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Ubushakashatsi butandukanye bwibanze kuri stent ya Eustachian yateye imbere (ET) burimo gukorwa, ariko ntiburakoreshwa mubikorwa byubuvuzi.Mu bushakashatsi bwibanze, ET scafolds yagarukiye gusa ku gukwirakwiza ingirabuzimafatizo.Ingaruka za cobalt-chromium sirolimus-eluting stent (SES) mukurinda ikwirakwizwa ryimitsi iterwa na stent nyuma yo gushyira stent yakozwe mubushakashatsi bwa porcine ET.Ingurube esheshatu zagabanyijwemo amatsinda abiri (ni ukuvuga itsinda rishinzwe kugenzura nitsinda rya SES) hamwe ningurube eshatu muri buri tsinda.Itsinda rishinzwe kugenzura ryakiriye stent ya cobalt-chromium (n = 6), naho itsinda rya SES ryakira cobalt-chromium stent hamwe na sirolimus-eluting (n = 6).Amatsinda yose yatambwe nyuma yibyumweru 4 nyuma yo gushyirwaho stent.Gushyira stent byagenze neza muri ET zose nta ngorane zijyanye no kubaga.Nta nimwe muri stent yashoboraga kugumana imiterere yumwimerere yabyo, kandi kwirundanya kwa mucus byagaragaye no muri stent muri matsinda yombi.Isesengura ry’amateka ryerekanye ko agace ko gukwirakwiza tissue hamwe nubunini bwa fibrosis ya subucosal mu itsinda rya SES byari hasi cyane ugereranije nitsinda rishinzwe kugenzura.SES isa nkingirakamaro muguhagarika ikwirakwizwa ryimitsi iterwa ningurube muri ET.Nyamara, ubushakashatsi buracyakenewe kugirango hemezwe ibikoresho byiza bya stent n'imiti igabanya ubukana.
Umuyoboro wa Eustachian (ET) ufite imirimo yingenzi mumatwi yo hagati (urugero, guhumeka, kubuza kwanduza virusi no gusohora kwa nasofarynx) 1.Harimo kandi kurinda amajwi ya nasofaryngeal na regurgitation2.Ubusanzwe ET ifunze, ariko ifungura no kumira, kwinuba, cyangwa guhekenya.Ariko, imikorere mibi ya ET irashobora kubaho mugihe umuyoboro udafunguye cyangwa ngo ufunge neza3,4.Imikorere idahwitse (obstructive) imikorere ya ET igabanya imikorere ya ET kandi, niba iyo mirimo itabitswe, irashobora gukura mubitangazamakuru bikaze cyangwa bidakira, imwe mundwara zikunze kugaragara mubikorwa bya ENT.Ubu buryo bwo kuvura imikorere mibi ya ET (urugero, kubaga izuru, gushyira umuyoboro uhumeka, hamwe nubuvuzi) bikoreshwa mubarwayi.Nyamara, ubwo buvuzi bufite imbaraga nke kandi bushobora gutuma ET ihagarikwa, kwandura, hamwe na tympanic membrane perforation idasubirwaho3,6,7.Eustachian tube balloon angioplasty yatangijwe nkubundi buryo bwo kuvura bwagutse ET 8 idakora neza.Nubwo ubushakashatsi bwinshi kuva mu mwaka wa 2010 bwerekanye ko gusana umupira wa ballon ya Eustachian biruta ubuvuzi busanzwe bwo gukora nabi ET, abarwayi bamwe ntibitabira kwaguka 8,9,10,11.Rero, stenting irashobora kuba uburyo bwiza bwo kuvura12,13.Nubwo ubushakashatsi bwinshi bwibanze bukomeje gusuzuma uburyo bwa tekiniki hamwe nigisubizo cya tissue nyuma yo gushyirwa muri ET, hyperplasia iterwa na stent iterwa no kwangirika kwa mashini iracyari ingorabahizi nyuma yibikorwa 14,15,16,17,18,19.ibiyobyabwenge bisizwe, byuzuye imiti igabanya ubukana biteza imbere iki kibazo.
Ibiyobyabwenge byangiza imiti byakoreshejwe mukubuza stent restenosis iterwa na tissue na hyperplasia neointimal hyperplasia nyuma yo gushyirwaho stent.Mubisanzwe, stent scaffolds cyangwa imirongo yashizwemo ibiyobyabwenge (urugero, everolimus, paclitaxel, na sirolimusi) 20,23,24.Sirolimus ni imiti isanzwe igabanya ubukana ibuza intambwe nyinshi za casade ya restenose (urugero, gutwika, hyperplasia ya neointimal, na synthesis ya kolagen) 25.Kubwibyo, ubu bushakashatsi bwatangaje ko stent ya sirolimusi ishobora gukumira hyperplasia iterwa na stent iterwa ningurube mu ngurube za ET (Ishusho 1).Icyari kigamijwe muri ubu bushakashatsi kwari ugukora ubushakashatsi ku kamaro ka stirolimus-eluting stent (SES) mu guhagarika ikwirakwizwa ry’imitsi iterwa na stent nyuma yo gushyirwa stent mu cyitegererezo cya ET.
Igishushanyo cyerekana cobalt-chromium sirolimus-eluting stent (SES) kugirango ivure imikorere mibi ya Eustachian, yerekana ko stent ya sirolimus ibuza ikwirakwizwa ryimitsi iterwa na stent.
Ibikoresho bya Cobalt-chromium (Co-Cr) byahimbwe no gukata lazeri ikata Co-Cr alloy tubes (Genoss Co., Ltd., Suwon, Koreya).Ihuriro rya stent rikoresha imiyoboro ibiri ifunguye hamwe nuburyo bumwe bwubatswe kugirango bihindurwe neza hamwe nimbaraga nziza ya radiyo, kugabanya no kubahiriza.Stent yari ifite umurambararo wa mm 3, uburebure bwa mm 18, n'ubugari bwa 78 µm (Ishusho 2a).Ibipimo bya Co-Cr alloy frame yagenwe hashingiwe kubushakashatsi bwatubanjirije.
Cobalt-chromium (Co-Cr) alloy stent hamwe nicyuma kiyobora icyuma cya Eustachian tube stent.Amafoto yerekana (a) Co-Cr alloy stent na (b) catheter ya ballon ifunze.(c) Catheter ya ballon na stent byoherejwe byuzuye.(d) Icyuma kiyobora icyuma cyateguwe kuri porcine ya Eustachian tube moderi.
Sirolimus yakoreshejwe hejuru ya stent hakoreshejwe tekinoroji ya ultrasonic.SES yagenewe kurekura hafi 70% yumutwaro wambere wibiyobyabwenge (1.15 µg / mm2) muminsi 30 yambere nyuma yo gushyirwa.Igikoresho cya ultra-thin 3 µm gikoreshwa gusa kuruhande rwa stent kugirango ugere kumurongo wifuza kurekura ibiyobyabwenge no kugabanya umubare wa polymer;iyi coatingable biodegradable irimo copolymer ya acide lactique na glycolique hamwe nuruvange rwihariye rwa poly (1)-acide lactique) 26,27.Ibikoresho bya Co-Cr byashyizwe kuri catheters ya ballon mm 3 z'umurambararo na mm 28 z'uburebure (Genoss Co., Ltd.; Ishusho 2b).Izi stent ziraboneka muri Koreya yepfo kugirango zivure indwara zifata umutima.
Icyuma gishya cyateguwe cyicyitegererezo cyingurube ET cyakozwe mubyuma bidafite ingese (Ishusho 2c).Imbere yimbere ninyuma yikigero ni mm 2 na mm 2,5, uburebure bwose ni mm 250.Urupapuro ruri hagati ya mm 30 rwagoramye mu buryo bwa J ku nguni ya 15 ° kugera ku murongo kugira ngo byoroherezwe kuva mu mazuru kugera mu mazuru ya nasofaryngeal ya ET mu ngurube.
Ubu bushakashatsi bwemejwe na komite ishinzwe kwita ku nyamaswa n’imikoreshereze y’ikigo cy’ubumenyi bw’ubuzima bwa Asan (Seoul, Koreya yepfo) kandi yubahiriza amabwiriza y’ikigo cy’igihugu cy’ubuzima ku bijyanye no kuvura abantu inyamaswa zo muri laboratoire (IACUC-2020-12-189)..Ubushakashatsi bwakozwe hakurikijwe amabwiriza ya ARRIVE.Ubu bushakashatsi bwakoresheje ET 12 mu ngurube 6 zipima 33.8-36.4 kg kumezi 3 y'amavuko.Ingurube esheshatu zagabanyijwemo amatsinda abiri (ni ukuvuga itsinda rishinzwe kugenzura nitsinda rya SES) hamwe ningurube eshatu muri buri tsinda.Itsinda rishinzwe kugenzura ryakiriye stent ya Co-Cr idasanzwe, mugihe itsinda rya SES ryakiriye Co-Cr alloy stent eluting sirolimus.Ingurube zose zashoboraga kubona amazi no kugaburira ku buntu kandi zabitswe kuri 24 ° C ± 2 ° C kugira ngo amasaha 12 nijoro azenguruke.Nyuma, ingurube zose zatambwe nyuma yibyumweru 4 nyuma yo gushyirwaho stent.
Ingurube zose zabonye imvange ya 50mg / kg zolazepam, 50mg / kg teletamide (Zoletil 50; Virbac, Carros, Ubufaransa) na 10mg / kg xylazine (Rompun; Bayer HealthCare, Les Varkouzins, Ubudage).noneho umuyoboro wa tracheal washyizwemo no guhumeka isoflurane 0.5-2% (Ifran®; Hana Pharm. Co, Seoul, Koreya) na ogisijeni 1: 1 (510 ml / kg / min) kugirango anesthesia.Ingurube zashyizwe mu mwanya wa supine na endoskopi y'ibanze (VISERA 4K UHD rhinolaryngoscope; Olympus, Tokiyo, Ubuyapani) yakozwe kugira ngo isuzume orifice ya nasofaryngeal ET.Icyuma kiyobora icyuma cyatejwe imbere mu mazuru kugera kuri orifice ya nasofaryngeal ya ET iyobowe na endoskopi (Ishusho 3a, b).Catheter ya ballon, stent ikonjeshejwe, yinjizwa binyuze muntangiriro muri ET kugeza igihe isonga ryayo rihuye no guhangana na isthmus ya osteochondral ya ET (Ishusho 3c).Catheter ya ballon yuzuye yuzuyemo saline kugeza mu kirere 9, nkuko byagenwe na monitor ya manometero (Ishusho 3d).Catheter ya ballon yakuweho nyuma yo gushyirwaho stent (Igishusho 3f), hanyuma gufungura amazuru byasuzumwe neza endoskopi yibibazo byo kubaga (Ishusho 3f).Ingurube zose zabazwe endoskopi mbere na ako kanya nyuma yo gutera, kimwe nibyumweru 4 nyuma yo gutera, kugirango isuzume ubushobozi bwikibanza cya stent hamwe n’ibisohoka.
Intambwe ya tekinike yo gushyira stent mumiyoboro ya eustachian (ET) yingurube iyobowe na endoskopi.(a) Ishusho ya Endoskopi yerekana gufungura izuru (umwambi) no gushiramo icyuma kiyobora icyuma (umwambi).(b) Kwinjiza icyuma (umwambi) mu gufungura amazuru..(d) Catheter ya ballon (umwambi) yuzuye.(e) Impera yegeranye ya stent isohoka muri ET orifice ya nasofarynx.(f) Ishusho ya Endoskopi yerekana stent lumen.
Ingurube zose zashizwemo mugutanga 75 mg / kg potasiyumu chloride ukoresheje inshinge zo mumatwi.Ibice bya sagittal yo hagati yumutwe wa pcine byakozwe hakoreshejwe urunigi hanyuma hakurikiraho gukuramo neza ingero za ET scaffold tissue kugirango isuzume amateka (Ishusho yinyongera 1a, b).Urugero rwa ET rwakosowe muri 10% itabogamye ya bufferi ya formine kumasaha 24.
Ingero za tissue tissue zagiye zikurikiranwa hamwe ninzoga yibitekerezo bitandukanye.Ingero zashyizwe mubice bya resin byinjira muri Ethylene glycol methacrylate (Technovit 7200® VLC; Heraus Kulzer GMBH, Wertheim, Ubudage).Ibice bya Axial byakorewe ku cyitegererezo cya ET cyashyizwe mu bice byegeranye kandi biri kure (Ishusho yinyongera. 1c).Ibice bya polymer noneho byashyizwe kumurongo wa acrylic.Igice cya resin cyahagaritswe cyari microground kandi gisizwe hamwe nimpapuro za karubide ya silicon yubunini butandukanye bugera kuri 20 µm ukoresheje sisitemu ya gride (Apparatebau GMBH, Hamburg, Ubudage).Amashusho yose yakorewe isuzuma ryamateka hamwe na hematoxyline na eosine.
Isuzumabumenyi ry’amateka ryakozwe kugira ngo hamenyekane ijanisha ry’ikwirakwizwa ry’imitsi, ubunini bwa fibrosis ya subucosal, hamwe n’urwego rwinjira mu ngirabuzimafatizo.Ijanisha rya hyperplasia ya tissue hamwe na ET ifunganye igice cyambukiranya igice cyabazwe mugukemura ikigereranyo:
Umubyimba wa fibrosis ya subucosal wapimwe uhagaritse kuva kumurongo wa stent kugera kuri subucosa.Urwego rwo kwinjirira mu ngirabuzimafatizo rwasuzumwe no gukwirakwiza n'ubucucike bw'utugingo ngengabuzima, aribyo: icyiciro cya 1 (cyoroheje) - kwinjira kwa leukocyte imwe;Icyiciro cya 2 (cyoroheje kugeza giciriritse) - kwibanda kuri leukocyte;Urwego rwa 3 (ruciriritse) - hamwe.hamwe na leukocytes idashobora gutandukanya loci kugiti cye;icyiciro cya 4 (giciriritse kugeza gikabije) leukocytes yinjira cyane muri subucosa yose, naho icyiciro cya 5 (gikabije) ikwirakwiza kwinjira hamwe nibintu byinshi bya nérosose.Umubyimba wa fibrosis ya subucosal hamwe nurwego rwo kwanduza ingirabuzimafatizo zabonetse ugereranije amanota umunani azengurutse umuzenguruko.Isesengura ry'amateka ya ET ryakozwe hakoreshejwe microscope (BX51; Olympus, Tokiyo, Ubuyapani).Ibipimo byabonetse hakoreshejwe porogaramu ya CaseViewer (CaseViewer; 3D HISTECH Ltd, Budapest, Hongiriya).Isesengura ryamakuru y’amateka ryashingiye ku bwumvikane bw’indorerezi eshatu zitagize uruhare mu bushakashatsi.
Ikizamini cya Mann-Whitney U cyakoreshejwe mu gusesengura itandukaniro riri hagati yitsinda nkuko bikenewe. A p <0.05 byafatwaga nkibyingenzi. A p <0.05 byafatwaga nkibyingenzi. Значение p <0,05 считалось статистически значимым. Agaciro p <0.05 byafatwaga nkibyingenzi. 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 byafatwaga nkibyingenzi. Ikizamini cya Bonferroni cyakosowe Mann - Whitney U-ikizamini cyakorewe p agaciro <0.05 kugirango hamenyekane itandukaniro ryitsinda (p <0.008 nkibisobanuro bifatika). Ikizamini cya Bonferroni cyakosowe Mann - Whitney U-ikizamini cyakorewe p agaciro <0.05 kugirango hamenyekane itandukaniro ryitsinda (p <0.008 nkibisobanuro bifatika). 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 Bonferroni cyahinduwe na Mann-Whitney U cyakorewe p agaciro <0.05 kugirango hamenyekane itandukaniro ryitsinda (p <0.008 nkibisobanuro bifatika).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). Bonferroni-yahinduwe na Mann-Whitney U-ikizamini cyakozwe kuri p <0.05 kugirango hamenyekane itandukaniro ryitsinda (p <0.008 byari bifite imibare ikomeye).Isesengura mibare ryakozwe hakoreshejwe software ya SPSS (verisiyo 27.0; SPSS, IBM, Chicago, IL, USA).
Ibyuma bya pcine byose byashyizwe mubuhanga.Icyuma kiyobora icyuma cyashyizwe neza muri orifice ya nasofaryngeal ET igenzurwa na endoskopi, nubwo gukomeretsa kwa mucosal hamwe no kuva amaraso byagaragaye muri 4 kuri 12 (33.3%) mugihe cyo gushyiramo icyuma.Nyuma yibyumweru 4, kuva amaraso byoroshye guhita bihagarara.Ingurube zose zarokotse kugeza ubushakashatsi burangiye nta kibazo kijyanye na stent.
Ibisubizo bya Endoscopi byerekanwe ku gishushanyo cya 4. Mugihe cy'ibyumweru 4 byakurikiranwe, stent yagumye mu mwanya w'ingurube zose.Ikwirakwizwa rya Mucus muri stent ya ET no hafi yaryo ryagaragaye muri ET zose (100%) mu itsinda rishinzwe kugenzura na bitatu (50%) muri ET esheshatu mu itsinda rya SES, kandi nta tandukaniro ryigeze ribaho mu matsinda yombi (p = 0.182).Nta kintu na kimwe cyashyizweho cyashoboraga kugumana imiterere.
Amashusho ya Endoskopi yumuyoboro wa Eustachian (ET) yingurube mumatsinda yo kugenzura hamwe nitsinda rifite cobalt-chromium stent (CXS) risohora sirolimusi.(a) Ishusho yibanze ya endoskopi yafashwe mbere yo gushyira stent yerekana gufungura izuru (umwambi) wa ET.(b) Ishusho ya Endoskopi yafashwe ako kanya nyuma yo gushyira stent yerekana ET yo gushyira stent.Guhuza amaraso byagaragaye kubera icyuma kiyobora icyuma (umwambi).(c) Ishusho ya Endoskopi yafashwe nyuma y'ibyumweru 4 nyuma yo gushyira stent yerekana kwirundanya kwa mucus hafi ya stent (umwambi).(d) Ishusho ya Endoskopi yerekana ko stent idashobora kuguma izengurutse (umwambi).
Ibyavuye mu mateka byerekanwe ku gishushanyo cya 5 n’inyongera Igishushanyo cya 2. Ikwirakwizwa ryimyanya ndangagitsina hamwe na fibrous ikwirakwizwa rya fibrous hagati yimyanya ya stent muri ET lumen yaya matsinda yombi. Ikigereranyo cyo hagati yubutaka bwa hyperplasia cyabaye kinini cyane mumatsinda yo kugenzura kuruta mu itsinda rya SES (79.48% ± 6.82% na 48.36% ± 10.06%, p <0.001). Ikigereranyo cyo hagati yubutaka bwa hyperplasia cyabaye kinini cyane mumatsinda yo kugenzura kuruta mu itsinda rya SES (79.48% ± 6.82% 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). Ikigereranyo cyo hagati ya hyperplasia ya tissue cyari kinini cyane mumatsinda yo kugenzura kuruta mu itsinda rya SES (79.48% ± 6.82% na 48.36% ± 10.06%, p <0.001).SES 组 9. 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). Ikigereranyo cyo hagati ya hyperplasia ya tissue mu itsinda rishinzwe kugenzura cyari hejuru cyane ugereranije no mu itsinda rya SES (79.48% ± 6.82% na 48.36% ± 10.06%, p <0.001). Byongeye kandi, uburebure buri hagati ya fibrosis ya subucosal nabwo bwari hejuru cyane mumatsinda yo kugenzura kuruta mu itsinda rya SES (1.41 ± 0.25 na 0.56 ± 0,20 mm, p <0.001). Byongeye kandi, uburebure buri hagati ya fibrosis ya subucosal nabwo bwari hejuru cyane mumatsinda yo kugenzura kuruta mu itsinda rya SES (1.41 ± 0.25 na 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, uburebure buri hagati ya fibrosis ya subucosal nabwo bwari hejuru cyane mumatsinda yo kugenzura kuruta mu itsinda rya SES (1.41 ± 0.25 na 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, uburebure buri hagati ya fibrosis ya subucosal mu itsinda rishinzwe kugenzura nabwo bwari hejuru cyane ugereranije no mu itsinda rya SES (1.41 ± 0.25 na 0.56 ± 0,20 mm, p <0.001).Ariko, nta tandukaniro rikomeye ryagaragaye murwego rwo kwinjiza ingirabuzimafatizo hagati yaya matsinda yombi (itsinda rishinzwe kugenzura [3.50 ± 0.55] na SES itsinda [3.00 ± 0.89], p = 0.270).
Isesengura ryamateka ya matsinda abiri ya stent yashyizwe muri Eustachian lumen..Urwego rwo gutwika ingirabuzimafatizo (3 ya a na b; imyambi) ntabwo rwatandukanye cyane hagati yaya matsinda yombi..SES, cobalt-chromium sirolimus eluting stent.
Kunywa ibiyobyabwenge bifasha kunoza stent no kwirinda stent restenosis20,21,22,23,24.Gukomera guterwa na stent bituruka kumiterere ya granulation tissue hamwe na fibrous tissue ihinduka mubice bitandukanye bidafite imitsi, harimo esofagusi, trachea, gastroduodenum, hamwe numuyoboro wa bile.Ibiyobyabwenge nka dexamethasone, paclitaxel, gemcitabine, EW-7197, na sirolimusi bishyirwa hejuru ya meshi ya wire cyangwa stent coating kugirango birinde cyangwa bivure hyperplasia ya tissue nyuma yo gushyirwaho stent29,30,34,35,36.Udushya tugezweho mubijyanye na stent nyinshi zikoreshwa hifashishijwe ikoranabuhanga rya fusion zirimo gukorwaho iperereza kugirango havurwe indwara zidafite imitsi 37,38,39.Mu bushakashatsi bwabanje mu cyitegererezo cya porcine ET, byagaragaye ko ikwirakwizwa rya tissue ryatewe na scafold.Nubwo iterambere rya stent muri ET ridasobanutse neza, igisubizo cyinyuma nyuma yo gushyira stent wasangaga gisa nizindi ngingo zidafite imitsi 19.Muri ubu bushakashatsi, SES yakoreshejwe kugirango ibuze ikwirakwizwa rya tissue scafold mu buryo bwa porcine ET.Sirolimus ni uburozi ku birwa bya pancreatic na beta selile, bigabanya imbaraga za selile kandi byongera apoptose40,41.Izi ngaruka zishobora gufasha kubuza ikwirakwizwa ryimyanya myibarukiro mu gukurura urupfu.Ubushakashatsi bwacu bwerekanye ko gukoresha bwa mbere ibiyobyabwenge biva muri ET byabujije cyane ikwirakwizwa ry’imitsi iterwa na ET.
Umupira waguka wa Co-Cr alloy stent ikoreshwa murubu bushakashatsi iraboneka byoroshye kuko isanzwe ikoreshwa mu kuvura indwara yimitsi yimitsi 42.Mubyongeyeho, Co-Cr alloys ifite imiterere yubukanishi (urugero, imbaraga za radiyo nini nimbaraga zidasanzwe) 43.Dukurikije endoskopi yubushakashatsi bugezweho, Co-Cr alloy stent ikoreshwa kuri ET yingurube ntishobora gukomeza kuzenguruka ingurube zose kubera ubworoherane budahagije kandi idafite ubushobozi bwo kwaguka.Imiterere ya stent yashizwemo irashobora kandi guhindurwa no kuzenguruka ET yinyamaswa nzima (urugero, guhekenya no kumira).Imiterere yubukorikori bwa Co-Cr alloy stent yahindutse imbogamizi mugushira pcine ET.Mubyongeyeho, gushyira stent muri isthmus bishobora kuvamo gufungura burundu ET.Guhora ufunguye cyangwa wagutse ET ituma imvugo n'amajwi ya nasofaryngeal, gastrointestinal refux, na pathogens1 bizamuka mumatwi yo hagati, bigatera uburibwe no kwandura.Kubwibyo, gufungura izuru rihoraho bigomba kwirindwa.Kubwibyo, ukurikije imiterere ya ET karitsiye, scafolds nibyiza bikozwe muburyo bwo kwibuka bwibikoresho bifite imiterere ya superelastique, nka nitinol.Muri rusange, gusohora cyane byabonetse muri noifaryngeal orifice ya stent.Kubera ko umuvuduko wa mucociliary usanzwe wa mucus wahagaritswe, biteganijwe ko ibanga rirundarundarunda muri scafolds isohoka kuva gufungura izuru.Kwirinda kwandura kwanduye kwamatwi yo hagati ni imwe mu ntego nyamukuru za ET, kandi hagomba kwirindwa gushyira stent igaragara hejuru ya ET, kubera ko guhura na stent hamwe na flora ya bacteri ya nasofaryngeal bishobora gutuma indwara ziyongera.
Eustachian tube ballon plasty unyuze mu gufungura izuru ni uburyo bushya bwo kwibasira cyane imikorere mibi ya ET igamije gufungura no kwagura igice cya karitsiye ya ET8,9,10,46.Nyamara, uburyo bwo kuvura bwibanze ntabwo bwamenyekanye47 kandi ibisubizo byigihe kirekire birashobora kuba suboptimal8,9,11,46.Muri ibi bihe, guhagarika icyuma byigihe gito birashobora kuba uburyo bwiza bwo kuvura abarwayi batitabira gusana imipira ya Eustachian tube ballon, kandi bishoboka ko stenting ya ET byagaragaye mubushakashatsi bwinshi bwibanze.Poly-l-lactide scafolds yatewe binyuze muri tympanic membrane muri chinchillas ninkwavu kugirango isuzume kwihanganira no kwangirika muri vivo17,18.Mubyongeyeho, icyitegererezo cyintama cyakozwe kugirango gisuzume imiterere yumupira wicyuma cyaguka muri vivo.Mu bushakashatsi bwabanje, ubushakashatsi bwakozwe na porcine ET bwakozwe kugirango hakorwe iperereza ku buryo bwa tekiniki no gusuzuma ibibazo biterwa na stent, 19 bitanga urufatiro rukomeye rw’ubu bushakashatsi bwo gukora iperereza ku mikorere ya SES hakoreshejwe uburyo bwashyizweho mbere.Muri ubu bushakashatsi, SES yagejejwe neza kuri karitsiye kandi ihagarika neza ikwirakwizwa ryimitsi.Nta ngorane zifitanye isano na stent, ariko habayeho gukomeretsa kwa mucosal byatewe nicyuma kiyobora icyuma hamwe no kuva amaraso byakemuwe bidatinze mugihe cyibyumweru 4.Urebye ingorane zishobora guterwa nicyuma, kunoza sisitemu yo gutanga SES byihutirwa kandi birakomeye.
Ubu bushakashatsi bufite aho bugarukira.Nubwo ibyavuye mu mateka bitandukanye cyane hagati yitsinda, umubare w’inyamaswa muri ubu bushakashatsi wari muto cyane ku isesengura ry’imibare ryizewe.Nubwo indorerezi eshatu zahumye amaso kugira ngo zisuzume itandukaniro riri hagati y’indorerezi, urugero rw’imitsi yinjira mu ngirabuzimafatizo ya subucosal rwagenwe hashingiwe ku gukwirakwiza n’ubucucike bw’uturemangingo twinshi bitewe n’ingorabahizi zo kubara ingirabuzimafatizo.Kubera ko ubushakashatsi bwacu bwakozwe hifashishijwe umubare muto w’inyamaswa nini, hakoreshejwe ikinini kimwe cy’ibiyobyabwenge, mu bushakashatsi bwa vivo pharmacokinetic ntabwo bwakozwe.Iyindi nyigisho irakenewe kugirango hemezwe urugero rwiza rwibiyobyabwenge numutekano wa sirolimusi muri ET.Hanyuma, ibyumweru 4 byo gukurikirana nabyo ni imbogamizi yubushakashatsi, bityo ubushakashatsi ku mikorere ndende ya SES burakenewe.
Ibyavuye muri ubu bushakashatsi byerekana ko SES ishobora guhagarika neza ikwirakwizwa ryimitsi iterwa no gukomeretsa ingirabuzimafatizo nyuma yo gushyira imipira yaguka ya Co-Cr alloy scafolds muburyo bwa porcine ET.Ibyumweru bine nyuma yo gushyira stent, impinduka zijyanye no gukwirakwiza ingirabuzimafatizo (harimo agace ko gukwirakwiza tissue hamwe nubunini bwa fibrosis ya subucosal) byari hasi cyane mumatsinda ya SES kuruta mumatsinda yo kugenzura.SES isa nkingirakamaro muguhagarika ikwirakwizwa ryimitsi iterwa ningurube muri ET.Nubwo hakenewe ubundi bushakashatsi kugirango hamenyekane ibikoresho byiza bya stent hamwe nigipimo cyabakandida banywa ibiyobyabwenge, SES ifite uburyo bwo kuvura bwaho mukurinda ET tissue hyperplasia nyuma yo gushyirwaho stent.
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