Department of Otolaryngology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China.
Am J Rhinol Allergy. 2012 Mar-Apr;26(2):152-6. doi: 10.2500/ajra.2012.26.3715. Epub 2011 Dec 16.
The postoperative scaring, ostial stenosis, and adhesions after functional endoscopic sinus surgery for chronic rhinosinusitis remains a major problem. This study was designed to evaluate two new hyaluronan (HA) hydrogels for neo-ostium antistenosis and promoting wound healing in a rabbit maxillary sinus model.
The anterior wall of the maxillary sinus of 48 rabbits was removed to create a 4-mm circumferential wound both on the nasal and on the sinus sides. A rapid-gelling HA hydrogel or preformed HA hydrogel was filled randomly into the right or left sinus, while the opposite sinus served as blank control or was treated with Merogel (Medtronic Xomed Surgical Products, Jacksonville, FL) as control. The neo-ostium diameter and histological scores were evaluated and analyzed postoperatively.
The neo-ostium diameter in the rapid-gelling HA hydrogel-treated side was significantly larger than that in the blank control side with a mean difference of 1.46 ± 0.99 mm (p = 0.03), 1.30 ± 0.61 mm (p = 0.0087), and 1.60 ± 0.25 mm (p = 0.00015) at 2, 3, and 4 weeks, respectively; the neo-ostium diameter in the preformed HA hydrogel-treated side at 2 weeks was significantly larger than that in the blank control side or Merogel control side with a mean difference of 1.46 ± 0.76 mm (p = 0.002) or 0.54 ± 0.36 mm (p = 0.007), respectively. The preformed HA hydrogel-treated side showed better histology scores at 2 weeks in heterophils, fibrosis, and osteogenesis than the blank control, and the chronic inflammation (lymphocyte/plasmacyte infiltration) was not prevalent.
During the postoperative follow-up period both of the two HA hydrogels significantly prevented neo-ostium stenosis and the preformed HA hydrogel promoted wound healing.
慢性鼻-鼻窦炎患者功能性内镜鼻窦手术后的术后瘢痕、吻合口狭窄和粘连仍然是一个主要问题。本研究旨在评估两种新型透明质酸（HA）水凝胶在兔上颌窦模型中新吻合口抗狭窄和促进伤口愈合的作用。
48 只兔子的上颌窦前壁被切除，在鼻腔和窦腔两侧形成一个 4mm 周长的环形伤口。快速凝胶化 HA 水凝胶或预制 HA 水凝胶随机填充到右侧或左侧窦腔，而对侧窦腔作为空白对照或用 Merogel（Medtronic Xomed Surgical Products，Jacksonville，FL）作为对照。术后评估和分析新吻合口直径和组织学评分。
快速凝胶化 HA 水凝胶治疗组的新吻合口直径明显大于空白对照组，平均差异分别为 1.46 ± 0.99mm（p = 0.03）、1.30 ± 0.61mm（p = 0.0087）和 1.60 ± 0.25mm（p = 0.00015）在 2、3 和 4 周时；预制 HA 水凝胶治疗组在 2 周时的新吻合口直径明显大于空白对照组或 Merogel 对照组，平均差异分别为 1.46 ± 0.76mm（p = 0.002）或 0.54 ± 0.36mm（p = 0.007）。预制 HA 水凝胶治疗组在 2 周时的嗜中性粒细胞、纤维化和成骨方面的组织学评分明显优于空白对照组，且慢性炎症（淋巴细胞/浆细胞浸润）不常见。
在术后随访期间，两种 HA 水凝胶均能显著预防新吻合口狭窄，预制 HA 水凝胶促进伤口愈合。
