻana o nā ʻiʻo ma hope o ke kau ʻana o ka stent ma ET, ʻo ka hyperplasia ʻiʻo i hoʻokomo ʻia e ka stent ma muli o ka hōʻino mechanical e mau ana he pilikia koʻikoʻi postoperative 14,15,16,17,18,19. i uhi ʻia i ka lāʻau lapaʻau, i hoʻouka ʻia me nā mea anti-proliferative e hoʻomaikaʻi i kēia kūlana.
Ua hoʻohana ʻia nā stents drug-eluting e kāohi i ka restenosis in-stent i hoʻokumu ʻia e ka hyperplasia ʻiʻo a me ka neointimal ma hope o ke kau ʻana o ka stent. ʻO ka maʻamau, ua uhi ʻia nā scaffolds a i ʻole nā ​​​​​​linings stent me nā lāʻau lapaʻau (e laʻa, everolimus, paclitaxel, a me sirolimus)20,23,24. ʻO Sirolimus kahi lāʻau antiproliferative maʻamau e kāohi ana i kekahi mau ʻanuʻu o ka restenosis cascade (e laʻa, ka mumū, ka hyperplasia neointimal, a me ka synthesis collagen)25. No laila, ua kuhiakau kēia haʻawina e hiki i nā stents i uhi ʻia e sirolimus ke pale i ka hyperplasia ʻiʻo i hoʻokomo ʻia e ka stent i nā puaʻa ET (Kiʻi 1). ʻO ka pahuhopu o kēia haʻawina, ʻo ia ke noiʻi i ka pono o nā stents sirolimus-eluting (SES) i ka pale ʻana i ka hoʻonui ʻia ʻana o nā ʻiʻo i hoʻokomo ʻia e ka stent ma hope o ke kau ʻana o ka stent i loko o kahi kumu hoʻohālike porcine ET.
Kiʻi hoʻohālike o kahi stent sirolimus-eluting cobalt-chromium (SES) no ka mālama ʻana i ka hana ʻino o ka ʻōpū Eustachian, e hōʻike ana ua kāohi ka stent sirolimus-eluting i ka hoʻonui ʻia ʻana o nā ʻiʻo i hoʻokomo ʻia e ka stent.
Ua hana ʻia nā stent alloy Cobalt-chromium (Co-Cr) e nā paipu alloy Co-Cr ʻoki laser (Genoss Co., Ltd., Suwon, Korea). Hoʻohana ka paepae stent i kahi pilina pālua hāmama me kahi hoʻolālā i hoʻohui ʻia no ka maʻalahi kiʻekiʻe me ka ikaika radial kūpono, ka pōkole a me ka hoʻokō. He 3 mm ke anawaena o ka stent, he 18 mm ka lōʻihi, a he 78 µm ka mānoanoa o ke strut (Kiʻi 2a). Ua hoʻoholo ʻia nā ana o ke kiʻikuhi alloy Co-Cr ma muli o kā mākou noiʻi mua.
ʻO ka stent alloy Cobalt-chromium (Co-Cr) a me ka ʻūpā alakaʻi metala no ke kau ʻana o ka stent tube Eustachian. Hōʻike nā kiʻi (a) kahi stent alloy Co-Cr a me (b) kahi catheter balloon i hoʻopaʻa ʻia me ka stent. (c) Ua hoʻolaha piha ʻia ka catheter balloon a me ka stent. (d) Ua hoʻomohala ʻia kahi ʻūpā alakaʻi metala no ke kumu hoʻohālike tube Eustachian puaʻa.
Ua hoʻopili ʻia ʻo Sirolimus ma luna o ka ʻili o ka stent me ka hoʻohana ʻana i ka ʻenehana pīpī ultrasonic. Ua hoʻolālā ʻia ʻo SES e hoʻokuʻu i kahi kokoke i 70% o ka ukana lāʻau mua (1.15 µg/mm2) i loko o nā lā 30 mua ma hope o ke kau ʻana. Hoʻopili wale ʻia kahi uhi lahilahi 3 µm i ka ʻaoʻao proximal o ka stent e hoʻokō i ka ʻano hoʻokuʻu lāʻau i makemake ʻia a hoʻemi i ka nui o ka polymer; aia kēia uhi biodegradable i kahi copolymer o nā waikawa lactic a me glycolic a me kahi hui ponoʻī o ka poly(1)-lactic acid)26,27. Ua ʻōwili ʻia nā stent alloy Co-Cr ma luna o nā catheters balloon 3 mm ke anawaena a me 28 mm ka lōʻihi (Genoss Co., Ltd.; Fig. 2b). Loaʻa kēia mau stent ma Korea Hema no ka mālama ʻana i ka maʻi puʻuwai coronary.
ʻO ka pūpū alakaʻi metala hou i hoʻomohala ʻia no ke kumu hoʻohālike puaʻa ET ua hana ʻia me ke kila kila (Kiʻi 2c). ʻO ke anawaena o loko a me waho o ka pūpū he 2 mm a me 2.5 mm, kēlā me kēia, ʻo ka lōʻihi holoʻokoʻa he 250 mm. Ua kulou ʻia ka ʻūpā distal 30 mm i loko o ke ʻano J ma kahi kihi 15° i ke axis e ʻae i ke komo maʻalahi mai ka ihu a i ka puka nasopharyngeal o ka ET i ke kumu hoʻohālike puaʻa.
Ua ʻāpono ʻia kēia haʻawina e ke Komite Mālama a me ka Hoʻohana ʻana i nā Holoholona o ka Asan Institute of Life Sciences (Seoul, Kōlea Hema) a ua kūlike me nā National Institutes of Health Guidelines for the Humane Treatment of Laboratory Animals (IACUC-2020-12-189). . Ua mālama ʻia ke aʻo ʻana e like me nā alakaʻi ARRIVE. Ua hoʻohana kēia haʻawina i 12 ET i loko o 6 puaʻa he 33.8-36.4 kg ke kaumaha i 3 mahina o ka makahiki. Ua māhele ʻia nā puaʻa ʻeono i ʻelua mau pūʻulu (ʻo ia hoʻi ka hui kaohi a me ka hui SES) me ʻekolu puaʻa i kēlā me kēia hui. Ua loaʻa i ka hui kaohi kahi stent Co-Cr alloy i uhi ʻole ʻia, ʻoiai ua loaʻa i ka hui SES kahi stent Co-Cr alloy eluting sirolimus. Loaʻa i nā puaʻa āpau ke komo manuahi i ka wai a me ka meaʻai a ua mālama ʻia ma 24°C ± 2°C no kahi pōʻaiapuni 12 hola o ke ao-pō. Ma hope iho, ua pepehi ʻia nā puaʻa āpau 4 mau pule ma hope o ke kau ʻana o ka stent.
Ua loaʻa i nā puaʻa a pau kahi hui ʻana o 50mg/kg zolazepam, 50mg/kg teletamide (Zoletil 50; Virbac, Carros, Palani) a me 10mg/kg xylazine (Rompun; Bayer HealthCare, Les Varkouzins, Kelemānia). a laila ua kau ʻia ka paipu tracheal ma ka hanu ʻana i ka 0.5-2% isoflurane (Ifran®; Hana Pharm. Co., Seoul, Korea) a me ka oxygen 1:1 (510 ml/kg/min) no ka anesthesia. Ua kau ʻia nā puaʻa ma ke kūlana supine a ua hana ʻia ka endoscopy baseline (VISERA 4K UHD rhinolaryngoscope; Olympus, Tokyo, Iapana) e nānā i ka puka nasopharyngeal o ET. Ua hoʻokuʻu ʻia kahi ʻūpā alakaʻi metala ma o ka puka ihu i ka puka nasopharyngeal o ET ma lalo o ka mana endoscopic (Kiʻi 3a, b). Hoʻokomo ʻia kahi catheter balloon, kahi stent corrugated, ma o ka mea hoʻokomo i loko o ka ET a hiki i kona wēlau e hālāwai me ke kū'ē ma ka osteochondral isthmus o ka ET (Kiʻi 3c). Ua hoʻopiha piha ʻia ka catheter balloon me ka saline i 9 mau lewa, e like me ka mea i hoʻoholo ʻia e ka monitor manometer (Kiʻi 3d). Ua wehe ʻia ka catheter balloon ma hope o ke kau ʻana o ka stent (Kiʻi 3f), a ua loiloi pono ʻia ka wehe ʻana o ka nasopharyngeal e ka endoscopy no nā pilikia ʻoki (Kiʻi 3f). Ua hana ʻia nā puaʻa āpau i ka endoscopy ma mua a ma hope koke iho o ka stenting, a me 4 mau pule ma hope o ka stenting, e loiloi i ka patency o ka wahi stent a me nā huna a puni.
Nā ʻanuʻu loea no ke kau ʻana i kahi stent i loko o ka ʻōmole eustachian (ET) o kahi puaʻa ma lalo o ka mana endoscopic. (a) Kiʻi endoscopic e hōʻike ana i ka puka nasopharyngeal (pua) a me ka ʻūpā alakaʻi metala i hoʻokomo ʻia (pua). (b) Hoʻokomo ʻia o kahi ʻūpā metala (pua) i loko o ka puka nasopharyngeal. (c) Hoʻokomo ʻia kahi catheter balloon i hoʻopaʻa ʻia me ka stent (pua) i loko o ka ET ma o kahi ʻūpā (pua). (d) Hoʻopiha piha ʻia ka catheter balloon (pua). (e) Ke puka nei ka hopena proximal o ka stent mai ka puka ET o ka nasopharynx. (f) Kiʻi endoscopic e hōʻike ana i ka patency lumen stent.
Ua pepehi ʻia nā puaʻa a pau ma ka hāʻawi ʻana i 75 mg/kg potassium chloride ma o ka hoʻokomo ʻana i nā aʻa pepeiao. Ua hana ʻia nā ʻāpana sagittal waena o ke poʻo puaʻa me ka hoʻohana ʻana i kahi chainsaw a ukali ʻia e ka unuhi akahele ʻana o nā laʻana ʻiʻo scaffold ET no ka hoʻokolokolo histological (Kiʻi Hoʻohui 1a,b). Ua hoʻopaʻa ʻia nā laʻana ʻiʻo ET i loko o 10% neutral buffered formalin no 24 mau hola.
Ua hoʻomaloʻo ʻia nā ʻāpana ʻiʻo ET me ka waiʻona o nā ʻano like ʻole. Ua kau ʻia nā ʻāpana i loko o nā poloka resin ma o ka hoʻokomo ʻana me ka ethylene glycol methacrylate (Technovit 7200® VLC; Heraus Kulzer GMBH, Wertheim, Kelemānia). Ua hana ʻia nā ʻāpana axial ma nā ʻāpana ʻiʻo ET i hoʻokomo ʻia i loko o nā ʻāpana proximal a me distal (Kiʻi Hoʻohui 1c). A laila ua kau ʻia nā poloka polymer ma nā paheʻe aniani acrylic. Ua wili ʻia nā paheʻe poloka resin i ka microground a ua poli ʻia me ka pepa silicon carbide o nā mānoanoa like ʻole a hiki i ka mānoanoa o 20 µm me ka hoʻohana ʻana i kahi ʻōnaehana grid (Apparatebau GMBH, Hamburg, Kelemānia). Ua hoʻokau ʻia nā paheʻe āpau i ka loiloi histological me ka hematoxylin a me ka hoʻoluʻu eosin.
Ua hana ʻia ka loiloi histological e loiloi i ka pakeneka o ka hoʻonui ʻana o nā ʻiʻo, ka mānoanoa o ka fibrosis submucosal, a me ke kekelē o ka infiltration cell inflammatory. Ua helu ʻia ka pakeneka o ka hyperplasia ʻiʻo me kahi ʻāpana cross-sectional ET haiki ma ka hoʻoponopono ʻana i ka hoohalike:
Ua ana ʻia ka mānoanoa o ka fibrosis submucosal ma ke ʻano kū pololei mai nā struts stent a i ka submucosa. Ua hoʻoholo ʻia ke kekelē o ka infiltration cell inflammatory ma ke ʻano pilikino e ka hoʻolaha a me ka nui o nā cell inflammatory, ʻo ia hoʻi: kekelē 1 (ʻoluʻolu) - hoʻokahi infiltration leukocyte hoʻokahi; kekelē 2 (ʻoluʻolu a waena) - infiltration leukocyte focal; kekelē 3 (waena) - hui pū ʻia. me nā leukocytes hiki ʻole ke hoʻokaʻawale ma waena o nā loci pākahi; papa 4 (waena a koʻikoʻi) leukocytes e komo nui ana i ka submucosa holoʻokoʻa, a me ka papa 5 (koʻikoʻi) infiltration diffuse me nā foci he nui o ka necrosis. Ua loaʻa ka mānoanoa o ka fibrosis submucosal a me ke kekelē o ka infiltration cell inflammatory ma ka awelika ʻana i ʻewalu mau kiko a puni ka pōʻai. Ua hana ʻia ka nānā ʻana o Histological o ET me ka hoʻohana ʻana i kahi microscope (BX51; Olympus, Tokyo, Iapana). Ua loaʻa nā ana me ka hoʻohana ʻana i ka polokalamu CaseViewer (CaseViewer; 3D HISTECH Ltd., Budapest, Hungary). Ua hoʻokumu ʻia ka nānā ʻana o ka ʻikepili histological ma ka ʻaelike o ʻekolu mau mea nānā i komo ʻole i ka haʻawina.
Ua hoʻohana ʻia ka hoʻāʻo U-Mann-Whitney e kālailai i nā ʻokoʻa ma waena o nā hui e like me ka mea e pono ai. Ua manaʻo ʻia he koʻikoʻi ka p < 0.05. Ua manaʻo ʻia he koʻikoʻi ka p < 0.05. Значение p < 0,05 считалось статистически значимым. Ua manaʻo ʻia he koʻikoʻi ka waiwai p < 0.05. p < 0.05 被认为具有统计学意义。 p < 0.05 p < 0,05 считали статистически значимым. ua manaʻo ʻia he koʻikoʻi ka p < 0.05. Ua hana ʻia kahi hoʻāʻo Mann-Whitney U i hoʻoponopono ʻia e Bonferroni no nā waiwai p < 0.05 e ʻike i nā ʻokoʻa hui (p < 0.008 ma ke ʻano he koʻikoʻi helu). Ua hana ʻia kahi hoʻāʻo Mann-Whitney U i hoʻoponopono ʻia e Bonferroni no nā waiwai p < 0.05 e ʻike i nā ʻokoʻa hui (p < 0.008 ma ke ʻano he koʻikoʻi helu helu). U-критерий Манна-Уитни с поправкой на Бонферрони был выполнен для значений p <0,05 для выявления групления групления групвый (8 plis <0ч0йх статистически значимое). Ua hana ʻia ka hoʻāʻo Mann-Whitney U i hoʻoponopono ʻia e Bonferroni no nā waiwai p <0.05 e ʻike i nā ʻokoʻa hui (p <0.008 ma ke ʻano he koʻikoʻi helu helu).对p 值< 0.05 进行 Bonferroni 校正的Mann-Whitney U 检验以检测组差异（p < 0.008 具有统计幦意。对p 值< 0.05 进行Bonferroni 校正的Mann-Whitney U U-критерий Манна-Уитни с поправкой на Бонферрони был выполнен для значений p < 0,05 для выявления групления групвих (0 <8 бпочвих статистически значимым). Ua hana ʻia ka hoʻāʻo Mann-Whitney U i hoʻoponopono ʻia e Bonferroni no p < 0.05 e ʻike i nā ʻokoʻa hui (p < 0.008 he koʻikoʻi ka helu helu).Ua hana ʻia ka loiloi helu me ka hoʻohana ʻana i ka polokalamu SPSS (mana 27.0; SPSS, IBM, Chicago, IL, USA).
Ua kūleʻa loa nā kau ʻana o ka stent puaʻa a pau. Ua kau pono ʻia kahi ʻūpā alakaʻi metala i loko o ka puka nasopharyngeal o ET ma lalo o ka mana endoscopic, ʻoiai ua ʻike ʻia ka ʻeha mucosal me ke kahe koko pili i 4 o 12 mau specimens (33.3%) i ka wā o ke kau ʻana o ka ʻūpā metala. Ma hope o 4 mau pule, ua pau koke ke kahe koko i ʻike ʻia. Ua ola nā puaʻa a pau a hiki i ka hopena o ke aʻo ʻana me ka ʻole o nā pilikia e pili ana i ka stent.
Ua hōʻike ʻia nā hopena Endoscopy ma ke Kiʻi 4. I ka wā o ka nānā ʻana he 4 pule, ua noho nā stents ma kahi o nā puaʻa āpau. Ua ʻike ʻia ka hōʻiliʻili ʻana o ka mucus i loko a puni ka ET stent ma nā ET āpau (100%) i ka hui kaohi a me ʻekolu (50%) o nā ET ʻeono i ka hui SES, a ʻaʻohe ʻokoʻa o ka hanana ma waena o nā hui ʻelua (p = 0.182). ʻAʻohe o nā stents i hoʻokomo ʻia i hiki ke mālama i kahi ʻano poepoe.
Nā kiʻi endoscopic o ka ʻōmole Eustachian (ET) o kahi puaʻa i loko o ka hui kaohi a me ka hui me kahi stent cobalt-chromium (CXS) e hoʻokuʻu ana i ka sirolimus. (a) Kiʻi endoscopic kumu i lawe ʻia ma mua o ke kau ʻana o ka stent e hōʻike ana i ka wehe ʻana o ka nasopharyngeal (pua) o ET. (b) Kiʻi endoscopic i lawe koke ʻia ma hope o ke kau ʻana o ka stent e hōʻike ana i ka ET o ke kau ʻana o ka stent. Ua ʻike ʻia ke kahe koko pili ma muli o ka ʻūpā alakaʻi metala (pua). (c) ʻO ke kiʻi endoscopic i lawe ʻia i 4 mau pule ma hope o ke kau ʻana o ka stent e hōʻike ana i ka hōʻiliʻili ʻana o ka mucus a puni ka stent (pua). (d) Kiʻi endoscopic e hōʻike ana ʻaʻole hiki i ka stent ke noho poepoe (pua).
Ua hōʻike ʻia nā ʻike histological ma ke Kiʻi 5 a me ke Kiʻi Hoʻohui 2. Ka hoʻonui ʻana o nā ʻiʻo a me ka hoʻonui ʻana o ka fibrous submucosal ma waena o nā pou stent i loko o ka lumen ET o nā hui ʻelua. ʻOi aku ka nui o ka pakeneka awelika o ka ʻāpana hyperplasia kiko i ka hui kaohi ma mua o ka hui SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p < 0.001). ʻOi aku ka nui o ka pakeneka awelika o ka ʻāpana hyperplasia kiko i ka hui kaohi ma mua o ka hui SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p < 0.001). Средний процент площади гиперплазии тканей был значительно больше в контрольной группе, чем в группе (7 ± 48% (7 ± 6% против 48,36% ± 10,06%, p <0,001). ʻOi aku ka nui o ka pakeneka ʻāpana o ka hyperplasia ʻiʻo ma ka hui kaohi ma mua o ka hui SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p < 0.001).SES 组（79.48% ± 6.82% vs.48.36% ± 10.06%, p < 0.001）. 48.36% ± 10.06%, p < 0.001）. Средний процент площади гиперплазии тканей в контрольной группе был значительно выше, чем в группе СЭС (7 ± 8% (7 ± 8% С). 48,36% ± 10,06%, p <0,001). ʻOi aku ka kiʻekiʻe o ka pakeneka ʻāpana awelika o ka hyperplasia ʻiʻo i ka hui kaohi ma mua o ka hui SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p < 0.001). Eia kekahi, ʻoi aku ka kiʻekiʻe o ka mānoanoa awelika o ka fibrosis submucosal i ka hui kaohi ma mua o ka hui SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001). Eia kekahi, ʻoi aku ka kiʻekiʻe o ka mānoanoa awelika o ka fibrosis submucosal i ka hui kaohi ma mua o ka hui SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001). Более того, средняя толщина подслизистого фиброза также была значительно выше в контрольной группе, чем в 1 гру, 1 против 0,56 ± 0,20 мм, p <0,001). Eia kekahi, ʻoi aku ka kiʻekiʻe o ka mānoanoa awelika o ka fibrosis submucosal i ka hui kaohi ma mua o ka hui SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001).SES 组（1.41 ± 0.25 vs.0.56 ± 0.20 mm, p < 0.001). 0.56±0.20mm, p<0.001）. Кроме того, средняя толщина подслизистого фиброза в контрольной группе также была значительно выше, чем в ,4 ±5пс (1 група против 0,56 ± 0,20 мм, p <0,001). Eia kekahi, ʻoi aku ka kiʻekiʻe o ka mānoanoa o ka fibrosis submucosal i ka hui kaohi ma mua o ka hui SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001).Eia nō naʻe, ʻaʻohe ʻokoʻa koʻikoʻi i ke kiʻekiʻe o ka infiltration cell inflammatory ma waena o nā hui ʻelua (hui kaohi [3.50 ± 0.55] vs. hui SES [3.00 ± 0.89], p = 0.270).
ʻO ka nānā ʻana i ka hoʻokolokolo histological o nā hui ʻelua o nā stents i kau ʻia ma ka lumen Eustachian. (a, b) ʻOi aku ka nui o ka wahi o ka hyperplasia kiko (1 o a a me b) a me ka mānoanoa o ka fibrosis submucosal (2 o a a me b; nā pua pālua) ma ka hui kaohi ma mua o ka hui SES me ka strut stenting (nā kiko ʻeleʻele), ka wahi o ka lumen haiki (melemele) a me ka wahi stent mua (ʻulaʻula). ʻAʻole ʻokoʻa nui ke kekelē o ka infiltration cell inflammatory (3 o a a me b; nā pua) ma waena o nā hui ʻelua. (c) Nā hopena histological o ka pakeneka o ka wahi o ka hyperplasia kiko, (d) ka mānoanoa o ka fibrosis submucosal, a me (e) ke kekelē o ka infiltration cell inflammatory 4 mau pule ma hope o ke kau ʻana o ka stent ma nā hui ʻelua. SES, cobalt-chromium sirolimus eluting stent.
Kōkua nā stent e hoʻopili ana i ka lāʻau lapaʻau i ka hoʻomaikaʻi ʻana i ka patency o ka stent a pale i ka restenosis o ka stent20,21,22,23,24. ʻO nā strictures i hoʻokomo ʻia e ka stent ka hopena o ka hoʻokumu ʻana o nā ʻiʻo granulation a me nā loli o nā ʻiʻo fibrous i nā ʻano ʻano ʻole vascular, me ka esophagus, trachea, gastroduodenum, a me nā ducts bile. Hoʻopili ʻia nā lāʻau lapaʻau e like me dexamethasone, paclitaxel, gemcitabine, EW-7197, a me sirolimus i ka ʻili o ka uea uea a i ʻole ka uhi stent e pale a mālama paha i ka hyperplasia ʻiʻo ma hope o ke kau ʻana o ka stent29,30,34,35,36. Ke noiʻi ikaika ʻia nei nā hana hou i ke kahua o nā stent multifunctional e hoʻohana ana i ka ʻenehana fusion no ka mālama ʻana i nā maʻi occlusive non-vascular37,38,39. Ma kahi noiʻi mua i loko o kahi kumu hoʻohālike ET porcine, ua ʻike ʻia ka hoʻonui ʻia ʻana o nā ʻiʻo i hoʻokomo ʻia e ka scaffold. ʻOiai ʻaʻole maopopo loa ka hoʻomohala ʻana o ka stent ma ET, ua ʻike ʻia ka pane ʻana o nā ʻiʻo ma hope o ke kau ʻana o ka stent e like me nā ʻōpū luminal nonvascular ʻē aʻe19. Ma ke aʻo ʻana i kēia manawa, ua hoʻohana ʻia ʻo SES e kāohi i ka hoʻonui ʻana o nā ʻiʻo i hoʻokumu ʻia e ka scaffold i loko o kahi kumu hoʻohālike ET porcine. He mea ʻawahia ʻo Sirolimus i nā islets pancreatic a me nā laina cell beta, hoʻemi i ke ola o nā cell a hoʻonui i ka apoptosis40,41. Hiki i kēia hopena ke kōkua i ka pale ʻana i ka hoʻokumu ʻana o ka hoʻonui ʻana o nā ʻiʻo ma ka hoʻoulu ʻana i ka make o nā cell. Ua hōʻike kā mākou noiʻi ʻo ka hoʻohana mua ʻana o nā stents drug-eluting ma ET ua kāohi pono i ka hoʻonui ʻana o nā ʻiʻo i hoʻokumu ʻia e ka stent ma ET.
Loaʻa koke ka stent Co-Cr alloy balloon-expandable i hoʻohana ʻia ma kēia haʻawina no ka mea maʻamau ia e mālama i nā maʻi artery coronary 42. Eia kekahi, loaʻa i nā alloys Co-Cr nā waiwai mechanical (no ka laʻana, ka ikaika radial kiʻekiʻe a me nā ikaika inelastic) 43. Wahi a ka endoscopy o ke aʻo ʻana o kēia manawa, ʻaʻole hiki i ka stent alloy Co-Cr i hoʻohana ʻia no ka ET o nā puaʻa ke mālama i kahi ʻano poepoe i nā puaʻa āpau ma muli o ka lawa ʻole o ka elasticity a ʻaʻohe ona hiki ke hoʻonui ponoʻī. Hiki ke hoʻololi ʻia ke ʻano o ka stent i hoʻokomo ʻia e ka neʻe ʻana a puni ka ET o kahi holoholona ola (e laʻa, ka nau ʻana a me ka moni ʻana). Ua lilo nā waiwai mechanical o nā stent alloy Co-Cr i mea hemahema i ke kau ʻana o nā stent ET porcine. Eia kekahi, ʻo ke kau ʻana o kahi stent i loko o ka isthmus e hopena i ka ET wehe mau loa. ʻO ka ET wehe mau a hoʻolōʻihi paha e ʻae i ka ʻōlelo a me nā leo nasopharyngeal, gastrointestinal reflux, a me nā pathogens1 e hele i luna i ka pepeiao waena, e hoʻoulu ai i ka huhū mucosal a me ka maʻi. No laila, pono e pale ʻia nā puka nasopharyngeal mau loa. No laila, i hāʻawi ʻia i ke ʻano o ke cartilage ET, ʻoi aku ka maikaʻi o ka hana ʻana i nā scaffolds mai nā mea hoʻomanaʻo ʻano me nā waiwai superelastic, e like me ka nitinol. Ma keʻano laulā, ua loaʻa ka hoʻokuʻu nui i loko a puni ka puka nasopharyngeal o ka stent. ʻOiai ua ālai ʻia ka neʻe ʻana o ka mucociliary maʻamau o ka mucus, manaʻo ʻia e hōʻiliʻili ka mea huna i loko o nā scaffolds e puka mai ana mai ka puka nasopharyngeal. ʻO ka pale ʻana i ka maʻi pepeiao waena e piʻi ana kekahi o nā pahuhopu nui o ET, a pono e pale ʻia ke kau ʻana o nā stents e puka ana ma ʻō aku o ET, ʻoiai ʻo ka hoʻopili pololei ʻana o nā stents me nā flora bacteria nasopharyngeal hiki ke alakaʻi i ka hoʻonui ʻia ʻana o nā maʻi e piʻi ana.
ʻO ka plasty balloon tube Eustachian ma o ka puka nasopharyngeal he lāʻau lapaʻau hou minimally invasive no ka ET dysfunction i manaʻo ʻia e wehe a hoʻonui i ka ʻāpana cartilaginous o ET8,9,10,46. Eia nō naʻe, ʻaʻole i ʻike ʻia ke ʻano therapeutic ma lalo47 a ʻo kona mau hopena lōʻihi he suboptimal8,9,11,46. Ma lalo o kēia mau kūlana, hiki i ka stenting metala manawa pōkole ke lilo i koho lapaʻau kūpono no nā poʻe maʻi i pane ʻole i ka hoʻoponopono balloon tube Eustachian, a ua hōʻike ʻia ka hiki ke hana i ka stenting ET i nā haʻawina preclinical he nui. Ua hoʻokomo ʻia nā scaffolds Poly-l-lactide ma o ka membrane tympanic i loko o nā chinchillas a me nā lāpaki e loiloi i ka tolerability a me ka degradation in vivo17,18. Eia kekahi, ua hana ʻia kahi kumu hoʻohālike hipa e loiloi i ke ʻano o nā stents expandable balloon metala in vivo. Ma kā mākou noiʻi mua, ua hoʻomohala ʻia kahi kumu hoʻohālike ET puaʻa e noiʻi i ka hiki ke hana loea a me ka loiloi ʻana i nā pilikia i hoʻokomo ʻia e ka stent,19 e hāʻawi ana i kahi kumu paʻa no kēia noiʻi e noiʻi i ka pono o SES me ka hoʻohana ʻana i nā ʻano hana i hoʻokumu mua ʻia. Ma kēia noiʻi, ua hoʻokomo pono ʻia ʻo SES i ke cartilage a ua kāohi pono i ka hoʻolaha ʻana o nā ʻiʻo. ʻAʻohe pilikia e pili ana i ka stent, akā aia ka ʻeha mucosal i hoʻokumu ʻia e ka ʻūpā alakaʻi metala me ke kahe koko pili i hoʻopau koke ʻia i loko o 4 mau pule. Ma muli o nā pilikia hiki o nā ʻūpā metala, ʻo ka hoʻomaikaʻi ʻana i ka ʻōnaehana hāʻawi SES he mea wikiwiki a koʻikoʻi.
He mau palena ko kēia haʻawina. ʻOiai ua ʻokoʻa nui nā ʻike histological ma waena o nā hui, ua liʻiliʻi loa ka nui o nā holoholona i loko o kēia haʻawina no kahi loiloi helu hilinaʻi. ʻOiai ua makapō ʻia ʻekolu mau mea nānā e loiloi i ka loli ma waena o nā mea nānā, ua hoʻoholo ʻia ke kiʻekiʻe o ka infiltration cell inflammatory submucosal ma ke ʻano pilikino ma muli o ka hoʻolaha a me ka nui o nā cell inflammatory ma muli o ka paʻakikī o ka helu ʻana i nā cell inflammatory. ʻOiai ua hana ʻia kā mākou haʻawina me ka hoʻohana ʻana i kahi helu palena o nā holoholona nui, ua hoʻohana ʻia hoʻokahi mahele o ka lāʻau, ʻaʻole i hana ʻia nā haʻawina pharmacokinetic in vivo. Pono nā haʻawina hou aʻe e hōʻoia i ka dosage kūpono o ka lāʻau a me ka palekana o sirolimus ma ET. ʻO ka hope loa, ʻo ka manawa hahai 4-pule he palena nō hoʻi ia o ke aʻo ʻana, no laila pono nā haʻawina e pili ana i ka pono lōʻihi o SES.
Hōʻike nā hopena o kēia noiʻi e hiki i ka SES ke kāohi pono i ka hoʻonui ʻana o nā ʻiʻo i hoʻoulu ʻia e ka ʻeha mechanical ma hope o ke kau ʻana o nā scaffolds alloy Co-Cr balloon-expandable i loko o kahi kumu hoʻohālike ET porcine. ʻEhā pule ma hope o ke kau ʻana o ka stent, ʻoi aku ka haʻahaʻa o nā loli e pili ana i ka hoʻonui ʻana o nā ʻiʻo i hoʻoulu ʻia e ka stent (me ka ʻāpana o ka hoʻonui ʻana o nā ʻiʻo a me ka mānoanoa o ka fibrosis submucosal) i ka hui SES ma mua o ka hui kaohi. ʻIke ʻia he pono ka SES i ka pale ʻana i ka hoʻonui ʻana o nā ʻiʻo i hoʻoulu ʻia e ka scaffold i nā puaʻa ET. ʻOiai pono ka noiʻi hou aku e hoʻāʻo i nā mea stent kūpono a me nā dosages o nā moho lāʻau, loaʻa i ka SES ka hiki ke therapeutic kūloko i ka pale ʻana i ka hyperplasia ʻiʻo ET ma hope o ke kau ʻana o ka stent.
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