Maccabee Mendy S, Trune Dennis R, Hwang Peter H
Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 97239-3098, USA.
Am J Rhinol. 2003 Jul-Aug;17(4):203-7.
Recently, nasal packing made of absorbable biomaterial has become increasingly popular. Although absorbable packs are effective for hemostasis, their impact on healing mucosa is unknown. Some have felt that a biocompatible sinus dressing actually may enhance healing, particularly in areas where the mucosa has been stripped. The aim of this study was to determine the effect of topical MeroGel and FloSeal on paranasal sinus mucosal healing in a rabbit model.
Bilateral maxillary sinuses of 12 New Zealand white rabbits were surgically opened and stripped of mucosa. The left maxillary sinus of six rabbits had sterile saline-soaked MeroGel placed in the antrum, and the other six rabbits received FloSeal. The right maxillary sinuses of all 12 animals were stripped and otherwise untreated to serve as stripped controls. The animals were killed at 2 weeks and specimens were examined by light microscopy.
MeroGel-treated mucosa showed extensive fibrosis of the basal lamina and lamina propria, complete loss of surface epithelium, and loss of the mucociliary blanket. There was minimal resorption of the MeroGel, and MeroGel fibers were frankly incorporated into the regenerated epithelium, associated with an exuberant lymphocytic infiltrate. FloSeal-treated mucosa showed similar fibrosis of the basal lamina and lamina propria with loss of the mucociliary blanket, although to a lesser degree than the MeroGel- treated group. FloSeal showed similar incorporation into the healed mucosa with lymphocytosis. Controls showed expected submucosal gland reduction, lamina propria fibrosis, and loss of cilia, but the lamina propria fibrosis seen in the MeroGel and FloSeal groups was markedly more prominent.
In a rabbit model, MeroGel and FloSeal appear to increase reactionary fibrosis of healing mucosa. These agents also appear to be incompletely resorbed and grossly incorporated into healing tissue. Mucosal healing may be impaired by the application of these agents.
近来，由可吸收生物材料制成的鼻腔填塞物越来越受欢迎。尽管可吸收填塞物对止血有效，但其对愈合黏膜的影响尚不清楚。一些人认为生物相容性鼻窦敷料实际上可能会促进愈合，特别是在黏膜已被剥离的区域。本研究的目的是确定局部应用美罗凝胶（MeroGel）和弗洛塞尔（FloSeal）对兔模型鼻窦黏膜愈合的影响。
对12只新西兰白兔的双侧上颌窦进行手术切开并剥离黏膜。6只兔子的左上颌窦在窦腔内放置无菌盐水浸泡的美罗凝胶，另外6只兔子接受弗洛塞尔治疗。所有12只动物的右上颌窦均被剥离且未进行其他处理，作为剥离对照组。2周后处死动物，标本进行光镜检查。
美罗凝胶处理的黏膜显示基底层和固有层广泛纤维化，表面上皮完全缺失，黏液纤毛毯消失。美罗凝胶的吸收极少，美罗凝胶纤维明显融入再生上皮，并伴有大量淋巴细胞浸润。弗洛塞尔处理的黏膜显示基底层和固有层有类似的纤维化，黏液纤毛毯消失，尽管程度比美罗凝胶处理组轻。弗洛塞尔在愈合黏膜中的融入情况及淋巴细胞增多情况类似。对照组显示预期的黏膜下腺减少、固有层纤维化和纤毛缺失，但美罗凝胶组和弗洛塞尔组所见的固有层纤维化明显更突出。
在兔模型中，美罗凝胶和弗洛塞尔似乎会增加愈合黏膜的反应性纤维化。这些药物似乎也未被完全吸收，而是大量融入愈合组织。应用这些药物可能会损害黏膜愈合。
