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Zvidzidzo zvakasiyana-siyana zvekutanga kwekiriniki yeEustachian tube (ET) stent yakagadzirwa zviri kuitwa parizvino, asi haisati yashandiswa mukurapa. Muzvidzidzo zvekutanga kwekiriniki, ET scaffolds dzakangogumira pakukura kwetishu inokonzerwa nescaffold. Kushanda kwe cobalt-chromium sirolimus-eluting stent (SES) mukudzivirira kuwanda kwetishu inokonzerwa nestent mushure mekuiswa kwestent kwakadzidzwa mumuenzaniso we ET yenguruve. Nguruve nhanhatu dzakakamurwa kuita mapoka maviri (kureva boka rekudzora neboka reSES) nenguruve nhatu muboka rega rega. Boka rekudzora rakagamuchira cobalt-chromium stent isina kuputirwa (n = 6), uye boka reSES rakagamuchira cobalt-chromium stent ine sirolimus-eluting coating (n = 6). Mapoka ese akaurayiwa mavhiki mana mushure mekuiswa kwestent. Kuiswa kwestent kwakabudirira muET dzese pasina matambudziko ane chekuita nekuvhiyiwa. Hapana kana stent imwe chete yaigona kuchengetedza chimiro chayo chepakutanga chakatenderera, uye kuunganidzwa kwemanyoka kwakaonekwa mukati nepakapoteredza stent mumapoka ese ari maviri. Ongororo yeHistological yakaratidza kuti nzvimbo yekuwanda kwenyama uye ukobvu hwe submucosal fibrosis muboka reSES zvaive zvakaderera zvakanyanya pane muboka rekutonga. SES inoita seinoshanda mukudzivirira kuwanda kwenyama inokonzerwa nescaffold munguruve dzeET. Zvisinei, zvidzidzo zvakawanda zvinodiwa kuti zvisimbise zvinhu zvakanakisisa zve stents nemishonga inodzivirira kupararira kwemasero.
Tubhu reEustachian (ET) rine mabasa akakosha munzeve yepakati (semuenzaniso, kufefetedza, kudzivirira kutamiswa kwezvirwere uye kubuda kwemvura mumhino)1. Inosanganisirawo dziviriro kubva kumanzwi emumhino uye kudzokororwa kwemudumbu2. Tubhu reET rinowanzo vharwa, asi rinovhurwa nekumedza, kushama, kana kutsenga. Zvisinei, kusashanda zvakanaka kweET kunogona kuitika kana tubhu rikasavhurika kana kuvhara zvakanaka3,4. Kusashanda zvakanaka kweET kwakakura (kunovhara) kunoderedza kushanda kweET uye, kana mabasa aya asina kuchengetedzwa, anogona kukura kuita acute kana chronic otitis media, chimwe chezvirwere zvakajairika mu ENT practice. Kurapa kuripo kwekusashanda zvakanaka kweET (semuenzaniso, kuvhiyiwa kwemhino, kuiswa kwetubhu remhepo, uye mishonga) kunoshandiswa muvarwere. Zvisinei, kurapwa uku kune mashoma kushanda uye kunogona kutungamira mukuvharika kweET, hutachiona, uye kubhoboka kwe tympanic membrane kusingadzoreki3,6,7. Eustachian tube balloon angioplasty yakaunzwa seimwe nzira yekurapa kusashanda zvakanaka kweET 8. Kunyangwe zvidzidzo zvakawanda kubva muna 2010 zvakaratidza kuti kugadzirisa mabhora eEustachian tube kwakanaka kupfuura kurapwa kwetsika kweET, vamwe varwere havapindure pakuwedzerwa kwe8,9,10,11. Saka, kuspensa masero kunogona kuva sarudzo inoshanda yekurapa12,13. Pasinei nezvidzidzo zvakawanda zviri kuitwa vasati vasvika pakiriniki zvichiongorora kugona kwehunyanzvi uye mhinduro yemasero mushure mekuiswa kwestent muET, hyperplasia yemasero inokonzerwa nestent nekuda kwekukuvadzwa kwemakemikari inoramba iri dambudziko guru mushure mekuvhiyiwa 14,15,16,17,18,19. Mishonga yakaputirwa, yakazara nemishonga inodzivirira kuwedzera kwemasero inovandudza mamiriro aya.
Ma stent anobvisa mishonga anoshandiswa kudzivirira in-stent restenosis inokonzerwa ne tissue uye neointimal hyperplasia mushure mekuiswa stent. Kazhinji, stent scaffolds kana linings dzinoputirwa nemishonga (semuenzaniso, everolimus, paclitaxel, uye sirolimus)20,23,24. Sirolimus mushonga unowanzo shandiswa kudzivirira proliferative unodzivirira matanho akati wandei e restenosis cascade (semuenzaniso, kuzvimba, neointimal hyperplasia, uye collagen synthesis)25. Nokudaro, chidzidzo ichi chakafungidzira kuti sirolimus-coated stents inogona kudzivirira stent-induced tissue hyperplasia munguruve dzeET (Mufananidzo 1). Chinangwa chechidzidzo ichi chaive chekuongorora kushanda kwe sirolimus-eluting stents (SES) mukudzivirira kuwanda kwe stent-induced tissue mushure mekuiswa stent mu modhi ye porcine ET.
Mufananidzo wechimiro che cobalt-chromium sirolimus-eluting stent (SES) yekurapa kusashanda zvakanaka kwechubhu yeEustachian, zvichiratidza kuti sirolimus-eluting stent inodzivirira kuwanda kwematishu anokonzerwa ne stent.
Ma stenti eCobalt-chromium (Co-Cr) alloy akagadzirwa nemachubhu eCo-Cr alloy akachekwa nelaser (Genoss Co., Ltd., Suwon, Korea). Puratifomu yestent inoshandisa open double bond ine architecture yakabatana kuti ikwanise kuchinjika zvakanyanya ne optimal radial force, shortening uye compliance. Stent yaive nedhayamita ye3 mm, kureba kwe18 mm, uye strut thickness ye78 µm (Mufananidzo 2a). Zviyero zveCo-Cr alloy frame zvakatsanangurwa zvichibva pane zvatakadzidza kare.
Cobalt-chromium (Co-Cr) alloy stent uye simbi inotungamira sheath yekuisa stent yechubhu yeEustachian. Mifananidzo yacho inoratidza (a) stent yeCo-Cr alloy uye (b) bharumu ine stent-clamped catheter. (c) Bherumu catheter nestent zvakaiswa zvizere. (d) Sheath yesimbi inotungamira yakagadzirwa yemhando yechubhu yenguruve yeEustachian.
Sirolimus yakaiswa pamusoro pestent uchishandisa tekinoroji ye ultrasonic spray. SES yakagadzirirwa kuburitsa inenge 70% yemutoro wepakutanga wemushonga (1.15 µg/mm2) mukati memazuva makumi matatu ekutanga mushure mekuiswa. Kuputira kwakatetepa kwazvo kwe3 µm kunoiswa chete parutivi rwe stent kuti uwane chimiro chekuburitsa mushonga chaunoda uye kuderedza huwandu hwe polymer; iyi coating inoora ine copolymer ye lactic ne glycolic acids uye musanganiswa chaiwo we poly(1)-lactic acid)26,27. Co-Cr alloy stents dzakasungirirwa pama catheters emabharuni ane dhayamita ye3 mm uye 28 mm kureba (Genoss Co., Ltd.; Mufananidzo 2b). Aya ma stents anowanikwa muSouth Korea pakurapa chirwere chemwoyo checoronary.
Goko resimbi richangobva kugadzirwa remhando yeET yenguruve rakagadzirwa nesimbi isingatsvedzeri (Mufananidzo 2c). Madhayamita emukati nekunze egoko iri 2 mm ne2.5 mm, zvichiteerana, kureba kwese kuri 250 mm. Goko re30 mm rekure rakakombamiswa kuita chimiro cheJ pakona ye15° kudivi kuti zvive nyore kusvika kubva pamhino kuenda kumuromo wemhino weET mumhando yenguruve.
Chidzidzo ichi chakatenderwa neInstitutional Animal Care and Use Committee yeAsan Institute of Life Sciences (Seoul, South Korea) uye chinotevedzera National Institutes of Health Guidelines for the Humane Treatment of Laboratory Animals (IACUC-2020-12-189). . Chidzidzo ichi chakaitwa zvichienderana nemirairo yeARRIVE. Chidzidzo ichi chakashandisa maET gumi nemaviri munguruve nhanhatu dzairema 33.8-36.4 kg pazera remwedzi mitatu. Nguruve nhanhatu dzakakamurwa kuita mapoka maviri (kureva boka rekutonga neboka reSES) nenguruve nhatu muboka rega rega. Boka rekutonga rakagamuchira stent yeCo-Cr alloy isina kuputirwa, nepo boka reSES rakagamuchira stent yeCo-Cr alloy eluting sirolimus. Nguruve dzese dzaiva nemvura uye chikafu mahara uye dzaichengetwa pa24°C ± 2°C kweawa gumi nemaviri masikati neusiku. Mushure mezvo, nguruve dzese dzakabayirwa mavhiki mana mushure mekuiswa stent.
Nguruve dzese dzakagamuchira musanganiswa we50mg/kg zolazepam, 50mg/kg teletamide (Zoletil 50; Virbac, Carros, France) uye 10mg/kg xylazine (Rompun; Bayer HealthCare, Les Varkouzins, Germany). Ipapo tracheal tube yakaiswa nekufema 0.5-2% isoflurane (Ifran®; Hana Pharm. Co., Seoul, Korea) uye oxygen 1:1 (510 ml/kg/min) yeanesthesia. Nguruve dzakaiswa panzvimbo yekurara uye baseline endoscopy (VISERA 4K UHD rhinolaryngoscope; Olympus, Tokyo, Japan) yakaitwa kuti iongorore nasopharyngeal orifice yeET. Chidimbu chesimbi chakafambiswa nemhino kuenda ku nasopharyngeal orifice yeET pasi pe endoscopic control (Mufananidzo 3a, b). Catheter yebharumu, stent yakakombama, inopinzwa nepamuchina wekuisa muET kusvika muromo wayo wasangana nekusasimba mu osteochondral isthmus yeET (Mufananidzo 3c). Catheter yebharumu yakazadzwa zvizere nesaline ku9 atmospheres, sezvakatsanangurwa ne manometer monitor (Mufananidzo 3d). Catheter yebharumu yakabviswa mushure mekuiswa stent (Mufananidzo 3f), uye nasopharyngeal open yakaongororwa nokungwarira endoscopy kuti ione matambudziko ekuvhiyiwa (Mufananidzo 3f). Nguruve dzese dzakaitwa endoscopy dzisati dzaiswa stent uye pakarepo mushure mekuiswa stent, pamwe nemavhiki mana mushure mekuiswa stent, kuti dzione kana nzvimbo yestent iri uye kubuda kwakapoteredza kwacho kuri patency.
Matanho ehunyanzvi ekuisa stent muchubhu ye eustachian (ET) yenguruve pasi pe endoscopic control. (a) Mufananidzo we endoscopic unoratidza kuvhura kwe nasopharyngeal (museve) uye sheath yesimbi inotungamirwa (museve). (b) Kuisa sheath yesimbi (museve) muburi re nasopharyngeal. (c) Catheter yebharuni ine stent-clamped (museve) inopinzwa muET kuburikidza nesheath (museve). (d) Catheter yebharuni (museve) yakazara. (e) Mugumo weproximal we stent unobuda kubva kuET orifice ye nasopharynx. (f) Mufananidzo we endoscopic unoratidza stent lumen patency.
Nguruve dzese dzakaurayiwa nekupa 75 mg/kg potassium chloride nekubaiwa mutsinga dzenzeve. Zvikamu zvepakati zvemusoro wenguruve zvakaitwa uchishandisa chainsaw zvichiteverwa nekunyatsobvisa sampuli dzetishu dzeET scaffold kuti dziongororwe histological (Supplementary Fig. 1a,b). Samples dzetishu dzeET dzakagadziriswa mu10% neutral buffered formalin kwemaawa makumi maviri nemana.
Sampuli dzetishu dzeET dzakabviswa mvura zvakatevedzana nealcohol ine huwandu hwakasiyana. Sampuli dzakaiswa mumabhuroko eresin nekuiswa mu ethylene glycol methacrylate (Technovit 7200® VLC; Heraus Kulzer GMBH, Wertheim, Germany). Zvikamu zveAxial zvakaitwa pasampuli dzetishu dzeET dzakaiswa muzvikamu zveproximal nedistal (Supplementary Fig. 1c). Mabhuroko epolymer akazoiswa pamasiraidhi egirazi e acrylic. Masiraidhi eResin block akakweshwa ne microground ndokukweshwa ne silicon carbide paper ine ukobvu hwakasiyana kusvika ku 20 µm uchishandisa grid system (Apparatebau GMBH, Hamburg, Germany). Masiraidhi ese akaongororwa histological ne hematoxylin ne eosin staining.
Ongororo yeHistological yakaitwa kuti iongorore huwandu hwekuwanda kwenyama, ukobvu hwe submucosal fibrosis, uye mwero wekupinda kwemasero anoputika. Chikamu che hyperplasia yenyama ine nzvimbo yakamanikana yeET yakaverengerwa nekugadzirisa equation:
Ukobvu hwe submucosal fibrosis hwakayerwa zvakananga kubva pa stent struts kusvika ku submucosa. Mwero wekupinda kwemasero ekuzvimba wakatongwa zvichienderana nekupararira uye kuwanda kwemasero ekuzvimba, zvinoti: dhigirii rekutanga (rakapfava) - kupinda kwe leukocyte imwe chete; dhigirii rechipiri (rakapfava kusvika pakati nepakati) - kupinda kwe leukocyte ye focal; dhigirii rechitatu (rakapfava) - rakasanganiswa. nema leukocytes asingakwanise kusiyanisa pakati pe loci yega yega; giredhi rechina (rakapfava kusvika pakati nepakati) ma leukocytes achipinda mu submucosa yese, uye giredhi rechishanu (rakapfava) kupinda mu diffuse ine multiple foci of necrosis. Ukobvu hwe submucosal fibrosis uye mwero wekupinda kwemasero ekuzvimba zvakawanikwa neavhareji yemapoinzi masere akatenderedza denderedzwa. Kuongororwa kwe histological kweET kwakaitwa uchishandisa microscope (BX51; Olympus, Tokyo, Japan). Kuyerwa kwacho kwakawanikwa uchishandisa CaseViewer software (CaseViewer; 3D HISTECH Ltd., Budapest, Hungary). Kuongororwa kwedata rekuongorora ruzivo rwemuchadenga kwakavakirwa pakubvumirana kwevacherechedzi vatatu vasina kutora chikamu muchidzidzo ichi.
Bvunzo yeMann-Whitney U yakashandiswa kuongorora mutsauko uripo pakati pemapoka sezvinodiwa. A p < 0.05 yaionekwa seinokosha muhuwandu. A p < 0.05 yaionekwa seinokosha muhuwandu. Значение p < 0,05 считалось статистически значимым. Kukosha kwe p < 0.05 kwakaonekwa sekukosha muhuwandu hwenhamba. 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 yaionekwa seyakakosha muhuwandu. Bvunzo yeMann-Whitney U yakagadziriswa neBonferroni yakaitwa pa p values ​​< 0.05 kuti ione mutsauko wemapoka (p < 0.008 seyakakosha muhuwandu hwemasvomhu). Bvunzo yeMann-Whitney U yakagadziriswa neBonferroni yakaitwa pa p values ​​​​< 0.05 kuti ione mutsauko wemapoka (p < 0.008 seyakakosha muhuwandu hwemasvomhu). U-критерий Манна-Уитни с поправкой на Бонферрони был выполнен для значений p значимое). Bvunzo yeMann-Whitney U yakagadziriswa neBonferroni yakaitwa pa p values ​​​​<0.05 kuti ione mutsauko wemapoka (p<0.008 seyakakosha muhuwandu hwemasvomhu).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 значимым). Bvunzo yeMann-Whitney U yakagadziriswa neBonferroni yakaitwa pa p < 0.05 kuti ione mutsauko wemapoka (p < 0.008 yaive yakakosha muhuwandu).Ongororo yenhamba yakaitwa uchishandisa software yeSPSS (vhezheni 27.0; SPSS, IBM, Chicago, IL, USA).
Kuiswa kwese kwe stent yenguruve kwakabudirira. Chidimbu chesimbi chakaiswa zvakanaka mumhino yeET pasi pekuongororwa kwe endoscopic, kunyangwe kukuvara kwemucosal nekubuda ropa kwakaonekwa muzvikamu zvina kubva pagumi nezviviri (33.3%) panguva yekuiswa kwesimbi. Mushure memavhiki mana, kubuda ropa kwakamira pakarepo. Nguruve dzese dzakararama kusvika pakupera kwechidzidzo pasina matambudziko ane chekuita nestent.
Mhedzisiro yeEndoscopy inoratidzwa muMufananidzo 4. Munguva yekutevera kwemavhiki mana, ma stents akaramba aripo munguruve dzese. Kuunganidzwa kwemanyoka mukati nepakapoteredza stent yeET kwakaonekwa mu (100%) ET dzese muboka rekudzora uye nhatu (50%) dzeET nhanhatu muboka reSES, uye pakanga pasina musiyano mukuitika pakati pemapoka maviri (p = 0.182). Hapana kana imwe ye stents dzakaiswa yaigona kuchengetedza chimiro chakatenderera.
Mifananidzo yeEndoscopic yechubhu yeEustachian (ET) yenguruve iri muboka rekutonga uye boka rine cobalt-chromium stent (CXS) inobvisa sirolimus. (a) Mufananidzo wekutanga we endoscopic wakatorwa usati waiswa stent unoratidza kuvhurika kwemhino (museve) yeET. (b) Mufananidzo weEndoscopic wakatorwa pakarepo mushure mekuiswa stent unoratidza ET yekuiswa stent. Kubuda ropa kwakaonekwa nekuda kwesimbi inotungamira sheath (museve). (c) Mufananidzo weEndoscopic wakatorwa mavhiki mana mushure mekuiswa stent unoratidza kuungana kwemanyoka akakomberedza stent (museve). (d) Mufananidzo weEndoscopic unoratidza kuti stent haigone kuramba yakatenderera (museve).
Zvakawanikwa muHistological zvinoratidzwa muMufananidzo 5 neMuenzaniso we2. Kuwanda kwetishu uye kuwanda kwetishu dzemudumbu pakati penzvimbo dzestent dziri muET lumen yemapoka ese ari maviri. Avhareji yehuwandu hwenzvimbo ye hyperplasia yetishu yaive yakakura zvakanyanya muboka rekutonga kupfuura muboka reSES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p < 0.001). Avhareji yehuwandu hwenzvimbo ye hyperplasia yetishu yaive yakakura zvakanyanya muboka rekutonga kupfuura muboka reSES (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 СЭС (79,68% 48,36% ± 10,06%, p <0,001). Avhareji yenzvimbo ye hyperplasia yetishu yaive yakakura zvakanyanya muboka rekutonga kupfuura muboka reSES (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 (79,8,48% ± 10,06%, p <0,001). Avhareji yenzvimbo yekuwedzera kwetishu muboka rekutonga yaive yakakwira zvakanyanya kupfuura muboka reSES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p < 0.001). Uyezve, ukobvu hwepakati hwe submucosal fibrosis hwakanga hwakakwirawo zvakanyanya muboka rekutonga kupfuura muboka reSES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001). Uyezve, ukobvu hwepakati hwe submucosal fibrosis hwakanga hwakakwirawo zvakanyanya muboka rekutonga kupfuura muboka reSES (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 группе СЭС, 410 СЭС, 410 СЭС ± 0,20 мм, p <0,001). Uyezve, ukobvu hwepakati hwe submucosal fibrosis hwakanga hwakakwirawo zvakanyanya muboka rekutonga kupfuura muboka reSES (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 группе СЭ0 ± 5,25 ± 1,5,4,4,6 ± 0,20 мм, p <0,001). Pamusoro pezvo, ukobvu hwepakati hwe submucosal fibrosis muboka rekutonga hwaive hwakakwirawo zvakanyanya kupfuura muboka reSES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001).Zvisinei, pakanga pasina musiyano wakakosha padanho rekupinda kwemasero ekuzvimba pakati pemapoka maviri (boka rekudzora [3.50 ± 0.55] zvichienzaniswa neboka reSES [3.00 ± 0.89], p = 0.270).
Kuongororwa kwekuongorora kwehistological kwemapoka maviri e stents akaiswa muEustachian lumen. (a, b) Nzvimbo ye tissue hyperplasia (1 ye a na b) uye ukobvu hwe submucosal fibrosis (2 ye a na b; miseve miviri) zvaive zvakakura zvakanyanya muboka rekudzora kupfuura muboka reSES rine strut stenting (madotsi matema), nzvimbo ye lumen yakamanikana (yero) uye nzvimbo ye stent yekutanga (tsvuku). Dhigirii rekupinda kwemasero ekuzvimba (3 ye a na b; miseve) harina kusiyana zvakanyanya pakati pemapoka maviri aya. (c) Mhedzisiro yehistological yenzvimbo ye tissue hyperplasia, (d) ukobvu hwe submucosal fibrosis, uye (e) dhigirii rekupinda kwemasero ekuzvimba mavhiki mana mushure mekuiswa kwe stent mumapoka ese ari maviri. SES, cobalt-chromium sirolimus eluting stent.
Ma stent anobvisa mishonga anobatsira kuvandudza stent patency uye kudzivirira stent restenosis20,21,22,23,24. Kuomarara kunokonzerwa ne stent kunobva mukuumbwa kwetishu re granulation uye shanduko dzetishu dze fibrous munhengo dzakasiyana dzisiri dzeropa, kusanganisira esophagus, trachea, gastroduodenum, uye bile ducts. Mishonga yakaita se dexamethasone, paclitaxel, gemcitabine, EW-7197, uye sirolimus inoiswa pamusoro pe wire mesh kana stent coating kudzivirira kana kurapa hyperplasia yetishu mushure mekuiswa kwe stent29,30,34,35,36. Zvitsva zvitsva mumunda we multifunctional stents uchishandisa fusion technology zviri kuongororwa zvakanyanya kurapa zvirwere zvisiri zveropa37,38,39. Muchidzidzo chakapfuura mu porcine ET model, kuwanda kwetishu kunokonzerwa ne scaffold kwakaonekwa. Kunyangwe kukura kwestent muET kusinganzwisiswi zvakanaka, mhinduro yenyama mushure mekuiswa kwestent yakawanikwa yakafanana neyedzimwe nhengo dzechiedza dzisiri dzeropa19. Muchidzidzo chino, SES yakashandiswa kudzivirira kuwanda kwenyama inokonzerwa nescaffold mumuenzaniso we ET yenguruve. Sirolimus ine chepfu kuislets dzepancreatic ne beta cell, inoderedza kushanda kwemasero uye inowedzera apoptosis40,41. Izvi zvinogona kubatsira kudzivirira kuumbwa kwekuwanda kwenyama nekukurudzira kufa kwemasero. Chidzidzo chedu chakaratidza kuti kushandiswa kwekutanga kwemishonga inouraya stent muET kwakadzivirira kuwanda kwenyama inokonzerwa nestent muET.
Stent yeCo-Cr alloy inowedzerwa nebharumu inoshandiswa muchidzidzo ichi inowanikwa nyore nyore sezvo ichinyanya kushandiswa kurapa chirwere chemwoyo 42. Pamusoro pezvo, Co-Cr alloys ine hunhu hwemakanika (semuenzaniso, simba rakawanda reradial uye simba reinelastic) 43. Zvichienderana ne endoscopy yechidzidzo chazvino, stent yeCo-Cr alloy inoshandiswa kuET yenguruve haigone kuchengetedza chimiro chakatenderera munguruve dzese nekuda kwekusakwana kwekusimba uye haina kugona kuzviwedzera. Chimiro chestent yakaiswa chinogonawo kuchinjwa nekufamba-famba kutenderedza ET yemhuka mhenyu (semuenzaniso, kutsenga nekumedza). Hunhu hwemakanika hweCo-Cr alloy stents hwave dambudziko pakuiswa kwe stent dzenguruve dzeET. Pamusoro pezvo, kuiswa kwestent mu isthmus kunogona kukonzera ET yakavhurika zvachose. ET yakavhurika kana yakawedzerwa inobvumira kutaura uye ruzha rwemhino, reflux yemudumbu, uye hutachiona1 kufamba uchienda pakati perenzeve, zvichikonzera kutsamwa kwemucosal uye hutachiona. Saka, nzvimbo dzinogara dziri mumhino dzinofanira kudzivirirwa. Saka, tichifunga nezvechimiro che ET cartilage, nzvimbo dzinoshandiswa pakugadzira ma scaffolds dzinonyanya kugadzirwa ne shape memory alloys dzine superelastic properties, dzakadai se nitinol. Kazhinji, kubuda kwemvura kwakawanda kwakawanikwa mukati nepakapoteredza nasopharyngeal orifice ye stent. Sezvo kufamba kwemucociliary kwema mucus kwakavharwa, chakavanzika chinotarisirwa kuungana mu scaffolds dzinobuda mumhino. Kudzivirira hutachiona hwenzeve dziri pakati nepakati dzinokwira ndicho chimwe chezvinangwa zvikuru zve ET, uye kuiswa kwe stents dzinobuda kunze kwe ET kunofanira kudzivirirwa, sezvo kusangana zvakananga kwe stents ne nasopharyngeal bacterial flora kunogona kukonzera kuwedzera kwehutachiona hunokwira.
Kushandiswa kweEustachian tube balloon plasty kuburikidza nekuvhurwa kwemhino nemhino inzira itsva yekurapa kusagadzikana kweET kwakanangana nekuvhura nekuwedzera chikamu checartilaginous cheET8,9,10,46. Zvisinei, nzira yekurapa haina kuzivikanwa47 uye mhedzisiro yayo yenguva refu inogona kunge isina kunaka8,9,11,46. Pasi pemamiriro ezvinhu aya, kushandisa simbi kwenguva pfupi kunogona kuva sarudzo inoshanda yekurapa varwere vasingapindure kugadziriswa kwemabharuni eEustachian tube, uye kugona kwekushandisa simbi yeET kwakaratidzwa muzvidzidzo zvakawanda zvepamberi pekiriniki. Mascaffoldhi ePoly-l-lactide akaiswa kuburikidza ne tympanic membrane mu chinchillas netsuro kuti vaongorore kushivirira uye kuora mu vivo17,18. Pamusoro pezvo, modhi yemakwai yakagadzirwa kuti iongorore chimiro chesimbi mabharuni anowedzerwa mu vivo. Muchidzidzo chedu chekare, modhi yenguruve yeET yakagadzirwa kuti iongorore kugona kwehunyanzvi uye kuongororwa kwezvinetso zvinokonzerwa nestent,19 zvichipa hwaro hwakasimba hwechidzidzo ichi kuti chiongorore kushanda kweSES uchishandisa nzira dzakamboshandiswa. Muchidzidzo ichi, SES yakabudirira kuwanikwa kune cartilage uye yakadzivirira kukura kwenyama. Pakanga pasina matambudziko ane chekuita nestent, asi pakanga paine kukuvara kwemucosal kwakakonzerwa nesimbi inotungamira sheath nekubuda ropa kwakabatana kwakapera pakarepo mukati memavhiki mana. Tichifunga nezvematambudziko anogona kuitika esimbi inodzivirira, kuvandudza SES delivery system kwakakosha uye kwakakosha.
Chidzidzo ichi chine zvimwe zvipingamupinyi. Kunyangwe zvakawanikwa mu histological zvakasiyana zvikuru pakati pemapoka, huwandu hwemhuka dziri muchidzidzo ichi hwaive hushoma kwazvo kuti hukwanise kuongororwa nenhamba dzakavimbika. Kunyangwe vaongorori vatatu vakapofumadzwa kuti vaongorore kusiyana kwevacherechedzi pakati pevacherechedzi, mwero wekupinda kwemasero ekudzivirira muviri pasi pemucosal wakatsanangurwa zvichienderana nekupararira uye kuwanda kwemasero ekudzivirira muviri nekuda kwekuoma kwekuverenga masero ekudzivirira muviri. Sezvo chidzidzo chedu chakaitwa tichishandisa huwandu hushoma hwemhuka hombe, dose imwe chete yemushonga yakashandiswa, zvidzidzo zve pharmacokinetic mu vivo hazvina kuitwa. Zvimwe zvidzidzo zvinodiwa kusimbisa dose yakakwana yemushonga uye kuchengetedzeka kwe sirolimus mu ET. Pakupedzisira, nguva yekutevera yemavhiki mana zvakare imuganhu wechidzidzo, saka zvidzidzo pamusoro pekushanda kwenguva refu kweSES zvinodiwa.
Zvakabuda muchidzidzo ichi zvinoratidza kuti SES inogona kudzivirira kukura kwenyama inokonzerwa nekukuvara kwemakemikari mushure mekuiswa kwezvigadziko zveCo-Cr alloy zvinogona kuwedzerwa nebharumu mumuenzaniso we ET yenguruve. Mavhiki mana mushure mekuiswa kwestent, zvinhu zvine chekuita nekuwanda kwenyama inokonzerwa nestent (kusanganisira nzvimbo yekuwanda kwenyama uye ukobvu hwe submucosal fibrosis) zvaive zvakaderera zvakanyanya muboka reSES pane muboka rekutonga. SES inoita seinoshanda mukudzivirira kuwanda kwenyama inokonzerwa nescat munguruve dzeET. Kunyangwe tsvakiridzo yakawanda ichidikanwa kuti kuyedze zvinhu zvestent zvakanakisa uye huwandu hwemishonga inogona kushandiswa, SES ine mukana wekurapa munharaunda mukudzivirira hyperplasia yenyama yeET mushure mekuiswa kwestent.
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