丝裂霉素C与壳聚糖预防犬CO2激光声带切除术术后声门前部狭窄的比较。

Comparison between mitomycin C and chitosan for prevention of anterior glottic steno after CO2 laser cordectomy in dogs.

作者信息

Fang Rui, Sun Jingwu, Wan Guanglun, Sun Dongdong

机构信息

Department of Otolaryngology-Head and Neck Surgery, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui Province, China.

出版信息

Laryngoscope. 2007 Nov;117(11):2057-62. doi: 10.1097/MLG.0b013e3181256511.

DOI:10.1097/MLG.0b013e3181256511

PMID:17721402

Abstract

OBJECTIVE

To compare the effectiveness of an immediate application of topical mitomycin C (MMC) with chitosan for prevention of anterior glottic stenosis (AGS) after microsurgical resecting of both vocal fold with CO2 laser, including the anterior commissure, in a canine model.

DESIGN

Prospective randomized experimental study.

METHOD

Twenty-four canine larynges were injured by a microresecting procedure of both vocal folds with a CO2 laser. The dogs were randomly divided into three groups for treatment, respectively with MMC, chitosan, or isotonic sodium chloride solution (control) for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected, the ultrastructures of the fibroblasts were examined with a transmission electronic microscope, and expression of basic fibroblast growth factor (bFGF) and transforming growth factor beta1 (TGF-beta1) were evaluated by enzyme-linked immunosorbent assay (ELISA). Three weeks after surgery, the remaining dogs' glottic web were lysed and repeatedly treated with MMC, chitosan, or isotonic sodium chloride solution. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically 6 weeks after the initial surgery.

RESULTS

Results included 1) transmission electronic microscope examination of the ultrastructures of the fibroblasts indicated that both MMC and chitosan inhibited the proliferation of fibroblast; 2) the expression of bFGF and TGF-beta1 increased both in the MMC group and the chitosan group, and the expression of bFGF in the chi-tosan group was higher than in the MMC group (P = .010), while the expression of TGF-beta1 was lower (P = .000);3) the extent of AGS formation was decreased both in the MMC group and the chitosan group, while it was less in the chitosan group than in the MMC group (P = .047); 4) the grade of collagen content between the MMC group and the chitosan group was not significantly different (P = .5).

CONCLUSION

Chitosan is more effective in preventing AGS after CO2 laser cordectomy than MMC.

摘要

目的

在犬模型中，比较局部应用丝裂霉素C（MMC）与壳聚糖即刻预防二氧化碳激光显微手术切除双侧声带（包括前联合）后声门前部狭窄（AGS）的效果。

设计

前瞻性随机实验研究。

方法

24个犬喉通过二氧化碳激光显微手术切除双侧声带造成损伤。将犬随机分为三组进行治疗，分别在术后即刻用MMC、壳聚糖或等渗氯化钠溶液（对照组）处理5分钟。初次手术后1周，每组随机选取3只犬，用透射电子显微镜检查成纤维细胞的超微结构，并用酶联免疫吸附测定（ELISA）评估碱性成纤维细胞生长因子（bFGF）和转化生长因子β1（TGF-β1）的表达。术后3周，对其余犬的声门蹼进行松解，并用MMC、壳聚糖或等渗氯化钠溶液反复处理。每周检查声门伤口愈合情况及AGS形成情况，初次手术后6周收集所有喉进行组织学检查。

结果

结果包括：1）成纤维细胞超微结构的透射电子显微镜检查表明，MMC和壳聚糖均抑制成纤维细胞增殖；2）MMC组和壳聚糖组bFGF和TGF-β1的表达均增加，壳聚糖组bFGF的表达高于MMC组（P = 0.010），而TGF-β1的表达较低（P = 0.000）；3）MMC组和壳聚糖组AGS形成程度均降低，壳聚糖组低于MMC组（P = 0.047）；4）MMC组和壳聚糖组之间的胶原含量分级无显著差异（P = 0.5）。