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Muaj ntau txoj kev tshawb fawb ua ntej kho mob ntawm Eustachian tube (ET) stent uas tau tsim tawm tam sim no, tab sis nws tseem tsis tau siv rau hauv kev kho mob. Hauv kev tshawb fawb ua ntej kho mob, ET scaffolds tau txwv rau scaffold-induced tissue proliferation. Kev ua haujlwm ntawm cobalt-chromium sirolimus-eluting stent (SES) hauv kev tiv thaiv stent-induced tissue proliferation tom qab stent tso tau kawm hauv tus qauv npua ET. Rau tus npua tau muab faib ua ob pawg (piv txwv li pawg tswj thiab pawg SES) nrog peb tus npua hauv txhua pawg. Pawg tswj tau txais uncoated cobalt-chromium stent (n = 6), thiab pawg SES tau txais cobalt-chromium stent nrog sirolimus-eluting coating (n = 6). Txhua pawg tau txi 4 lub lis piam tom qab stent tso. Stent tso tau ua tiav hauv txhua ETs yam tsis muaj teeb meem cuam tshuam nrog kev phais. Tsis muaj ib qho ntawm cov stents tuaj yeem khaws lawv cov duab puag ncig qub, thiab mucus accumulation tau pom nyob rau hauv thiab nyob ib puag ncig cov stents hauv ob pawg. Kev tshuaj xyuas keeb kwm qhia tau hais tias thaj chaw ntawm cov ntaub so ntswg loj hlob thiab qhov tuab ntawm submucosal fibrosis hauv pawg SES qis dua li hauv pawg tswj. SES zoo li muaj txiaj ntsig zoo hauv kev tiv thaiv scaffold-induced cov ntaub so ntswg loj hlob hauv ET npua. Txawm li cas los xij, xav tau kev tshawb fawb ntxiv kom paub meej cov ntaub ntawv zoo tshaj plaws rau stents thiab tshuaj antiproliferative.
Lub raj Eustachian (ET) muaj cov haujlwm tseem ceeb hauv pob ntseg nruab nrab (piv txwv li, cua nkag, tiv thaiv kev xa cov kab mob thiab cov kua qaub mus rau nasopharynx)1. Kuj suav nrog kev tiv thaiv tiv thaiv suab nasopharyngeal thiab regurgitation2. Lub ET feem ntau kaw, tab sis qhib nrog kev nqos, yawning, lossis zom. Txawm li cas los xij, ET dysfunction tuaj yeem tshwm sim yog tias lub raj tsis qhib lossis kaw kom zoo3,4. Dilated (obstructive) dysfunction ntawm ET ua rau ET ua haujlwm tsis zoo thiab, yog tias cov haujlwm no tsis raug khaws cia, yuav tsim mus rau hauv mob otitis media mob hnyav lossis mob ntev, ib qho ntawm cov kab mob feem ntau hauv kev xyaum ENT. Cov kev kho mob tam sim no rau ET dysfunction (piv txwv li, phais qhov ntswg, tso lub raj cua nkag, thiab tshuaj) yog siv rau cov neeg mob. Txawm li cas los xij, cov kev kho mob no muaj txiaj ntsig tsawg thiab yuav ua rau ET thaiv, kab mob, thiab tsis rov qab tau tympanic membrane perforation3,6,7. Eustachian tube balloon angioplasty tau qhia ua lwm txoj kev kho mob rau dilated ET 8 dysfunction. Txawm hais tias ntau txoj kev tshawb fawb txij li xyoo 2010 tau qhia tias kev kho lub raj Eustachian zoo dua li kev kho mob ib txwm muaj rau ET dysfunction, qee tus neeg mob tsis teb rau dilatation8,9,10,11. Yog li, stenting yuav yog ib qho kev xaiv kho mob zoo12,13. Txawm hais tias muaj ntau txoj kev tshawb fawb ua ntej kev kho mob uas ntsuas qhov ua tau thiab cov ntaub so ntswg teb tom qab stent tso rau hauv ET, stent-induced cov ntaub so ntswg hyperplasia vim yog kev puas tsuaj rau lub cev tseem yog qhov teeb meem tom qab phais 14,15,16,17,18,19. tshuaj-coated, loaded nrog anti-proliferative agents txhim kho qhov xwm txheej no.
Cov tshuaj stents uas tsis muaj tshuaj tau siv los tiv thaiv kev rov qab los ntawm cov nqaij thiab neointimal hyperplasia tom qab muab stent tso rau hauv. Feem ntau, stent scaffolds lossis linings yog coated nrog cov tshuaj (piv txwv li, everolimus, paclitaxel, thiab sirolimus)20,23,24. Sirolimus yog ib qho tshuaj antiproliferative ib txwm muaj uas inhibits ntau kauj ruam ntawm restenosis cascade (piv txwv li, o, neointimal hyperplasia, thiab collagen synthesis)25. Yog li ntawd, txoj kev tshawb fawb no tau xav tias sirolimus-coated stents tuaj yeem tiv thaiv stent-induced tissue hyperplasia hauv ET npua (Daim Duab 1). Lub hom phiaj ntawm txoj kev tshawb fawb no yog los tshawb nrhiav qhov ua tau zoo ntawm sirolimus-eluting stents (SES) hauv kev tiv thaiv stent-induced tissue proliferation tom qab muab stent tso rau hauv tus qauv porcine ET.
Daim duab kos ntawm lub stent cobalt-chromium sirolimus-eluting (SES) rau kev kho mob Eustachian tube dysfunction, qhia tias lub stent sirolimus-eluting inhibits stent induced tissue proliferation.
Cov hlau nplaum Cobalt-chromium (Co-Cr) tau tsim los ntawm kev txiav laser Co-Cr alloy tubes (Genoss Co., Ltd., Suwon, Kauslim Teb). Lub platform stent siv qhov qhib ob chav sib txuas nrog lub tsev sib koom ua ke rau kev ywj pheej siab nrog lub zog radial zoo tshaj plaws, luv luv thiab ua raws li. Lub stent muaj txoj kab uas hla ntawm 3 hli, ntev ntawm 18 hli, thiab strut tuab ntawm 78 µm (Daim Duab 2a). Qhov ntev ntawm Co-Cr alloy thav duab tau txiav txim siab raws li peb txoj kev tshawb fawb yav dhau los.
Cobalt-chromium (Co-Cr) alloy stent thiab hlau guide sheath rau Eustachian tube stent tso. Cov duab qhia (a) Co-Cr alloy stent thiab (b) lub stent-clamped balloon catheter. (c) Lub balloon catheter thiab stent tau xa tawm tag nrho. (d) Ib lub hlau guide sheath tau tsim rau tus qauv porcine Eustachian tube.
Sirolimus tau siv rau ntawm qhov chaw ntawm lub stent siv cov thev naus laus zis ultrasonic tsuag. SES yog tsim los tso tawm yuav luag 70% ntawm cov tshuaj thawj zaug (1.15 µg / mm2) hauv 30 hnub thawj zaug tom qab muab tso rau. Ib txheej ultra-thin 3 µm tsuas yog siv rau sab proximal ntawm lub stent kom ua tiav cov tshuaj tso tawm xav tau thiab txo qhov ntau ntawm polymer; cov txheej txheem biodegradable no muaj cov copolymer ntawm lactic thiab glycolic acids thiab cov khoom sib xyaw ntawm poly (1) -lactic acid) 26,27. Co-Cr alloy stents tau crimped rau ntawm lub raj mis catheters 3 hli hauv txoj kab uas hla thiab 28 hli ntev (Genoss Co., Ltd.; Daim duab 2b). Cov stents no muaj nyob rau hauv Kaus Lim Qab Teb rau kev kho mob ntawm cov kab mob plawv coronary.
Lub plhaub hlau tshiab tsim rau tus qauv npua ET yog ua los ntawm cov hlau tsis xeb (Daim Duab 2c). Lub plhaub sab hauv thiab sab nraud yog 2 hli thiab 2.5 hli, feem, tag nrho ntev yog 250 hli. Lub plhaub 30 hli distal tau khoov rau hauv J-puab ntawm lub kaum sab xis 15° rau lub axis kom yooj yim nkag mus los ntawm lub qhov ntswg mus rau qhov nasopharyngeal orifice ntawm ET hauv tus qauv npua.
Txoj kev tshawb fawb no tau txais kev pom zoo los ntawm Pawg Neeg Saib Xyuas thiab Siv Tsiaj ntawm Asan Institute of Life Sciences (Seoul, Kaus Lim Qab Teb) thiab ua raws li National Institutes of Health Guidelines for the Humane Treatment of Laboratory Animals (IACUC-2020-12-189). . Txoj kev tshawb fawb no tau ua raws li ARRIVE cov lus qhia. Txoj kev tshawb fawb no siv 12 ETs hauv 6 tus npua uas hnyav 33.8-36.4 kg thaum muaj hnub nyoog 3 lub hlis. Rau tus npua tau muab faib ua ob pawg (piv txwv li pawg tswj thiab pawg SES) nrog peb tus npua hauv txhua pawg. Pawg tswj tau txais lub stent Co-Cr alloy uas tsis muaj txheej, thaum pawg SES tau txais lub stent Co-Cr alloy eluting sirolimus. Tag nrho cov npua muaj kev nkag mus rau dej thiab pub dawb thiab tau khaws cia ntawm 24 ° C ± 2 ° C rau 12-teev hnub-hmo voj voog. Tom qab ntawd, tag nrho cov npua tau tua 4 lub lis piam tom qab muab stent tso.
Tag nrho cov npua tau txais kev sib xyaw ntawm 50mg / kg zolazepam, 50mg / kg teletamide (Zoletil 50; Virbac, Carros, Fabkis) thiab 10mg / kg xylazine (Rompun; Bayer HealthCare, Les Varkouzins, Lub Tebchaws Yelemees). tom qab ntawd lub raj tracheal tau muab tso rau los ntawm kev nqus pa ntawm 0.5-2% isoflurane (Ifran®; Hana Pharm. Co., Seoul, Kauslim Teb) thiab oxygen 1: 1 (510 ml / kg / min) rau kev siv tshuaj loog. Cov npua tau muab tso rau hauv txoj haujlwm supine thiab kev kuaj mob endoscopy (VISERA 4K UHD rhinolaryngoscope; Olympus, Tokyo, Nyiv) tau ua los tshuaj xyuas qhov ntswg ntawm ET. Lub hnab hlau coj tau nce mus los ntawm qhov ntswg mus rau qhov ntswg ntawm ET nyob rau hauv kev tswj hwm endoscopic (Daim duab 3a, b). Ib lub catheter uas muaj lub raj xa dej, uas yog ib lub stent uas muaj corrugated, raug ntxig los ntawm lub introducer rau hauv ET kom txog thaum nws lub hau ntsib qhov kev tiv thaiv hauv osteochondral isthmus ntawm ET (Daim Duab 3c). Lub catheter uas muaj lub raj xa dej tau raug cua kom puv nrog saline mus rau 9 atmospheres, raws li tau txiav txim los ntawm lub manometer monitor (Daim Duab 3d). Lub catheter uas muaj lub raj xa dej tau raug tshem tawm tom qab muab stent tso rau hauv (Daim Duab 3f), thiab qhov qhib ntawm nasopharyngeal tau raug soj ntsuam zoo zoo los ntawm endoscopy rau cov teeb meem phais (Daim Duab 3f). Tag nrho cov npua tau raug endoscopy ua ntej thiab tom qab stenting, nrog rau 4 lub lis piam tom qab stenting, los soj ntsuam qhov patency ntawm qhov chaw stent thiab cov kua qaub nyob ib puag ncig.
Cov kauj ruam kev siv tshuab rau kev tso lub stent rau hauv lub raj eustachian (ET) ntawm tus npua nyob rau hauv kev tswj hwm endoscopic. (a) Duab Endoscopic qhia txog qhov qhib nasopharyngeal (xub) thiab lub plhaub hlau qhia (xub). (b) Kev ntxig lub plhaub hlau (xub) rau hauv qhov qhib nasopharyngeal. (c) Lub raj xa dej uas muaj stent clamped (xub) raug ntxig rau hauv ET los ntawm lub plhaub (xub). (d) Lub raj xa dej uas muaj balloon (xub) raug inflated tag nrho. (e) Qhov kawg ntawm lub stent tawm ntawm lub qhov ET ntawm lub nasopharynx. (f) Duab Endoscopic qhia txog stent lumen patency.
Tag nrho cov npua raug tua pov tseg los ntawm kev muab 75 mg / kg potassium chloride los ntawm kev txhaj tshuaj rau ntawm cov hlab ntsha pob ntseg. Cov ntu nruab nrab ntawm lub taub hau npua tau ua tiav siv lub tshuab txiav nyom ua raws li kev rho tawm cov qauv ntaub so ntswg ET scaffold kom zoo rau kev kuaj mob histological (Daim Duab Ntxiv 1a, b). Cov qauv ntaub so ntswg ET tau kho rau hauv 10% neutral buffered formalin rau 24 teev.
Cov qauv ntaub so ntswg ET tau raug ziab kom qhuav nrog cawv ntawm ntau yam kev sib xyaw. Cov qauv tau muab tso rau hauv cov pob zeb resin los ntawm kev nkag mus nrog ethylene glycol methacrylate (Technovit 7200® VLC; Heraus Kulzer GMBH, Wertheim, Lub Tebchaws Yelemees). Cov ntu axial tau ua rau cov qauv ntaub so ntswg ET uas tau muab tso rau hauv cov ntu proximal thiab distal (Supplementary Fig. 1c). Cov pob zeb polymer tom qab ntawd tau teeb tsa rau ntawm cov iav acrylic. Cov pob zeb resin tau microground thiab polished nrog daim ntawv silicon carbide ntawm ntau yam thicknesses txog li 20 µm siv lub grid system (Apparatebau GMBH, Hamburg, Lub Tebchaws Yelemees). Tag nrho cov pob zeb tau raug rau kev ntsuam xyuas histological nrog hematoxylin thiab eosin staining.
Kev ntsuam xyuas histological tau ua los ntsuas qhov feem pua ​​ntawm cov ntaub so ntswg loj hlob, qhov tuab ntawm submucosal fibrosis, thiab qib ntawm cov hlwb inflammatory infiltration. Qhov feem pua ​​ntawm cov ntaub so ntswg hyperplasia nrog thaj tsam ET nqaim tau suav los ntawm kev daws qhov sib npaug:
Qhov tuab ntawm cov kab mob submucosal fibrosis tau ntsuas ntsug los ntawm cov stent struts mus rau submucosa. Qhov degree ntawm inflammatory cell infiltration tau txiav txim siab los ntawm kev faib tawm thiab qhov ceev ntawm cov cell inflammatory, uas yog: 1st degree (me me) - ib qho leukocyte infiltration; 2nd degree (me me mus rau nruab nrab) - focal leukocyte infiltration; 3rd degree (nruab nrab) - ua ke. nrog leukocytes tsis tuaj yeem paub qhov txawv ntawm ib tus neeg loci; qib 4 (nruab nrab mus rau hnyav) leukocytes diffusely infiltrating tag nrho submucosa, thiab qib 5 (hnyav) diffuse infiltration nrog ntau foci ntawm necrosis. Qhov tuab ntawm submucosal fibrosis thiab qib ntawm inflammatory cell infiltration tau txais los ntawm kev nruab nrab yim lub ntsiab lus nyob ib puag ncig circumference. Histological kev tshuaj xyuas ntawm ET tau ua tiav siv lub microscope (BX51; Olympus, Tokyo, Nyiv). Cov kev ntsuas tau txais los ntawm kev siv CaseViewer software (CaseViewer; 3D HISTECH Ltd., Budapest, Hungary). Kev tshuaj xyuas cov ntaub ntawv histological yog raws li kev pom zoo ntawm peb tus neeg soj ntsuam uas tsis koom nrog txoj kev tshawb fawb.
Kev xeem Mann-Whitney U tau siv los tshuaj xyuas qhov sib txawv ntawm cov pab pawg raws li qhov xav tau. Ib qho p <0.05 tau suav hais tias yog qhov tseem ceeb ntawm kev suav lej. Ib qho p <0.05 tau suav hais tias yog qhov tseem ceeb ntawm kev suav lej. Значение p < 0,05 считалось статистически значимым. Tus nqi p <0.05 tau suav tias yog qhov tseem ceeb ntawm kev suav lej. p <0.05 被认为具有统计学意义. p < 0.05 p <0,05 считали статистически значимым. p <0.05 tau suav hais tias yog qhov tseem ceeb ntawm kev suav lej. Ib qho kev xeem Mann-Whitney U-test uas tau kho los ntawm Bonferroni tau ua rau p tus nqi < 0.05 los ntes qhov sib txawv ntawm pawg (p < 0.008 raws li qhov tseem ceeb ntawm kev suav lej). Ib qho kev xeem Mann-Whitney U-test uas tau kho los ntawm Bonferroni tau ua rau p tus nqi <0.05 los ntes qhov sib txawv ntawm pawg (p <0.008 raws li qhov tseem ceeb ntawm kev suav lej). U-критерий Манна-Уитни с поправкой на Бонферрони был выполнен для значений p <0,05 для выявления <0,05 для выявления груполнен груполнен как статистически значимое). Kev xeem Mann-Whitney U uas tau kho los ntawm Bonferroni tau ua rau p tus nqi <0.05 los ntes qhov sib txawv ntawm pawg (p<0.008 raws li qhov tseem ceeb ntawm kev suav lej).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 具有统计学意义).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 груполнен 0,008 был статистически значимым). Kev xeem Mann-Whitney U-test uas tau kho los ntawm Bonferroni tau ua rau p < 0.05 los nrhiav qhov sib txawv ntawm pawg (p < 0.008 yog qhov tseem ceeb ntawm kev suav lej).Kev tshuaj xyuas cov ntaub ntawv tau ua tiav siv SPSS software (version 27.0; SPSS, IBM, Chicago, IL, USA).
Txhua qhov chaw tso stent rau npua tau ua tiav hauv kev siv tshuab. Lub hnab hlau coj tau ua tiav hauv qhov ntswg ntawm ET nyob rau hauv kev tswj hwm endoscopic, txawm hais tias mucosal raug mob nrog kev sib cuag los ntshav tau pom nyob rau hauv 4 ntawm 12 tus qauv (33.3%) thaum lub sijhawm ntxig hlau. Tom qab 4 lub lis piam, kev los ntshav palpable tau nres tam sim ntawd. Tag nrho cov npua tau dim mus txog thaum kawg ntawm kev tshawb fawb yam tsis muaj teeb meem cuam tshuam nrog stent.
Cov txiaj ntsig ntawm kev kuaj mob endoscopy tau qhia nyob rau hauv Daim Duab 4. Thaum lub sijhawm 4-lub lis piam saib xyuas, cov stents tseem nyob hauv qhov chaw hauv txhua tus npua. Kev sib sau ua ke ntawm cov hnoos qeev hauv thiab ib puag ncig ET stent tau pom nyob rau hauv txhua (100%) ETs hauv pawg tswj thiab peb (50%) ntawm rau ETs hauv pawg SES, thiab tsis muaj qhov sib txawv ntawm qhov tshwm sim ntawm ob pawg (p = 0.182). Tsis muaj ib qho ntawm cov stents uas tau teeb tsa tuaj yeem tswj tau lub voj voog.
Cov duab Endoscopic ntawm Eustachian tube (ET) ntawm ib tug npua hauv pawg tswj thiab pawg nrog cobalt-chromium stent (CXS) eluting sirolimus. (a) Cov duab endoscopic baseline coj ua ntej tso stent qhia qhov qhib nasopharyngeal (xub) ntawm ET. (b) Cov duab Endoscopic coj tam sim ntawd tom qab tso stent qhia ET ntawm stent tso. Kev los ntshav tau pom vim yog lub hlau qhia sheath (xub). (c) Cov duab Endoscopic coj 4 lub lis piam tom qab tso stent qhia txog cov hnoos qeev sib sau ua ke nyob ib puag ncig stent (xub). (d) Cov duab Endoscopic qhia tias stent tsis tuaj yeem nyob ib puag ncig (xub).
Cov kev tshawb pom txog keeb kwm tau qhia nyob rau hauv Daim Duab 5 thiab Daim Duab Ntxiv 2. Kev loj hlob ntawm cov nqaij thiab kev loj hlob ntawm cov fibrous submucosal ntawm cov stent posts hauv ET lumen ntawm ob pawg. Qhov feem pua ​​nruab nrab ntawm thaj chaw hyperplasia ntawm cov ntaub so ntswg loj dua hauv pawg tswj hwm dua li hauv pawg SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p < 0.001). Qhov feem pua ​​nruab nrab ntawm thaj chaw hyperplasia ntawm cov ntaub so ntswg loj dua hauv pawg tswj hwm dua li hauv pawg 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 7 ± 4 групе 6,82% против 48,36% ± 10,06%, p < 0,001). Qhov feem pua ​​​​​​ntawm thaj chaw nruab nrab ntawm cov ntaub so ntswg hyperplasia yog qhov ntau dua hauv pawg tswj hwm dua li hauv pawg 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 6 груС, 7% пе против 48,36% ± 10,06%, p <0,001). Qhov feem pua ​​​​​​ntawm thaj chaw nruab nrab ntawm cov nqaij hyperplasia hauv pawg tswj hwm yog siab dua li hauv pawg SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p < 0.001). Ntxiv mus, qhov nruab nrab tuab ntawm submucosal fibrosis kuj siab dua hauv pawg tswj hwm dua li hauv pawg SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001). Ntxiv mus, qhov nruab nrab tuab ntawm submucosal fibrosis kuj siab dua hauv pawg tswj hwm dua li hauv pawg 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 , груга СЭС (1,41 ± 0,25 против 0,56 ± 0,20 мм, p < 0,001). Ntxiv mus, qhov nruab nrab tuab ntawm submucosal fibrosis kuj siab dua hauv pawg tswj hwm dua li hauv pawg 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 hli, p < 0.001). 0.56 ± 0.20 hli, p <0.001). Кроме того, средняя толщина подслизистого фиброза в контрольной группе также была значительно чруппе была значительно (1,41 ± 0,25 против 0,56 ± 0,20 мм, p < 0,001). Ntxiv mus, qhov nruab nrab tuab ntawm submucosal fibrosis hauv pawg tswj hwm kuj siab dua li hauv pawg SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001).Txawm li cas los xij, tsis muaj qhov sib txawv tseem ceeb hauv qib ntawm kev nkag mus ntawm cov hlwb inflammatory ntawm ob pawg (pawg tswj [3.50 ± 0.55] vs. SES pawg [3.00 ± 0.89], p = 0.270).
Kev tshuaj xyuas ntawm kev kuaj mob histological ntawm ob pawg ntawm stents tso rau hauv Eustachian lumen. (a, b) Thaj chaw ntawm cov ntaub so ntswg hyperplasia (1 ntawm a thiab b) thiab qhov tuab ntawm submucosal fibrosis (2 ntawm a thiab b; ob lub xub) tau ntau dua hauv pawg tswj hwm dua li hauv pawg SES nrog strut stenting (cov dots dub), thaj chaw ntawm lumen nqaim (daj) thiab thaj chaw stent qub (liab). Qib ntawm inflammatory cell infiltration (3 ntawm a thiab b; xub) tsis txawv ntau ntawm ob pawg. (c) Cov txiaj ntsig histological ntawm feem pua ​​​​​​ntawm thaj chaw ntawm cov ntaub so ntswg hyperplasia, (d) tuab ntawm submucosal fibrosis, thiab (e) qib ntawm inflammatory cell infiltration 4 lub lis piam tom qab stent tso rau hauv ob pawg. SES, cobalt-chromium sirolimus eluting stent.
Cov tshuaj stents uas tshem cov tshuaj pab txhim kho qhov stent patency thiab tiv thaiv kom tsis txhob muaj stent restenosis20,21,22,23,24. Cov kev nruj uas tshwm sim los ntawm stent yog los ntawm kev tsim cov ntaub so ntswg granulation thiab kev hloov pauv ntawm cov ntaub so ntswg fibrous hauv ntau yam kab mob uas tsis yog vascular, suav nrog lub esophagus, trachea, gastroduodenum, thiab cov ducts bile. Cov tshuaj xws li dexamethasone, paclitaxel, gemcitabine, EW-7197, thiab sirolimus raug siv rau ntawm qhov chaw ntawm cov hlau mesh lossis stent txheej kom tiv thaiv lossis kho cov ntaub so ntswg hyperplasia tom qab muab stent tso rau29,30,34,35,36. Cov kev hloov pauv tshiab tsis ntev los no hauv kev siv cov multifunctional stents siv cov thev naus laus zis fusion tab tom raug tshawb nrhiav rau kev kho cov kab mob uas tsis yog vascular occlusive37,38,39. Hauv kev tshawb fawb yav dhau los hauv tus qauv porcine ET, kev loj hlob ntawm cov ntaub so ntswg scaffold tau pom. Txawm hais tias kev tsim stent hauv ET tsis tau nkag siab zoo, cov lus teb ntawm cov ntaub so ntswg tom qab muab stent tso rau hauv tau pom tias zoo ib yam li lwm cov kab mob tsis muaj hlab ntsha19. Hauv kev tshawb fawb tam sim no, SES tau siv los tiv thaiv scaffold-induced tissue proliferation hauv tus qauv porcine ET. Sirolimus yog lom rau pancreatic islets thiab beta cell kab, txo cov cell viability thiab txhim kho apoptosis40,41. Cov nyhuv no yuav pab tiv thaiv kev tsim cov ntaub so ntswg proliferation los ntawm kev txhawb nqa cell tuag. Peb txoj kev tshawb fawb qhia tau hais tias thawj zaug siv cov tshuaj stents hauv ET tau tiv thaiv stent-induced tissue proliferation hauv ET.
Lub pob zeb Co-Cr alloy stent uas siv tau rau hauv txoj kev tshawb fawb no muaj nyob rau hauv kev tshawb fawb no vim nws feem ntau siv los kho tus kab mob coronary artery 42. Tsis tas li ntawd, Co-Cr alloys muaj cov khoom siv kho tshuab (piv txwv li, lub zog radial siab thiab cov rog inelastic) 43. Raws li kev tshawb fawb tam sim no, Co-Cr alloy stent siv rau ET ntawm npua tsis tuaj yeem tswj tau lub puab tsaig hauv txhua tus npua vim tsis txaus elasticity thiab tsis muaj peev xwm nthuav dav nws tus kheej. Cov duab ntawm lub stent ntxig kuj tseem tuaj yeem hloov pauv los ntawm kev txav mus los ib puag ncig ET ntawm tus tsiaj muaj sia (piv txwv li, zom thiab nqos). Cov khoom siv kho tshuab ntawm Co-Cr alloy stents tau dhau los ua qhov tsis zoo hauv kev tso cov porcine ET stents. Tsis tas li ntawd, kev tso stent hauv isthmus yuav ua rau ET qhib tas mus li. ET qhib tas mus li lossis ntev tso cai rau kev hais lus thiab nasopharyngeal suab, gastrointestinal reflux, thiab pathogens1 mus rau hauv pob ntseg nruab nrab, ua rau mucosal khaus thiab kis kab mob. Yog li ntawd, yuav tsum tsis txhob muaj qhov qhib nasopharyngeal tas mus li. Yog li ntawd, vim yog cov qauv ntawm ET pob txha mos, cov scaffolds zoo dua yog ua los ntawm cov hlau nplaum uas muaj cov khoom superelastic, xws li nitinol. Feem ntau, muaj cov kua tawm ntau hauv thiab ib puag ncig lub qhov ntswg ntawm lub stent. Txij li thaum cov mucociliary txav mus los ib txwm muaj, qhov zais cia yuav sib sau ua ke hauv cov scaffolds uas tawm ntawm qhov qhib nasopharyngeal. Kev tiv thaiv kev kis kab mob pob ntseg nruab nrab yog ib qho ntawm cov hom phiaj tseem ceeb ntawm ET, thiab yuav tsum tsis txhob muab cov stents uas tawm dhau ET, vim tias kev sib cuag ncaj qha ntawm cov stents nrog cov kab mob nasopharyngeal tuaj yeem ua rau muaj kev kis kab mob nce ntxiv.
Kev kho lub raj Eustachian tube balloon plasty los ntawm qhov qhib nasopharyngeal yog ib txoj kev kho mob tshiab uas tsis tshua muaj kev cuam tshuam rau ET dysfunction uas tsom mus rau kev qhib thiab nthuav dav ntawm cov pob txha mos ntawm ET8,9,10,46. Txawm li cas los xij, txoj hauv kev kho mob tseem ceeb tsis tau txheeb xyuas47 thiab nws cov txiaj ntsig mus sij hawm ntev yuav tsis zoo8,9,11,46. Hauv qab cov xwm txheej no, kev siv hlau stenting ib ntus yuav yog ib txoj kev xaiv kho mob zoo rau cov neeg mob uas tsis teb rau kev kho lub raj Eustachian tube balloon, thiab qhov ua tau ntawm ET stenting tau pom tseeb hauv ntau txoj kev tshawb fawb ua ntej. Poly-l-lactide scaffolds tau cog rau hauv daim nyias nyias tympanic hauv chinchillas thiab luav los ntsuas kev kam rau siab thiab kev puas tsuaj hauv vivo17,18. Tsis tas li ntawd, tus qauv yaj tau tsim los ntsuas qhov profile ntawm cov hlau balloon expandable stents hauv vivo. Hauv peb txoj kev tshawb fawb yav dhau los, tus qauv ET ntawm npua tau tsim los tshawb nrhiav qhov ua tau thiab kev ntsuam xyuas cov teeb meem uas tshwm sim los ntawm stent,19 muab lub hauv paus ruaj khov rau txoj kev tshawb fawb no los tshawb nrhiav qhov ua tau zoo ntawm SES siv cov txheej txheem uas tau tsim ua ntej. Hauv txoj kev tshawb fawb no, SES tau ua tiav hauv thaj chaw ntawm cov pob txha mos thiab tiv thaiv cov ntaub so ntswg kom loj hlob zoo. Tsis muaj teeb meem cuam tshuam nrog stent, tab sis muaj kev raug mob ntawm cov mucosal los ntawm lub sheath hlau nrog kev los ntshav uas daws tau yam tsis muaj kev cuam tshuam hauv 4 lub lis piam. Muab qhov teeb meem ntawm cov hlau sheaths, kev txhim kho SES txoj kev xa khoom yog qhov ceev thiab tseem ceeb.
Txoj kev tshawb fawb no muaj qee qhov kev txwv. Txawm hais tias cov kev tshawb pom histological sib txawv ntawm cov pab pawg, tus naj npawb ntawm cov tsiaj hauv txoj kev tshawb fawb no me dhau rau kev tshuaj xyuas kev suav txheeb xyuas txhim khu kev qha. Txawm hais tias peb tus neeg saib xyuas tau dig muag los ntsuas qhov sib txawv ntawm cov neeg saib xyuas, qib ntawm submucosal inflammatory cell infiltration tau txiav txim siab raws li kev faib tawm thiab qhov ceev ntawm cov hlwb inflammatory vim qhov nyuaj ntawm kev suav cov hlwb inflammatory. Txij li thaum peb txoj kev tshawb fawb tau ua tiav siv cov tsiaj loj tsawg, ib koob tshuaj ntawm cov tshuaj tau siv, kev tshawb fawb pharmacokinetic hauv vivo tsis tau ua. Xav tau kev tshawb fawb ntxiv kom paub meej tias cov tshuaj zoo tshaj plaws thiab kev nyab xeeb ntawm sirolimus hauv ET. Thaum kawg, lub sijhawm saib xyuas 4 lub lis piam kuj yog qhov txwv ntawm txoj kev tshawb fawb, yog li kev tshawb fawb txog kev ua haujlwm ntev ntawm SES yog qhov xav tau.
Cov txiaj ntsig ntawm txoj kev tshawb fawb no qhia tau tias SES tuaj yeem tiv thaiv kev raug mob los ntawm kev ua kom cov nqaij loj hlob tom qab muab cov khoom siv Co-Cr alloy scaffolds uas nthuav tau hauv tus qauv porcine ET. Plaub lub lis piam tom qab muab stent tso rau, cov yam ntxwv cuam tshuam nrog stent-induced tissue proliferation (suav nrog thaj chaw ntawm cov nqaij loj hlob thiab tuab ntawm submucosal fibrosis) qis dua hauv pawg SES dua li hauv pawg tswj. SES zoo li muaj txiaj ntsig zoo hauv kev tiv thaiv scaffold-induced tissue proliferation hauv ET npua. Txawm hais tias xav tau kev tshawb fawb ntxiv los sim cov khoom siv stent zoo tshaj plaws thiab cov koob tshuaj ntawm cov neeg sib tw tshuaj, SES muaj peev xwm kho mob hauv zos hauv kev tiv thaiv ET cov nqaij hyperplasia tom qab muab stent tso rau.
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