[壳聚糖预防二氧化碳激光声带切除术术后前声门狭窄]

[Prevention of anterior glottic stenosis after CO2 laser cordectomy with chitosan].

作者信息

Fang Rui, Sun Jing-Wu, Wan Guang-Lun, Sun Dong-Dong

机构信息

Department of Otorhinolaryngology Head and Neck Surgery, Anhui Medical University Affiliated Anhui Provincial Hospital, Hefei 230001, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2009 Jul;44(7):581-5.

PMID:19957657

Abstract

OBJECTIVE

To observe the effect of immediate topical application of chitosan on preventing anterior glottic stenosis (AGS) after microsurgical resection of both vocal fold with CO2 laser, including the anterior commissure, in a canine model.

METHODS

Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO2 laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution (control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with 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 rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery.

RESULTS

Transmission electronic microscope examination of the ultrastructure of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-beta1, and bFGF and TGF-beta1 in chitosan group, which was significantly higher than that in control group (z=-2.887 and -2.005, P=0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z=-2.619, P=0.008). The grade of collagen content in chitosan group was significantly lower than that in control group (P=0.003).

CONCLUSION

Chitosan is effective in preventing AGS after CO2 laser cordectomy.

摘要

目的

在犬模型中观察壳聚糖即时局部应用对二氧化碳激光显微手术切除双侧声带（包括前联合）后预防声门前部狭窄（AGS）的效果。

方法

用二氧化碳激光显微手术切除双侧声带对16只犬的喉部造成损伤。将犬随机分为两组，壳聚糖组和对照组。术后立即分别用壳聚糖和等渗氯化钠溶液（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，并分别反复用壳聚糖和等渗氯化钠溶液处理。每周检查声门伤口愈合情况和AGS形成情况，初次手术后6周收集所有喉部进行组织学检查。

结果

成纤维细胞超微结构的透射电子显微镜检查表明壳聚糖抑制成纤维细胞增殖。壳聚糖增加了bFGF和TGF-β1的表达，壳聚糖组的bFGF和TGF-β1显著高于对照组（z = -2.887和-2.005，P = 0.002和0.041）。壳聚糖降低了AGS形成的程度。术后3周，对照组的AGS病变平均累及从前联合至声带突的声带长度的49%，而壳聚糖组平均累及7%，明显小于对照组的蹼形成范围（z = -2.619，P = 0.008）。壳聚糖组的胶原含量分级显著低于对照组（P = 0.003）。