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Ubushakashatsi butandukanye bwakozwe mbere yo kuvura bwakozwe kuri stent ya Eustachian tube (ET) stent burimo gukorwa, ariko ntabwo irakoreshwa mu buvuzi. Mu bushakashatsi bwakozwe mbere yo kuvura, stent za ET zagabanijwe ku kwiyongera kw'imitsi bitewe n'ingufu. Akamaro ka stent ya cobalt-chromium sirolimus-eluting (SES) mu kubuza kwiyongera kw'imitsi bitewe n'ingufu nyuma yo gushyirwaho stent kakorewe mu buryo bwa ET bw'ingurube. Ingurube esheshatu zagabanijwemo amatsinda abiri (ni ukuvuga itsinda rigenzura n'itsinda rya SES) hamwe n'ingurube eshatu muri buri tsinda. Itsinda rigenzura ryahawe stent ya cobalt-chromium idatwikiriwe (n = 6), naho itsinda rya SES rihabwa stent ya cobalt-chromium ifite irangi rya sirolimus-eluting (n = 6). Amatsinda yose yatanzwe nyuma y'ibyumweru 4 yo gushyirwaho stent. Gushyiraho stent byagenze neza muri ET zose nta ngorane zijyanye no kubagwa. Nta stent imwe muri zo yashoboye kugumana imiterere yayo ya mbere izengurutse, kandi amatembabuzi yagaragaye mu ma stent no mu nkengero zayo muri ayo matsinda yombi. Isesengura ry’amateka ryagaragaje ko agace k’ingirabuzimafatizo z’umubiri n’ubunini bwa submucosal fibrosis mu itsinda rya SES byari hasi cyane ugereranyije n’itsinda ryagenzuwe. SES isa nkaho ifite akamaro mu gukumira ikwirakwira ry’ingingo ziterwa n’uruti mu ngurube za ET. Ariko, hakenewe ubundi bushakashatsi kugira ngo hemezwe ibikoresho byiza byo gukoresha stents n’imiti igabanya ikwirakwira ry’umubiri.
Umuyoboro wa Eustachian (ET) ufite imirimo y'ingenzi mu gutwi hagati (urugero: guhumeka, gukumira ko indwara n'ibinyabutabire byinjira mu mazuru)1. Harimo kandi no kurinda urusaku rwo mu mazuru no gusubira inyuma2. Umuyoboro wa ET ukunze gufungwa, ariko ukingurwa no kumira, kwayura, cyangwa guhekenya. Ariko, imikorere mibi ya ET ishobora kubaho iyo umuyoboro udafungutse cyangwa ngo ufungwe neza3,4. Imikorere mibi ya ET yo kwaguka (ibangamira) igabanya imikorere ya ET kandi, iyo iyi mirimo idakomeje, ishobora guhinduka indwara ikomeye cyangwa idakira ya otitis media, imwe mu ndwara zikunze kugaragara mu buvuzi bw'indwara zo mu mazuru. Ubu buryo bwo kuvura imikorere mibi ya ET (urugero: kubaga amazuru, gushyira imiyoboro y'umwuka mu mazuru, n'imiti) bukoreshwa ku barwayi. Ariko, ubu buryo bwo kuvura bufite akamaro gake kandi bushobora gutera kuziba kwa ET, kwandura, no gutobora membrane ya tympanic 3,6,7. Eustachian tube balloon angioplasty yashyizweho nk'ubundi buryo bwo kuvura imikorere mibi ya ET 8 yo kwaguka. Nubwo ubushakashatsi bwinshi kuva mu 2010 bwagaragaje ko gusana imiyoboro ya Eustachian tube balloon ari byiza kurusha uburyo busanzwe bwo kuvura ikibazo cya ET, bamwe mu barwayi ntibakira kwaguka8,9,10,11. Bityo, gutera stent bishobora kuba uburyo bwiza bwo kuvura12,13. Nubwo hari ubushakashatsi bwinshi bukomeje gukorwa mbere yo kuvura busuzuma ubushobozi bwa tekiniki n'uburyo ingingo zikora nyuma yo gushyira stent muri ET, hyperplasia iterwa n'ingufu ziterwa na stent ikomeje kuba ikibazo gikomeye nyuma yo kubagwa14,15,16,17,18,19. Imiti ivanze n'imiti, yuzuyemo imiti igabanya ubukana bw'ingufu irushaho kunoza iki kibazo.
Imisemburo yo gukurura imiti yakoreshejwe mu gukumira igabanuka ry’imisemburo iterwa n’ingirangingo n’igabanuka ry’imisemburo nyuma yo gushyirwaho stent. Ubusanzwe, uduce tw’imisemburo cyangwa uduce tw’imisemburo dutwikiriwe n’imiti (urugero: everolimus, paclitaxel, na sirolimus)20,23,24. Sirolimus ni umuti usanzwe ugabanya ikwirakwira ry’imisemburo i ...
Ishusho y'icyitegererezo ya stent ya cobalt-chromium sirolimus-eluting (SES) yo kuvura ikibazo cy'imikorere mibi y'imiyoboro ya Eustachian, igaragaza ko stent ya sirolimus-eluting ibuza ikwirakwira ry'ingingo ziterwa na stent.
Ibyuma bya Cobalt-chromium (Co-Cr) byakozwe hakoreshejwe imiyoboro ya Co-Cr alloy yaciwe na laser (Genoss Co., Ltd., Suwon, Koreya). Urubuga rwa stent rukoresha uburyo bworoshye bwo guhuza ibintu byombi hamwe n’imiterere ihuriweho kugira ngo byoroshye cyane hamwe n’imbaraga nziza za radial, kugabanya no kubahiriza amabwiriza. Ibyuma byari bifite umurambararo wa mm 3, uburebure bwa mm 18, n’ubugari bwa strut bwa 78 µm (Ishusho ya 2a). Ingano z’urukuta rwa Co-Cr alloy zagenwe hashingiwe ku bushakashatsi bwacu bwabanje.
Istent ya Cobalt-chromium (Co-Cr) alloy hamwe n'agace k'icyuma gashinzwe gushyiramo stent ya Eustachian tube. Amafoto agaragaza (a) stent ya Co-Cr alloy na (b) catheter ya balloon ifite stent. (c) Catheter ya balloon na stent byose byashyizwe mu buryo bwuzuye. (d) Agace k'icyuma gashinzwe kuyobora kakozwe ku buryo bwa elegitoroniki ya Eustachian tube.
Sirolimus yashyizwe ku buso bwa stent hakoreshejwe ikoranabuhanga rya ultrasonic spray. SES yagenewe kurekura hafi 70% by'umutwaro w'umuti wa mbere (1.15 µg / mm2) mu minsi 30 ya mbere nyuma yo gushyirwamo. Irangi rito cyane rya 3 µm rishyirwa gusa ku ruhande rw'imbere rwa stent kugira ngo hagerwe ku rugero rw'umuti wifuzwa kandi bigabanye ingano ya polymer; iri rangi rishobora kwangirika rigizwe na copolymer ya aside lactic na glycolic hamwe n'uruvange rwihariye rwa aside poly(1)-lactic)26,27. Aloyi ya Co-Cr stents yashyizwe kuri catheters za balloon zifite umurambararo wa mm 3 na mm 28 z'uburebure (Genoss Co., Ltd.; Ishusho ya 2b). Izi stent ziboneka muri Koreya y'Epfo mu kuvura indwara z'umutima.
Igikonoshwa gishya cy’icyuma gifasha ingurube gukora icyitegererezo cya ET cyakozwe mu cyuma kitagira umugese (Ishusho ya 2c). Imbere n’inyuma by’igikonoshwa ni mm 2 na mm 2.5, uburebure bwose hamwe ni mm 250. Agashishwa ka 30 mm kari gafite ishusho ya J ku nguni ya 15° ku murongo kugira ngo byorohe kugera ku mazuru ku mwobo wa ET mu gishushanyo cy’ingurube.
Ubu bushakashatsi bwemejwe na Komite ishinzwe kwita no gukoresha inyamaswa yo mu kigo cya Asan Institute of Life Sciences (Seoul, Koreya y'Epfo) kandi bwubahiriza amabwiriza y'ikigo cy'igihugu gishinzwe ubuzima ku bijyanye no kuvura inyamaswa zo muri laboratwari (IACUC-2020-12-189). Ubu bushakashatsi bwakozwe hakurikijwe amabwiriza ya ARRIVE. Ubu bushakashatsi bwakoresheje ET 12 mu ngurube 6 zipima ibiro 33.8-36.4 ku mezi 3. Ingurube esheshatu zagabanyijwemo amatsinda abiri (ni ukuvuga itsinda ryo kugenzura n'itsinda rya SES) hamwe n'ingurube eshatu muri buri tsinda. Itsinda ryo kugenzura ryahawe stent ya Co-Cr alloy idapfutse, mu gihe itsinda rya SES ryahawe stent ya Co-Cr alloy eluting sirolimus. Ingurube zose zari zifite uburenganzira bwo kubona amazi n'ibiryo ku buntu kandi zabikwaga kuri 24°C ± 2°C mu gihe cy'amasaha 12 y'amanywa n'ijoro. Nyuma yaho, ingurube zose zaratanzwe nyuma y'ibyumweru 4 zishyizwemo stent.
Ingurube zose zahawe uruvange rwa 50mg/kg zolazepam, 50mg/kg teletamide (Zoletil 50; Virbac, Carros, France) na 10mg/kg xylazine (Rompun; Bayer HealthCare, Les Varkouzins, Ubudage). Hanyuma umuyoboro wa trachea washyizwemo hakoreshejwe guhumeka 0.5-2% isoflurane (Ifran®; Hana Pharm. Co., Seoul, Koreya) na ogisijeni 1:1 (510 ml/kg/min) kugira ngo hakoreshwe ikinya. Ingurube zashyizwe mu mwanya wo kuryamaho hanyuma hakorwa endoscopy y'ibanze (VISERA 4K UHD rhinolaryngoscope; Olympus, Tokyo, Ubuyapani) kugira ngo hasuzumwe orifice y'inkari ya ET. Agakoresho k'icyuma gashyirwa mu mazuru kanyuze mu mwobo wa ET munsi y'umuyoboro wa ET munsi y'umuyoboro wa endoscopic (Ishusho ya 3a, b). Catheter y'ibaluni, stent ifite corrugated, ishyirwa mu gice cyo kuyinjiza mu gice cyo hejuru cya ET kugeza igihe umutwe wayo uhuye n'ubudahangarwa mu gice cyo hasi cya osteochondral cya ET (Ishusho ya 3c). Catheter y'ibaluni yashyizwemo umunyu wose mu kirere 9, nk'uko byagaragajwe na moteri ya manometer (Ishusho ya 3d). Catheter y'ibaluni yakuweho nyuma yo gushyiramo stent (Ishusho ya 3f), maze umwobo wo mu mazuru ugenzurwa neza kugira ngo harebwe niba hari ibibazo byo kubagwa (Ishusho ya 3f). Ingurube zose zakorewe endoscopy mbere na nyuma yo kuyishyiramo stent, ndetse n'ibyumweru 4 nyuma yo kuyishyiramo stent, kugira ngo harebwe niba aho stent iri n'aho iva n'ibiyikikije bifite ubukana.
Intambwe za tekiniki zo gushyira stent mu muyoboro wa eustachian (ET) w'ingurube munsi y'igenzura rya endoscopic. (a) Ishusho ya endoscopic igaragaza umwobo w'inyuma (umwambi) n'icyuma gifata (umwambi) cyinjijwemo. (b) Gushyiramo icyuma gifata (umwambi) mu mwobo w'inyuma. (c) Katheteri ya baluni ifite stent (umwambi) yinjizwa muri ET binyuze mu mwobo (umwambi). (d) Katheteri ya baluni (umwambi) yuzuye umwuka. (e) Impera y'agace k'inyuma k'umuyoboro ituruka ku gice cya ET cy'inyuma. (f) Ishusho ya endoscopic igaragaza ubushobozi bwa stent lumen.
Ingurube zose zarashwe hakoreshejwe 75 mg/kg ya potasiyumu kloride binyuze mu gutera imitsi yo mu matwi. Ibice by'umutwe w'ingurube byakozwe hakoreshejwe umucanga wa chainsaw hanyuma hakurwamo neza ingero z'utunyangingo twa ET kugira ngo bisuzumwe hifashishijwe ikoranabuhanga (Ishusho y'inyongera ya 1a, b). Ingero z'utunyangingo twa ET zashyizwe muri formalin ya 10% idafite aho ibogamiye mu gihe cy'amasaha 24.
Ingero z'uturemangingo twa ET zaciwe amazi mu buryo bukurikiranye hamwe na alcool y'ibipimo bitandukanye. Ingero zashyizwe mu duce twa resin hifashishijwe ethylene glycol methacrylate (Technovit 7200® VLC; Heraus Kulzer GMBH, Wertheim, Ubudage). Ibice bya Axial byakorewe ku duce twa ET twashyizwe mu bice bya hafi n'ibya kure (Ishusho y'inyongera ya 1c). Hanyuma uduce twa polymer twashyizwe ku duce twa acrylic glass. Uduce twa resin bloc twashyizwe mu butaka buto hanyuma dusukurwa n'impapuro za silicon carbide zifite ubunini butandukanye kugeza ku bunini bwa 20 µm hakoreshejwe sisitemu ya grid (Apparatebau GMBH, Hamburg, Ubudage). Uduce twose twasuzumwe histological hakoreshejwe hematoxylin na eosin staining.
Isuzuma ry’amateka ryakozwe kugira ngo harebwe ijanisha ry’ubwiyongere bw’imitsi, ubunini bwa submucosal fibrosis, n’urugero rw’ubwinjirire bw’uturemangingo tw’ububyimba. Ijanisha rya hyperplasia y’imitsi ifite agace gato ka ET kanyuramo ryabazwe hakemurwa ikigereranyo:
Ubunini bwa submucosal fibrosis bwapimwe buhagaze uhereye ku duce duto tw’uturemangingo kugeza kuri submucosa. Igipimo cy’ubwinjirire bw’uturemangingo tw’ubushyuhe cyagenwe hakurikijwe uko uturemangingo tw’ubushyuhe dukwirakwira n’ubucucike bw’uturemangingo tw’ubushyuhe dukwirakwira, ari byo: urwego rwa 1 (rworoshye) - kwinjira kwa leukocyte imwe; urwego rwa 2 (rworoshye kugeza kuri hagati) - kwinjira kwa leukocyte y’ibanze; urwego rwa 3 (rworoshye) - hamwe n’uturemangingo tw’ubushyuhe tudashobora gutandukanya loci imwe; urwego rwa 4 (rworoshye kugeza kuri bukabije) tugenda twinjira muri submucosa yose, n’urwego rwa 5 (rworoshye) rugenda rwinjira hamwe n’ibyiciro byinshi bya necrosis. Ubunini bwa submucosal fibrosis n’igipimo cy’ubwinjirire bw’uturemangingo tw’ubushyuhe byabonetse hakoreshejwe impuzandengo y’amanota umunani hirya no hino. Isesengura ry’amateka rya ET ryakozwe hakoreshejwe mikorosikopi (BX51; Olympus, Tokyo, Ubuyapani). Ibipimo byabonetse hakoreshejwe porogaramu ya CaseViewer (CaseViewer; 3D HISTECH Ltd., Budapest, Hongiriya). Isesengura ry'amakuru yerekeye imiterere y'ibinyabuzima ryashingiye ku bwumvikane bw'abakurikiranira hafi batatu batitabiriye ubushakashatsi.
Ikizamini cya Mann-Whitney U cyakoreshejwe mu gusesengura itandukaniro riri hagati y’amatsinda uko byari bikenewe. A p < 0.05 yafatwaga nk'ifite agaciro mu mibare. A p < 0.05 yafatwaga nk'ifite agaciro mu mibare. Значение p <0,05 считалось статистически значимым. Agaciro ka p < 0.05 kafatwaga nk'akamaro gafite ishingiro mu mibare. 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 yafatwaga nk'ifite agaciro mu mibare. Ikizamini cya Mann-Whitney U cyakosowe na Bonferroni cyakozwe ku gaciro ka p < 0.05 kugira ngo hamenyekane itandukaniro ry'amatsinda (p < 0.008 nk'ikimenyetso cy'imibare). Ikizamini cya Mann-Whitney U cyakosowe na Bonferroni cyakozwe ku gaciro ka p < 0.05 kugira ngo hamenyekane itandukaniro ry'amatsinda (p < 0.008 nk'ikimenyetso cy'imibare). U-критерий Манна-Уитни с поправкой на Бонферрони был выполнен для значений p <0,05 для вявления групповых различий (p <0,008 как статистически значимое). Ikizamini cya Mann-Whitney U cyahinduwe na Bonferroni cyakozwe ku gaciro ka p <0.05 kugira ngo hamenyekane itandukaniro ry'amatsinda (p <0.008 nk'ikimenyetso cy'imibare).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 вявления групповых различий (p <0,008 был статистически значимым). Ikizamini cya Mann-Whitney U cyahinduwe na Bonferroni cyakozwe kuri p < 0.05 kugira ngo hamenyekane itandukaniro ry'amatsinda (p < 0.008 yari ifite agaciro gakomeye mu mibare).Isesengura ry'imibare ryakozwe hakoreshejwe porogaramu ya SPSS (version 27.0; SPSS, IBM, Chicago, IL, USA).
Imiterere yose y’ingurube yagenze neza mu buryo bwa tekiniki. Agakoresho k’icyuma gashyirwa mu mwobo wa ET gakozwe mu buryo bwa endoscopic, nubwo kwangirika kw’uturemangingo tw’umubiri hamwe no kuva amaraso byagaragaye mu bipimo 4 kuri 12 (33.3%) mu gihe cyo gushyiramo agakoresho k’icyuma. Nyuma y’ibyumweru 4, kuva amaraso mu buryo bw’umubiri byahagaze ku buryo butunguranye. Ingurube zose zarokotse kugeza ku iherezo ry’ubushakashatsi nta ngorane zijyanye na stent.
Ibisubizo bya Endoscopy bigaragazwa ku Ishusho ya 4. Mu gihe cy'ibyumweru 4 byo gukurikirana, stent zagumye mu ngurube zose. Kwiyongera kw'ibihumyo muri stent ya ET no hafi yayo byagaragaye muri ET zose (100%) mu itsinda ryagenzuwe na ET eshatu (50%) muri esheshatu mu itsinda rya SES, kandi nta tandukaniro ryagaragaye hagati y'amatsinda abiri (p = 0.182). Nta stent n'imwe muri zo yashoboraga kugumana ishusho izengurutse.
Amashusho ya endoskopi y'umuyoboro wa Eustachian (ET) w'ingurube iri mu itsinda rigenzura n'itsinda rifite stent ya cobalt-chromium (CXS) idafite sirolimus. (a) Ishusho y'ibanze ya endoskopi yafashwe mbere yo gushyirwaho stent igaragaza umwobo w'inyuma (umwambi) wa ET. (b) Ishusho ya endoskopi yafashwe ako kanya nyuma yo gushyirwaho stent igaragaza ET y'aho stent iherereye. Kuva amaraso byagaragaye bitewe n'icyuma gifata stent (umwambi). (c) Ishusho ya endoskopi yafashwe nyuma y'ibyumweru 4 yo gushyirwaho stent igaragaza ko amatembabuzi yirundanyije hafi ya stent (umwambi). (d) Ishusho ya endoskopi yerekana ko stent idashobora kuguma izengurutse (umwambi).
Ibyavuye mu bushakashatsi bw’amateka bigaragazwa ku Ishusho ya 5 n’Ishusho y’inyongera ya 2. Kwiyongera kw’uturemangingo no kwiyongera kw’udusimba duto hagati y’imyanya ya stent muri ET lumen y’amatsinda yombi. Igipimo cy’ubuso bw’uturemangingo tw’umubiri cyari kinini cyane mu itsinda ry’abagenzurwaga kurusha itsinda rya SES (79.48% ± 6.82% ugereranije na 48.36% ± 10.06%, p < 0.001). Igipimo cy’ubuso bw’uturemangingo tw’umubiri cyari kinini cyane mu itsinda ry’abagenzurwaga kurusha itsinda rya SES (79.48% ± 6.82% ugereranije na 48.36% ± 10.06%, p < 0.001). Средний пл площ ради гиперплазии тканей был значительно больше в нанной группе, чем в группе СЭС (79,48% ± 6,82% против 48,36% ± 10,06%, p <0,001). Igipimo cy’ubuso bw’uturemangingo cyari kinini cyane mu itsinda ry’abagenzuye kurusha itsinda rya SES (79.48% ± 6.82% ugereranije na 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 п площ ради гиперплазии тканей в нанной группе был значительно выше, чем в группе СЭС (79,48% ± 6,82% против 48,36% ± 10,06%, p <0,001). Igipimo cy’ubuso bw’uturemangingo mu itsinda ry’abagenzurwa cyari hejuru cyane ugereranyije n’itsinda rya SES (79.48% ± 6.82% ugereranije na 48.36% ± 10.06%, p < 0.001). Byongeye kandi, ubugari bw'impuzandengo bwa submucosal fibrosis nabwo bwari hejuru cyane mu itsinda ry’abagenzurwaga kurusha mu itsinda rya SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001). Byongeye kandi, ubugari bw'impuzandengo bwa submucosal fibrosis nabwo bwari hejuru cyane mu itsinda ry’abagenzurwaga kurusha mu itsinda rya SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001). Более того, средняя толщина подслизистого фиброза также б б значительно выше в нанной группе, чем в группе СЭС (1,41 ± 0,25 против 0,56 ± 0,20 mm, p <0,001). Byongeye kandi, ubugari bw'impuzandengo bwa submucosal fibrosis nabwo bwari hejuru cyane mu itsinda ry’abagenzurwaga kurusha mu itsinda rya 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 ннной группе также б б значительно выше, чем в группе СЭС (1,41 ± 0,25 против 0,56 ± 0,20 mm, p <0,001). Byongeye kandi, ubunini bw'impuzandengo bwa submucosal fibrosis mu itsinda rigenzura nabwo bwari hejuru cyane ugereranyije n'itsinda rya SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001).Ariko, nta tandukaniro rigaragara ryagaragaye mu rugero rw’ubwinjirire bw’uturemangingo tw’ububyimbirwe hagati y’ayo matsinda abiri (itsinda rigenzura [3.50 ± 0.55] ugereranije n’itsinda rya SES [3.00 ± 0.89], p = 0.270).
Isesengura ry’isuzuma ry’imiterere y’uturemangingo tw’amatsinda abiri ya stents yashyizwe muri lumen ya Eustachian. (a, b) Agace ka hyperplasia y’uturemangingo (1 ya a na b) n’ubugari bwa submucosal fibrosis (2 ya a na b; imyambi ibiri) byari binini cyane mu itsinda ry’abagenzurwa kurusha mu itsinda rya SES rifite strut stenting (utudomo twirabura), agace ka stent nto (umuhondo) n’agace ka stent y’umwimerere (umutuku). Igipimo cy’ubwinjirire bw’uturemangingo tw’ubushyuhe (3 ya a na b; imyambi) nticyatandukanye cyane hagati y’ayo matsinda yombi. (c) Ibisubizo by’amateka by’ijanisha ry’ubugari bwa hyperplasia y’uturemangingo, (d) ubugari bwa submucosal fibrosis, na (e) igipimo cy’ubwinjirire bw’uturemangingo tw’ubushyuhe nyuma y’ibyumweru 4 stent ishyizwe mu matsinda yombi. SES, cobalt-chromium sirolimus eluting stent.
Imisemburo ikoresha imiti ifasha kunoza ubushobozi bwo gufata stent no gukumira stent restenosis20,21,22,23,24. Imiterere iterwa na stent ituruka ku miterere y'imitsi n'impinduka mu ngingo zitandukanye zitari iz'imitsi, harimo umwobo, trachea, gastroduodenum, n'imiyoboro y'amaraso. Imiti nka dexamethasone, paclitaxel, gemcitabine, EW-7197, na sirolimus ishyirwa ku buso bw'icyuma cyangwa stent coating kugira ngo hirindwe cyangwa havurwe hyperplasia y'imitsi nyuma yo gushyirwaho stent29,30,34,35,36. Udushya duherutse gukorwa mu rwego rwa stent nyinshi zikoresha ikoranabuhanga ryo guhuza imikorere y'imitsi turimo gusuzumwa cyane mu kuvura indwara zitari iz'imitsi37,38,39. Mu bushakashatsi bwakozwe mbere mu icyitegererezo cya ET cy'ingurube, hagaragaye ko ikwirakwira ry'imitsi riterwa n'uruti rw'umugongo ryagaragaye. Nubwo iterambere rya stent muri ET ritasobanuka neza, uburyo ingingo zikora nyuma yo gushyirwaho stent byagaragaye ko bisa n'iby'izindi ngingo z'urumuri zitari iz'imitsi19. Muri ubu bushakashatsi, SES yakoreshejwe mu kubuza kwiyongera kw'ingingo ziterwa n'urusobe rw'imitsi mu buryo bwa ET bw'ingurube. Sirolimus ni uburozi ku mpande zombi za pancreas na beta cell lines, igabanya ubushobozi bw'uturemangingo bwo kubaho kandi yongera apoptosis40,41. Iyi ngaruka ishobora gufasha kubuza kwiyongera kw'ingingo binyuze mu gutuma uturemangingo dupfa. Ubushakashatsi bwacu bwagaragaje ko gukoresha bwa mbere stent zitera imiti muri ET byabujije kwiyongera kw'ingingo ziterwa na stent muri ET.
Istent ya Co-Cr alloy ishobora kwaguka yakoreshejwe muri ubu bushakashatsi iraboneka byoroshye kuko ikunze gukoreshwa mu kuvura indwara z'imitsi y'umutima 42. Byongeye kandi, iy'imitsi ya Co-Cr ifite imiterere ya mekanike (urugero, imbaraga nyinshi za radial n'imbaraga za inelastic) 43. Dukurikije endoscopy y'ubushakashatsi buriho, stent ya Co-Cr alloy ikoreshwa kuri ET y'ingurube ntishobora kugumana imiterere izengurutse mu ngurube zose kubera ko idakomeye kandi ntifite ubushobozi bwo kwiyagura. Imiterere ya stent yinjijwemo ishobora kandi guhinduka no kugenda hirya no hino kuri ET y'inyamaswa nzima (urugero, guhekenya no kumira). Imiterere ya stent ya Co-Cr alloy yabaye imbogamizi mu gushyira stent za ET z'ingurube. Byongeye kandi, gushyira stent mu gice cy'ubutayu bishobora gutuma ET ifunguka burundu. ET ifunguka cyangwa yagutse ituma imvugo n'amajwi yo mu nda, reflux y'igifu, n'udukoko twanduza indwara1 bizamuka mu gutwi ko hagati, bigatera ububabare mu mucosa no kwandura. Kubwibyo, imyobo ihoraho yo mu mazuru igomba kwirindwa. Kubera iyo mpamvu, bitewe n'imiterere ya cartilage ya ET, scaffolds byaba byiza zikozwe mu byuma bipima imiterere bifite imiterere ya superelastic, nka nitinol. Muri rusange, habonetse imyobo myinshi mu mfuruka y'inyuma no hafi yayo. Kubera ko ururenda rusanzwe rw'ururenda rufunze, ibanga ryitezwe ko riziba mu mfuruka zituruka mu mfuruka y'inyuma. Kurinda kwandura kw'amatwi yo hagati ni imwe mu ntego z'ingenzi za ET, kandi gushyira stent zisohoka inyuma ya ET bigomba kwirindwa, kuko gukorana neza kwa stent n'ibimera bya bagiteri byo mu mazuru bishobora gutuma indwara zizamuka.
Imashini ya Eustachian tube balloon inyura mu mwenge w'imbere mu nda ni uburyo bushya bwo kuvura indwara ya ET idakora neza bugamije gufungura no kwagura igice cy'umurambo cya ET8,9,10,46. Ariko, uburyo bw'ubuvuzi bw'ibanze ntiburamenyekana47 kandi ingaruka zabwo z'igihe kirekire zishobora kuba mbi cyane8,9,11,46. Muri ibi bihe, gukoresha icyuma gishyushya by'agateganyo bishobora kuba uburyo bwiza bwo kuvura abarwayi batumvise uburyo bwo gusana icyuma gishyushya, kandi ubushobozi bwo gukoresha ET stenting bwagaragaye mu bushakashatsi bwinshi bwakozwe mbere yo kuvura. Udupira twa poly-l-lactide twashyizwe mu ruhu rw'imbere mu nda mu nkanka no mu nkwavu kugira ngo harebwe uburyo bwo kwihanganira no kwangirika mu nda17,18. Byongeye kandi, hakozwe icyitegererezo cy'intama kugira ngo harebwe imiterere y'udupira dushyushya tw'icyuma dushobora kwaguka mu nda mu mubiri. Mu bushakashatsi bwacu bwa mbere, hakozwe icyitegererezo cya ET cy’ingurube kugira ngo gikore ubushakashatsi ku buryo bwa tekiniki bwo gusuzuma ibibazo biterwa na stent,19 bitanga ishingiro rikomeye ry’ubu bushakashatsi kugira ngo bukore ubushakashatsi ku bushobozi bwa SES hakoreshejwe uburyo bwari bwarashyizweho mbere. Muri ubu bushakashatsi, SES yashyizwe mu gace k’umugongo w’inyama kandi yabujije ikwirakwira ry’imitsi. Nta bibazo byagaragaye bitewe na stent, ariko habayeho kwangirika k’umuyoboro w’amaraso byatewe n’icyuma gifata amaraso cyavuye mu maraso cyakemutse mu byumweru 4. Bitewe n’ibibazo bishobora guterwa n’icyuma gifata, kunoza uburyo bwo gutanga SES ni ngombwa kandi ni ingenzi.
Ubu bushakashatsi bufite imbogamizi zimwe na zimwe. Nubwo ibyavuye mu bushakashatsi byagiye bitandukana cyane hagati y’amatsinda, umubare w’inyamaswa muri ubu bushakashatsi wari muto cyane ku buryo bitakorwa isesengura ryizewe ry’imibare. Nubwo abagenzuzi batatu bahumishijwe amaso kugira ngo barebe itandukaniro ry’abagenzuzi hagati y’abandi, urwego rw’ubwinjirire bw’uturemangingo tw’ubushyuhe mu turemangingo twa submucosal rwagenwe hakurikijwe uko uturemangingo dukwirakwira n’ubucucike bw’uturemangingo tw’ubushyuhe bitewe n’ingorane zo kubara uturemangingo tw’ubushyuhe. Kubera ko ubushakashatsi bwacu bwakozwe hakoreshejwe umubare muto w’inyamaswa nini, hakoreshejwe dose imwe y’umuti, inyigo za farumasi mu mubiri ntizakozwe. Hakenewe izindi nyigo kugira ngo hemezwe ingano nziza y’umuti n’umutekano wa sirolimus muri ET. Amaherezo, igihe cyo gukurikirana cy’ibyumweru 4 nacyo ni imbogamizi ku bushakashatsi, bityo hakenewe inyigo ku mikorere y’igihe kirekire ya SES.
Ibisubizo by'ubu bushakashatsi bigaragaza ko SES ishobora gukumira neza kwiyongera kw'imitsi bitewe n'imvune nyuma yo gushyiramo uduce twa Co-Cr alloy dushobora kwaguka mu gishushanyo cya ET cy'ingurube. Nyuma y'ibyumweru bine hashyizwemo stent, ibintu bifitanye isano no kwiyongera kw'imitsi bitewe na stent (harimo n'aho ingirangingo ziyongera n'ubunini bwa submucosal fibrosis) byari bike cyane mu itsinda rya SES ugereranyije n'itsinda ryagenzuwe. SES isa nkaho ifite akamaro mu gukumira kwiyongera kw'imitsi bitewe na stent mu ngurube za ET. Nubwo hakenewe ubushakashatsi bwiyongereye kugira ngo hagenzurwe ibikoresho byiza bya stent n'ingano y'imiti ishobora gukoreshwa, SES ifite ubushobozi bwo kuvura mu gukumira hyperplasia y'imitsi ya ET nyuma yo gushyirwamo stent.
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