Olmos-Zúñiga J R, Santos-Cordero J A, Jasso-Victoria R, Sotres-Vega A, Gaxiola-Gaxiola M O, Mora-Fol J R, Franco-Oropeza J A, Santillan-Doherty P
Departamento de Investigación en Cirugía Experimental, Hospital Central Sur de Alta Especialidad PEMEX, México, D.F.
Acta Otorrinolaringol Esp. 2004 Feb;55(2):81-7. doi: 10.1016/s0001-6519(04)78487-3.
Several drugs have been used to modulate of the tracheal healing process in order to prevent tracheal stenosis. Hyaluronic acid (HA) is a modulator of the fibrogenesis. In this work we evaluate the effect in order the application of hyaluronic acid has on tracheal healing, after cervical tracheoplasty in dogs. A cervical tracheal resection and tracheoplasty was performed in 12 dogs and they were treated following surgery as follows: Group I (n = 6) Topical application of normal saline solution (0.9%) on the anastomosis site. Group II Topical application of hyaluronic acid on the trachea anastomosed. The animals were evaluated clinical, radiological and tracheoscopically during 4 weeks and were submitted to euthanasia. Macroscopic and microscopic examinations of the tracheal anastomotic healing were evaluated. Biochemical collagen quantification by the Woessner method was performed to evaluate the collagen development at the anastomotic site. All the animals survived the surgical procedure and the study time. No animal presented differences in clinical evaluation. Radiological and endoscopical findings both two showed more development of the tracheal stenosis in-group than in group II. The tracheoscopy and macroscopic studies showed major inflammation and development of fibrotic tissue with a firm consistency in the healing of the group I than in group II. Microscopic examination in group I showed severe fibrosis and inflammatory reaction. The group II presented deposits of a thin and organized collagen fibers and minimal inflammatory reaction. Biochemical collagen concentration was larger in-group I, however significantly. We conclude that the hyaluronic acid applied after cervical tracheoplasty in dogs reduces postsurgical tracheal stenosis and inflammation, as well as improve the quality of the tracheal healing.
为预防气管狭窄,已有多种药物用于调节气管愈合过程。透明质酸(HA)是一种纤维生成调节剂。在本研究中,我们评估了透明质酸在犬颈段气管成形术后对气管愈合的影响。对12只犬进行颈段气管切除和气管成形术,术后按以下方式治疗:第一组(n = 6)在吻合部位局部应用生理盐水(0.9%)。第二组在气管吻合处局部应用透明质酸。在4周内对动物进行临床、放射学和气管镜检查评估,并实施安乐死。对气管吻合口愈合进行大体和显微镜检查评估。采用Woessner法进行生化胶原定量分析,以评估吻合部位的胶原生成情况。所有动物均存活至手术和研究结束。在临床评估中,所有动物均无差异。放射学和内镜检查结果均显示,第一组气管狭窄的进展程度高于第二组。气管镜检查和大体研究显示,与第二组相比,第一组愈合过程中炎症更严重,纤维化组织进展明显,质地坚实。第一组的显微镜检查显示严重纤维化和炎症反应。第二组可见薄而有序的胶原纤维沉积,炎症反应轻微。第一组的生化胶原浓度更高,但差异有统计学意义。我们得出结论,犬颈段气管成形术后应用透明质酸可减轻术后气管狭窄和炎症,并改善气管愈合质量。