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Daraasado kala duwan oo hore oo caafimaad oo ku saabsan tubbada Eustachian (ET) ee la sameeyay ayaa hadda socda, laakiin weli looma isticmaalin waxqabadka kiliinikada.Daraasadaha hore ee bukaan-socodka, ET-saffolds waxay ku xaddidan yihiin kororka unugyada is-biirsaday.Waxtarka cobalt-chromium sirolimus-eluting stent (SES) ee xakameynaya faafinta unugyada stent-ku-soo-baxa ka dib markii meelaynta stent lagu bartay qaabka ET porcine.Lixda doofaar ayaa loo qaybiyay laba kooxood (ie kooxda kantaroolka iyo kooxda SES) iyadoo koox kasta ay ku jiraan saddex doofaar.Kooxda xakamaynta waxay heleen stent kobalt-chromium ah oo aan la daboolin (n = 6), kooxda SES waxay heleen stent cobalt-chromium oo leh dahaarka sirolimus-eluting (n = 6).Dhammaan kooxaha waxaa la sadqeeyay 4 usbuuc ka dib meelaynta stent.Meelaynta stent waxay ku guulaysatay dhammaan ET-yada iyada oo aan lahayn dhibaatooyin la xidhiidha qalliinka.Midkoodna stent-yada ma haysan karo qaabkoodii asalka ahaa, ururinta xab-xabkuna waxa lagu arkay gudaha iyo hareeraha stent-yada labada kooxood.Falanqaynta taariikhiga ah waxay muujisay in aagga fidinta unugyada iyo dhumucda fibrosis submucosal ee kooxda SES ay aad uga hooseeyaan kooxda kantaroolka.SES waxay u muuqataa inay wax ku ool u tahay joojinta faafinta unugyada is-daba-mareenka ah ee doofaarka ET.Si kastaba ha ahaatee, daraasado dheeraad ah ayaa loo baahan yahay si loo xaqiijiyo alaabta ugu fiican ee stent iyo daawooyinka ka hortagga faaruqa.
Tuubbada Eustachian (ET) waxay leedahay hawlo muhiim ah oo ay ku leedahay dhegta dhexe (tusaale, hawo-qaadasho, ka-hortagga u-wareejinta cudur-sidaha iyo dheecaannada nasopharynx)1.Waxa kale oo ka mid ah ka-hortagga dhawaaqa nasopharyngeal iyo regurgitation2.ET inta badan waa la xidhaa, laakiin waxa uu ku furmaa liqidda, hamaansiga, ama qayilaada.Si kastaba ha ahaatee, cillad la'aanta ET waxay dhici kartaa haddii tuubada aysan si fiican u furin ama u xirmin3,4.Qalafsanaan la'aan (obstructive) ee ET waxay niyad-jabisaa shaqada ET, haddii hawlahan aan la ilaalin, waxay u koraan otitis media ba'an ama daba-dheer, mid ka mid ah cudurrada ugu badan ee dhaqanka ENT.Daawaynta hadda jirta ee cillad la'aanta ET (tusaale, qalliin sanka, meelaynta tuubada hawo-qaadista, iyo daawada) ayaa loo isticmaalaa bukaannada.Si kastaba ha ahaatee, daawayntani waxay leeyihiin waxtarkoodu xaddidan yahay waxayna u horseedi karaan xannibaad ET, caabuqa, iyo daloolinta xuubabka tympanic ee aan laga noqon karin3,6,7.Eustachian tube biibiile angioplasty ayaa loo soo bandhigay sidii daaweyn kale oo loogu talagalay cillad la'aanta ET 8.Inkasta oo daraasado dhowr ah laga soo bilaabo 2010 ay muujiyeen in dayactirka tuubada Eustachian uu ka sarreeyo daaweynta caadiga ah ee cilladda ET, bukaannada qaarkood kama jawaabaan dilatation8,9,10,11.Markaa, stenting waxay noqon kartaa ikhtiyaar daawaynta wax ku ool ah12,13.In kasta oo ay jiraan daraasado badan oo hore oo socda oo qiimeynaya suurtagalnimada farsamada iyo jawaabta unugyada ka dib meelaynta stent ee ET, hyperplasia unug-ku-soo-baxa oo ay sababto burburka farsamada ayaa ah dhibaato weyn oo qalliinka kadib ah 14,15,16,17,18,19.Dahaarka maandooriyaha, oo ay ku raran yihiin wakiilada ka hortagga faafinta ayaa hagaajiya xaaladdan.
stent-daroogo ayaa loo isticmaalay in lagu joojiyo restenosis in-stent oo ay keento unug iyo hyperplasia neointimal ka dib meelaynta stent.Caadi ahaan, qolofyada stent ama dahaarka waxaa lagu dahaadhay daawooyin (tusaale, everolimus, paclitaxel, iyo sirolimus)20,23,24.Sirolimus waa daawada caadiga ah ee ka hortagga proliferative taas oo joojisa dhowr tillaabo oo ka mid ah cascade restenosis (tusaale, caabuq, neointimal hyperplasia, iyo kolajka synthesis)25.Sidaa darteed, daraasaddan ayaa qiyaaseysa in stent-dahaarka sirolimus ay ka hortagi karto hyperplasia unug-ka-soo-baxa ee doofaarka ET (Jaantus 1).Ujeedada daraasaddan waxay ahayd in la baaro waxtarka sirolimus-eluting stent (SES) ee xakameynaya faafinta unugyada stent-ku-soo-baxa ka dib meelaynta stent ee qaabka porcine ET.
Sharaxaada qaabaysan ee cobalt-chromium sirolimus-eluting stent (SES) ee loogu talagalay daawaynta cillad la'aanta tuubada Eustachian, taas oo muujinaysa in stent-ka sirolimus-eluting uu joojiyo faafinta unugyada stent-ku keeno.
Cobalt-chromium (Co-Cr) stent aluminium ah ayaa la sameeyay iyadoo la jaray laser Co-Cr tuubooyin alloy ah (Genoss Co., Ltd., Suwon, Korea).Goobta stent waxay isticmaashaa dammaanad labanlaab ah oo furan oo leh qaabdhismeed midaysan oo loogu talagalay dabacsanaan sare leh oo leh xoog shucaac ah, gaabin iyo u hoggaansanaansho.Istaarku wuxuu lahaa dhexroor 3 mm, dhererkiisu yahay 18 mm, dhumucdiisuna tahay 78 µm (Jaantus. 2a).Cabbirrada qaabka Co-Cr alloy-ga waxaa lagu go'aamiyay iyadoo lagu salaynayo daraasaddeennii hore.
Cobalt-chromium (Co-Cr) stent alloy ah iyo gal hagaha biraha ee meelaynta stent tube Eustachian.Sawiradu waxay muujinayaan (a) Co-Cr alloy stent iyo (b) tuubbada buufin ee stent-ku-xidhan.(c) Kateetarka buufinta iyo stent si buuxda ayaa loo daad gureeyay.(d) Galka hagaha birta ayaa loo sameeyay qaabka tuubada Eustachian porcine.
Sirolimus ayaa lagu dabaqay dusha sare ee stent iyadoo la isticmaalayo tignoolajiyada buufinta ultrasonic.SES waxaa loogu talagalay in lagu sii daayo ku dhawaad ​​70% culayska daawada asalka ah (1.15 µg/mm2) 30 ka maalmood ee ugu horreeya ka dib meelaynta.Daahan 3 µm aadka u dhuuban ayaa lagu dabaqayaa kaliya dhinaca u dhow ee stent si loo gaaro astaanta siideynta daroogada ee la doonayo oo loo yareeyo tirada polymer;dahaarkan biodegradable ka kooban yahay copolymer ah lactic iyo glycolic acids iyo isku darka lahaansho ee poly(1) -lactic acid)26,27.Co-Cr stent aloy ah ayaa lagu dhuftey kateetarka buufinta 3 mm dhexroor iyo 28 mm dheer (Genoss Co., Ltd.; Jaantuska 2b).Xargahaan ayaa laga heli karaa Kuuriyada Koonfureed si loogu daweeyo cudurrada wadnaha.
Qolfoofka hagaha birta ee dhowaan la sameeyay ee nooca doofaarka ET wuxuu ka samaysan yahay bir aan lahayn (Jaantus. 2c).Dhexroorka gudaha iyo dibadda ee qolofka waa 2 mm iyo 2.5 mm, siday u kala horreeyaan, dhererka guud waa 250 mm.Galka fog ee 30 mm waxaa loo leexiyay qaab J oo ah xagal 15° dhanka dhidika si uu ugu ogolaado in si fudud looga galo sanka ilaa cirifka sanka ee ET ee qaabka doofaarka.
Daraasaddan waxaa ansixiyay Guddiga Adeegga Xayawaanka ee Hay'adda Xannaanada Xoolaha ee Machadka Asan ee Sayniska Nolosha (Seoul, South Korea) waxayna u hoggaansamaan Machadyada Qaranka ee Tilmaamaha Caafimaadka ee Daaweynta Bani'aadamnimada ee Xayawaanka Shaybaarka (IACUC-2020-12-189)..Daraasadda waxaa loo sameeyay si waafaqsan tilmaamaha ARRIVE.Daraasadani waxay isticmaashay 12 ETs ee 6 doofaarro oo miisaankoodu yahay 33.8-36.4 kg ee 3 bilood da'da.Lixda doofaar ayaa loo qaybiyay laba kooxood (ie kooxda kantaroolka iyo kooxda SES) iyadoo koox kasta ay ku jiraan saddex doofaar.Kooxda xakamaynta waxay heshay stent Co-Cr alloy ah oo aan daboolin, halka kooxda SES ay heleen Co-Cr alloy stent eluting sirolimus.Dhammaan doofaarradu waxay heleen biyo iyo quud bilaash ah waxaana lagu hayn jiray 24°C ± 2°C wareegga habeen-maalmeedka 12-saac.Ka dib, dhammaan doofaarrada ayaa la sadqeeyay 4 toddobaad ka dib meelaynta stent.
Dhammaan doofaarradu waxay heleen isku dar ah 50mg/kg zolazepam, 50mg/kg teletamide (Zoletil 50; Virbac, Carros, France) iyo 10mg/kg xylazine (Rompun; Bayer HealthCare, Les Varkouzins, Germany).ka dibna tuubada hawo mareenka waxaa la geliyay neefsashada 0.5-2% isoflurane (Ifran®; Hana Pharm. Co., Seoul, Korea) iyo oxygen 1: 1 (510 ml/kg/min) suuxinta.Doofaarka ayaa la dhigay booska dhabarka iyo endoscopy aasaasiga ah (VISERA 4K UHD rhinolaryngoscope; Olympus, Tokyo, Japan) ayaa la sameeyay si loo baaro marinka sanka ee sanka ee ET.Galka hagaha birta ayaa lagu hormariyay duleelka sanka ilaa cidhifka sanka ee ET ee hoos yimaada xakamaynta endoscopic (Jaantus. 3a, b).Kateetarka buufinta, stent jiingad ah, ayaa la dhex geliyaa soo-bandhigiyaha ET ilaa caaradeedu ay la kulanto iska caabbinta osteochondral isthmus ee ET (Jaantus. 3c).Kateetarka buufinta ayaa si buuxda loogu buufiyay milix ilaa 9 jawi, sida uu go'aamiyay kormeeraha manometerka (Jaantus. 3d).Kateetarka buufinta ayaa laga saaray ka dib meelaynta stent (Jaantus. 3f), iyo furitaanka sanka ayaa si taxadar leh loo qiimeeyay endoscopy dhibaatooyinka qalliinka (Jaantus. 3f).Dhammaan doofaarrada ayaa la maray endoscopy ka hor iyo isla markiiba ka dib stenting, iyo sidoo kale 4 toddobaad ka dib stenting, si loo qiimeeyo patency ee goobta stent iyo sirta ku hareeraysan.
Tallaabooyinka farsamada ee gelinta stent tuubada eustachian (ET) ee doofaarka ee hoos yimaada xakamaynta endoscopic.(a) Sawirka Endoscopic oo muujinaya furitaanka naasopharyngeal ( fallaadha) iyo gal-galka hagaha birta ( fallaadha).(b) Gelida gal bir ah ( falaarta ) oo la geliyo daloolka sanka.(c) Kateetarka buufinta ee stent-ku-duuban ( falaarta) ayaa lagu dhex geliyaa ET iyada oo loo marayo gal (falaar).(d) Kateetarka buufinta ( fallaadha) si buuxda ayaa loo buufiyay.(e) Dhammaadka u dhow ee stent ka ayaa ka soo baxa ET afka naasopharynx.(f) Sawirka Endoscopic oo muujinaya patency lumen.
Dhammaan doofaarradu waa la nadiifiyey iyada oo la maamulay 75 mg/kg potassium chloride oo lagu duray xididdada dhegta.Qaybaha sagittal ee dhexdhexaadka ah ee madaxa porcine ayaa lagu sameeyay iyadoo la adeegsanayo silsilad silsilad ah oo ay ku xigto si taxadar leh oo laga soo saaray muunadaha unugyada ET scaffold ee baaritaanka taariikhiga ah (Jaantuska Dheeraadka ah 1a,b).Tijaabooyin unugyo ET ah ayaa lagu hagaajiyay 10% formalin dhexdhexaad ah muddo 24 saacadood ah.
Muunadaha unugyada ET ayaa si isdaba joog ah loogu fuuqbaxay aalkolo leh xaddi kala duwan.Tusaalooyinka waxaa lagu dhejiyay baloogyada resinka iyadoo la dhex gelinayo ethylene glycol methacrylate (Technovit 7200® VLC; Heraus Kulzer GMBH, Wertheim, Germany).Qaybaha axial waxaa lagu sameeyay shaybaarada unugyada ET-ga ee ku dhex jira qaybaha u dhow iyo kuwa fog (Jaantuska Dheeraadka ah 1c).Dabaqyada polymerka ayaa markaa lagu rakibay sawiro dhalo ah oo akrilik ah.Sawirada xabagta xabagta ayaa ahaa dhul-yaro waxaana lagu dahaadhay warqad silikoon carbide ah oo dhumucyo kala duwan leh ilaa dhumucdiisuna tahay 20 µm iyadoo la isticmaalayo nidaamka grid (Apparatebau GMBH, Hamburg, Germany).Dhammaan boggaga waxaa lagu sammeeyay qiimeynta histological iyadoo la raacayo hematoxylin iyo eosin midab leh.
Qiimaynta taariikhiga ah ayaa la sameeyay si loo qiimeeyo boqolkiiba korodhka unugyada, dhumucda fibrosis submucosal, iyo heerka dhexgalka unugyada bararka.Boqolkiiba hyperplasia unug leh meel cidhiidhi ah oo ET ah ayaa lagu xisaabiyey iyadoo la xalinayo isla'egta:
Dhumucda xuubka xuubka hoose ee fibrosis ayaa si toos ah loo cabbiray laga soo bilaabo stent struts ilaa xuubka hoose.Heerka caabuqa unugyada bararka ayaa si macquul ah loo xukumay qaybinta iyo cufnaanta unugyada caabuqa, kuwaas oo ah: 1st degree ( khafiif ah) - hal leukocyte oo keliya;heerka 2-aad (fudud ilaa dhexdhexaad) - faleebo leukocyte focal;Darajada 3aad (dhexdhexaad) - oo la isku daray.oo leh leukocytes oo aan awoodin inay kala soocaan goobta shakhsi ahaaneed;fasalka 4 (dhex dhexaad ilaa daran) leukocytes si fidsan u soo qulqulaya dhammaan submucosa, iyo fasalka 5 (daran) waxay faafiyaan dhexgalka facis badan oo necrosis ah.Dhumucda xuubka xuubka hoose iyo heerka dhexgalka unugyada bararka ayaa lagu helay celcelis ahaan siddeed dhibcood oo ku wareegsan wareegga.Falanqaynta taariikhiga ah ee ET waxa lagu sameeyay mikroskoob (BX51; Olympus, Tokyo, Japan).Cabbirrada waxa lagu helay software-ka CaseViewer (CaseViewer; 3D HISTECH Ltd., Budapest, Hungary).Falanqaynta xogta taariikhiga ah waxay ku salaysnayd is-afgaradka saddexda goobjooge ee aan ka qayb qaadan daraasadda.
Imtixaanka Mann-Whitney U-tijaabada waxaa loo isticmaalay in lagu falanqeeyo faraqa u dhexeeya kooxaha marka loo baahdo. A p <0.05 ayaa loo tixgaliyay inay muhiim tahay. A p <0.05 ayaa loo tixgaliyay inay muhiim tahay. Значение p <0,05 считалось статистически значимым. Qiimaha p <0.05 ayaa loo tixgaliyay inay muhiim tahay. 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 ayaa loo tixgaliyay inay muhiim tahay. Imtixaanka Bonferroni-lagu saxay Mann–Whitney U-tijaabada waxaa loo sameeyay p qiyamka <0.05 si loo ogaado kala duwanaanshaha kooxda (p <0.008 sida tirakoob ahaan muhiim ah). Imtixaanka Bonferroni-lagu saxay Mann-Whitney U-tijaabada ayaa loo sameeyay p qiyamka <0.05 si loo ogaado kala duwanaanshaha kooxda (p <0.008 sida tirakoob ahaan muhiim ah). U-критерий Манна-Уитни скачать видео - атистически значимое). Bonferroni-lagu hagaajiyay Mann-Whitney U tijaabada waxaa loo sameeyay p qiyamka <0.05 si loo ogaado kala duwanaanshaha kooxda (p <0.008 sida tirakoob ahaan muhiim ah).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 статистически значимым). Bonferroni-lagu hagaajiyay Mann-Whitney U-tijaabada waxaa loo sameeyay p <0.05 si loo ogaado kala duwanaanshaha kooxda (p <0.008 waxay ahayd mid muhiim ah).Falanqaynta tirakoobka ayaa la sameeyay iyadoo la isticmaalayo software SPSS (nooca 27.0; SPSS, IBM, Chicago, IL, USA).
Dhammaan meelaynta stent porcine waxay ahaayeen kuwo farsamo ahaan lagu guulaystay.Galka hagaha birta ayaa si guul leh loogu dhejiyay marinka sanka ee nasopharyngeal ee ET ee hoos yimaada kontoroolka endoscopic, inkasta oo dhaawaca xuubka ee dhiigbaxa taabashada lagu arkay 4 ee shaybaarada 12 (33.3%) inta lagu jiro galinta birta.4 usbuuc ka dib, dhiigbaxa la dareemi karo ayaa si kedis ah u istaagay.Dhammaan doofaarradu way badbaadeen ilaa dhammaadka daraasadda iyada oo aan lahayn dhibaatooyin la xidhiidha stent.
Natiijooyinka Endoscopy-ga waxaa lagu muujiyey Jaantuska 4. Intii lagu jiray dabagalka 4-usbuuc, stents ayaa ku sii jiray dhammaan doofaarrada.Isku-ururinta xabka ee gudaha iyo hareeraha ET stent ayaa lagu arkay dhammaan (100%) ET ee kooxda kantaroolka iyo saddex (50%) ee lixda ET ee kooxda SES, mana jirin farqi u dhexeeya dhacdooyinka labada kooxood (p = 0.182).Midna stent-yada la rakibay ma hayn karo qaab wareegsan.
Sawirada Endoscopic ee tuubada Eustachian (ET) ee doofaarka ee kooxda kantaroolka iyo kooxda leh cobalt-chromium stent (CXS) ee koraya sirolimus.(a) Sawirka asalka ah ee endoscopic ee la qaaday ka hor inta aan la dhigin stent muujinaya furitaanka naasopharyngeal (falaarta) ee ET.(b) Sawirka Endoscopic ee la qaaday isla markiiba ka dib meelaynta stent ee muujinaysa ET ee meelaynta stent.Dhiigbaxa xidhiidhka ayaa lagu arkay gadhka hagaha birta dartiis.(c) Sawirka Endoscopic ee la qaaday 4 usbuuc ka dib meelaynta stent waxay muujinaysaa xab ku urursan hareeraha stent (falaarta).(d) Sawirka Endoscopic ee muujinaya in stent-ku aanu sii ahaan karin wareegsan (falaar).
Natiijooyinka taariikhiga ah ayaa lagu muujiyey jaantuska 5 iyo Jaantuska Dheeraadka ah 2. Kororka unugyada iyo fibroska xuubka hoose ee u dhexeeya dhejiska stent ee ET lumen ee labada kooxood. Celceliska boqolkiiba aagga hyperplasia unug ayaa si aad ah uga weyn kooxda kantaroolka marka loo eego kooxda SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001). Celceliska boqolkiiba aagga hyperplasia unug ayaa si aad ah uga weyn kooxda kantaroolka marka loo eego kooxda SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001). Средний процент площади гиперплазии тканей былзначительно быльше ротив 48,36% ± 10,06%, p <0,001). Celcelis ahaan boqolkiiba aagga hyperplasia unugyada ayaa si aad ah uga weyn kooxda kantaroolka marka loo eego kooxda SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001).SES (79.48% ± 6.82% vs.48.36% ± 10.06%, p <0.001) 48.36% ± 10.06%, p <0.001) Средний процент площади гиперплазии ткане в контрольной группе былзначительно выше, чем в 8 48,36% ± 10,06%, p <0,001). Celcelis ahaan boqolkiiba aagga hyperplasia unug ee kooxda xakamaynta ayaa aad uga sarreeyay kooxda SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001). Waxaa intaa dheer, dhumucda celceliska fibrosis submucosal ayaa sidoo kale si aad ah uga sarreeya kooxda kantaroolka marka loo eego kooxda SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p <0.001). Waxaa intaa dheer, dhumucda celceliska fibrosis submucosal ayaa sidoo kale si aad ah uga sarreeya kooxda kantaroolka marka loo eego kooxda SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p <0.001). Боле того, средня толщина подслизистого фиброза также 1 ± 0,25 против 0,56 ± 0,20 мм, p <0,001). Waxaa intaa dheer, dhumucda celceliska fibrosis submucosal ayaa sidoo kale si aad ah uga sarreeya kooxda kantaroolka marka loo eego kooxda 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) DAAWO:- 1 ± 0,25 против 0,56 ± 0,20 мм, p <0,001). Intaa waxaa dheer, dhumucda celceliska fibrosis submucosal ee kooxda xakamaynta ayaa sidoo kale si aad ah uga sarreeya kooxda SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p <0.001).Si kastaba ha ahaatee, ma jirin farqi weyn oo u dhexeeya heerka unugyada caabuqa ee u dhexeeya labada kooxood (kooxda xakamaynta [3.50 ± 0.55] vs. Kooxda SES [3.00 ± 0.89], p = 0.270).
Falanqaynta baaritaanka histological ee laba kooxood oo stent ah oo lagu dhejiyay lumen Eustachian.(a, b) Aagga hyperplasia unug (1 ee a iyo b) iyo dhumucda fibrosis submucosal (2 ee a iyo b; fallaadho labajibbaaran) ayaa si aad ah uga weyn kooxda kantaroolka marka loo eego kooxda SES ee leh stenting strut (dhibcaha madow), aagga lumen cidhiidhi ah (jaalle) iyo aagga asalka ah (casaan).Heerka gelitaanka unugyada bararka (3 of a iyo b; fallaadho) si weyn ugamay duwanayn labada kooxood.(c) Natiijooyinka taariikhiga ah ee boqolkiiba aagga unugyada hyperplasia, (d) dhumucda fibrosis submucosal, iyo (e) heerka dhexgalka unugyada bararka 4 toddobaad ka dib meelaynta stent ee labada kooxood.SES, cobalt-chromium sirolimus eluting stent.
Stent-ka-daawadu waxay gacan ka geysataa hagaajinta stent patency iyo ka hortagga restenosis stent20,21,22,23,24.Cadaadiska stent-ku keeno waxay ka dhashaan samaynta unugyada granulation iyo isbeddellada unugyada fibreed ee xubnaha kala duwan ee aan xididdada dhiigga ahayn, oo ay ku jiraan hunguriga, trachea, gastroduodenum, iyo xuubka xadhkaha.Daawooyinka sida dexamethasone, paclitaxel, gemcitabine, EW-7197, iyo sirolimus ayaa lagu dabaqaa dusha sare ee mesh siliga ama dahaarka stent si looga hortago ama loo daweeyo unugyada hyperplasia ka dib meelaynta stent29,30,34,35,36.Wax cusub oo cusub oo ku saabsan stents multifunctional iyadoo la adeegsanayo tignoolajiyada fiyuuska ayaa si firfircoon loogu baarayaa daawaynta cudurada occlusive ee aan xididada lahayn37,38,39.Daraasad hore oo lagu sameeyay qaabka porcine ET, fidinta unugyada qolof-ku-laaban ayaa la arkay.Inkasta oo horumarka stent ee ET aan si fiican loo fahmin, jawaabta unugga ka dib meelaynta stent ayaa la ogaaday inay u egtahay kuwa kale ee xubnaha nalalka aan xididada lahayn19.Daraasadda hadda jirta, SES waxaa loo isticmaalay in lagu xakameeyo faafinta unug-ku-soo-baxa ee qaabka ET porcine.Sirolimus waxay sun u tahay jasiiradaha ganaca iyo xadhkaha unugyada beta, waxay yaraynaysaa jiritaanka unugyada waxayna wanaajisaa apoptosis40,41.Saamayntan ayaa laga yaabaa inay gacan ka geysato joojinta samaynta faafinta unugyada iyadoo kicinaysa dhimashada unugyada.Daraasaddeenu waxay muujisay in isticmaalka ugu horreeya ee stent-daroogo ee ET ay si wax ku ool ah u joojisay kororka unugyada stent-ka ee ET.
Buufin-ballaadhin kara Co-Cr daawaynta daawaynta loo isticmaalo daraasaddan ayaa diyaar u ah maadaama inta badan loo isticmaalo daaweynta cudurka halbowlaha halbowlaha 42.Intaa waxaa dheer, Alloys Co-Cr waxay leeyihiin sifooyin farsamo (tusaale, xoog shucaac ah oo sarreeya iyo xoogag aan dabacsanayn) 43.Marka loo eego endoscopy-ga daraasadda hadda jirta, Co-Cr alloy stent loo isticmaalo ET ee doofaarradu ma ilaalin karaan qaabka wareegsan ee doofaarrada oo dhan sababtoo ah dabacsanaan ku filan oo aan lahayn awood is-ballaarinta.Qaabka taranka la geliyey waxa kale oo lagu beddeli karaa dhaqdhaqaaqa ET ee xayawaanka nool (tusaale, ruugista iyo liqidda).Astaamaha makaanikada ee Co-Cr alloy stents waxay noqdeen khasaare meelaynta stent porcine ET.Intaa waxaa dheer, meelaynta stent ee isthmus waxay keeni kartaa ET si joogto ah u furan.ET furan ama fidsan joogtada ah waxay u ogolaataa hadalka iyo sanqadha sanka, reflux mindhicirka, iyo cudur-sidaha 1 inay u socdaalaan dhegta dhexe, taasoo keenta xab-xabxab iyo caabuq.Sidaa darteed, waa in laga fogaadaa furitaanka sanka ee joogtada ah.Sidaa darteed, marka la eego qaab dhismeedka carjawda ET, xargaha ayaa la doorbidayaa in laga sameeyo alaabo xusuusta qaabaysan oo leh astaamo superelastic ah, sida nitinol.Guud ahaan, dheecaan culus ayaa laga helay gudaha iyo hareeraha marinka nasopharyngeal ee stent.Maaddaama dhaqdhaqaaqa caadiga ah ee xuubka xabka uu xanniban yahay, sirta ayaa la filayaa inay ku ururto qolofyo ka soo baxa naasopharyngeal furitaanka.Ka-hortagga caabuqa dhegta dhexe ee kor u kaca waa mid ka mid ah ujeedooyinka ugu muhiimsan ee ET, waana in laga fogaadaa meelaynta stent ka soo baxa ET-da, maadaama taabashada tooska ah ee stents ee bakteeriyada nasopharyngeal ay keeni karto infekshannada kor u kaca.
Eustachian tube balloon balaastiig dhex mara daloolka sanka ayaa ah daawaynta ugu yar ee ET8,9,10,46.Si kastaba ha ahaatee, habka daawaynta ee hoose lama aqoonsan47 natiijooyinkeeda muddada fogna waxay noqon karaan kuwo aad u hooseeya8,9,11,46.Xaaladahan hoos yimaada, birta ku-meel-gaadhka ah ee ku-meel-gaadhka ah waxay noqon kartaa ikhtiyaar daweyn oo waxtar leh bukaannada aan ka jawaabin hagaajinta buufinta tuubada Eustachian, iyo suurtogalnimada ET stenting ayaa lagu muujiyay daraasado badan oo takhasus ah.Qalabyada poly-l-lactide ayaa lagu dhex beeray xuubka tympanic ee chinchillas iyo bakaylaha si loo qiimeeyo dulqaadka iyo hoos u dhaca vivo17,18.Intaa waxaa dheer, moodal ido ah ayaa la sameeyay si loo qiimeeyo astaanta birta birta ah ee buufinta la fidin karo ee vivo.Daraasaddeenii hore, qaabka ET porcine ayaa la sameeyay si loo baaro suurtagalnimada farsamada iyo qiimeynta dhibaatooyinka stent-ku keeno,19 siinta saldhig adag oo daraasaddan lagu baarayo waxtarka SES iyadoo la adeegsanayo habab hore loo aasaasay.Daraasaddan, SES ayaa si guul leh loogu meeleeyay carjawda waxayna si wax ku ool ah u joojisay faafinta unugyada.Ma jiraan dhibaatooyin la xiriira stent, laakiin waxaa jiray dhaawac xuubka ah oo uu sababay galka hagaha birta oo leh dhiig-bax taabasho ah oo si kedis ah u xalliyay 4 toddobaad gudahood.Marka la eego dhibaatooyinka suurtagalka ah ee galka biraha, hagaajinta nidaamka bixinta SES waa degdeg iyo muhiim.
Daraasadani waxay leedahay xaddidaadyo.Inkasta oo natiijooyinka taariikhiga ahi ay si weyn ugu kala duwanaayeen kooxaha, tirada xayawaanka ee daraasaddan ayaa aad u yarayd falanqaynta tirakoobka ee la isku halayn karo.Inkasta oo saddex indho-indhayn ah la indho-tiray si ay u qiimeeyaan kala duwanaanshiyaha isdhexgalka, heerka submucosal inflammatory cell infiltration ayaa la go'aamiyay si macquul ah oo ku salaysan qaybinta iyo cufnaanta unugyada bararka sababtoo ah dhibka tirinta unugyada bararka.Tan iyo markii aan daraasadda lagu sameeyay iyada oo la adeegsanayo tiro xaddidan oo xayawaanno waaweyn ah, hal dose oo daroogada ah ayaa la isticmaalay, in vivo daraasadaha farmashiyaha lama samayn.Daraasado dheeraad ah ayaa loo baahan yahay si loo xaqiijiyo qiyaasta ugu fiican ee daawada iyo badbaadada sirolimus ee ET.Ugu dambeyntii, muddada dabagalka ee 4-usbuuc sidoo kale waa xaddidaadda daraasadda, sidaas darteed daraasado ku saabsan waxtarka muddada dheer ee SES ayaa loo baahan yahay.
Natiijooyinka daraasaddan waxay muujinayaan in SES ay si wax ku ool ah u joojin karto kororka unugyada dhaawaca farsamada ka dib meelaynta buufin-ballaadhinta Co-Cr aluminium ee qaabka porcine ET.Afar usbuuc ka dib meelaynta stent, doorsoomayaasha la xidhiidha kororka unugyada stent-ku-soo-baxa (oo ay ku jiraan aagga fidinta unugyada iyo dhumucda fibrosis submucosal) ayaa aad uga hooseeya kooxda SES marka loo eego kooxda kantaroolka.SES waxay u muuqataa inay wax ku ool u tahay joojinta faafinta unugyada is-daba-mareenka ah ee doofaarka ET.In kasta oo cilmi-baaris dheeraad ah loo baahan yahay si loo tijaabiyo agabka stent-ka ugu fiican iyo qiyaasta musharrixiinta daroogada, SES waxay leedahay awood daweyn deegaanka ah oo looga hortagayo hyperplasia unugga ET ka dib meelaynta stent.
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