Department of Otolaryngology–Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA.
Am J Rhinol Allergy. 2010 Nov-Dec;24(6):464-6. doi: 10.2500/ajra.2010.24.3507.
A previous study on wound healing with a rabbit model showed thermal injury to sinus mucosa with complete respiratory re-epithelialization by postoperative day (POD) 29. This study was designed to further understand the pattern of injury using the bipolar radiofrequency plasma process used by the Coblator and evaluate postprocedure healing.
Based on experience with our rabbit model, three sheep underwent endoscopic sinus surgery. Coblation was applied to inferior turbinate mucosa in three areas for 2, 4, or 6 seconds. After resection of the contralateral middle turbinate and ethmoidectomy, Coblation was applied to the lateral wall or lamina papyracea for 2 seconds. The ethmoid and turbinate specimens were resected en bloc during necropsy immediately for the first sheep and on POD 14 for the others.
Coblation resulted in immediate loss of surface respiratory epithelium and thermal-type injury to the underlying seromucinous glands. On POD 14, the Coblation site showed re-epithelialization with respiratory epithelium. The underlying seromucinous glands were replaced by mild fibrosis. A small, well-defined zone of injury was shown. Longer use did not result in a deeper injury. Rather, the depth of injury was dependent on the type of submucosal tissue present. Underlying bone was associated with reactive, regenerative changes. No histological changes were shown in the orbit.
The effects of Coblation on sheep mucosa show a similar injury and healing pattern to that shown on rabbit mucosa. Based on this work and the previous rabbit study, the Coblator may be an additional tool for use in endoscopic sinus surgery.
先前一项使用兔模型进行的伤口愈合研究表明，窦黏膜在术后第 29 天经历热损伤，完全实现呼吸再上皮化。本研究旨在使用 Coblator 所使用的双极射频等离子体处理方法进一步了解损伤模式，并评估术后愈合情况。
基于我们兔模型的经验，三只绵羊接受了鼻内镜鼻窦手术。在三个区域将 Coblation 应用于下鼻甲黏膜，持续时间为 2、4 或 6 秒。切除对侧中鼻甲和筛窦后，将 Coblation 应用于外侧壁或纸样板 2 秒。在第一只绵羊立即进行尸检时整块切除筛窦和鼻甲标本，在其余两只绵羊时在术后第 14 天进行。
Coblation 导致表面呼吸上皮立即丧失和热型损伤，从而累及下层浆液黏液腺。在术后第 14 天，Coblation 部位出现呼吸上皮的再上皮化。下层浆液黏液腺被轻度纤维化所取代。显示出一个小而明确的损伤区域。使用时间延长不会导致更深的损伤。相反，损伤的深度取决于存在的黏膜下组织类型。下面的骨骼与反应性、再生性变化相关。在眼眶中未显示出组织学变化。
Coblation 对绵羊黏膜的影响显示出与兔黏膜相似的损伤和愈合模式。基于这项工作和之前的兔研究，Coblator 可能是鼻内镜鼻窦手术的另一种工具。
