Department of Radiology, The Sixth Affiliated People's Hospital, Medical school of Shanghai Jiao Tong University, Shanghai, China.
Endoscopy. 2013 Jun;45(6):458-68. doi: 10.1055/s-0032-1326399. Epub 2013 Apr 11.
The aim of the current study was to assess whether placement of the biodegradable rapamycin-eluting nano-fiber membrane-covered metal stent is followed by less fibroblast proliferation and tissue hyperplasia compared with bare stents in experimental stricture in a dog model.
A total of 80 dog models of stricture were randomly divided into a control group (n = 20, no stent insertion), a bare stent group (BSG, n = 20, 1-week retention), and two drug-eluting stent sub-groups (DESG-1w, n = 20, 1-week retention; DESG-4w, n = 20, 4-week retention). Lower esophageal sphincter (LES) pressure, 5-minute barium height (5-mBH), and cardia diameter were assessed before, immediately after the procedure, and regularly thereafter for 6 months. Five dogs in each group were euthanized for histological examination at each follow-up assessment.
Stent insertion was well tolerated, with similar migration rates (0 % in BSG vs. 7.5 % in DESGs; P = 0.5441). At 6 months, LES pressure and 5-mBH improved in DESG-1w (26.70 ± 5.02 mmHg and 6.50 ± 2.98 cm) and DESG-4w (20.16 ± 5.50 mmHg and 1.54 ± 0.98 cm) compared with BSG (39.94 ± 5.22 mmHg and 11.1 ± 5.46 cm) (P < 0.05), with DESG-4w being more stable than DESG-1w (P < 0.05). The cardia maintained greater patency in the DESGs (7.10 ± 3.09 mm in DESG-1w; 9.16 ± 3.77 mm in DESG-4w) than in the BSG (1.86 ± 2.45 mm; P < 0.05). Reduced peak inflammatory reactions and scarring occurred in DESGs compared with the BSG (P < 0.05), with a better outcome in DESG-4w than in DESG-1w (P < 0.05).
In this experimental stricture model, rapamycin-eluting stents were more effective than bare stents for the reduction of fibroblast proliferation and tissue hyperplasia after stent placement. Furthermore, 4-week retention of the drug-eluting stent led to a better outcome than 1-week retention.
本研究旨在评估在犬狭窄模型中，与裸支架相比，生物可降解雷帕霉素洗脱纳米纤维膜覆盖的金属支架的放置是否导致更少的成纤维细胞增殖和组织增生。
80 只犬狭窄模型被随机分为对照组（n=20，无支架置入）、裸支架组（BSG，n=20，1 周保留）和两个药物洗脱支架亚组（DESG-1w，n=20，1 周保留；DESG-4w，n=20，4 周保留）。在术前、术后即刻以及此后定期进行 6 个月，评估下食管括约肌（LES）压力、5 分钟钡高度（5-mBH）和贲门直径。每组中有 5 只狗在每次随访评估时被安乐死进行组织学检查。
支架置入耐受良好，迁移率相似（BSG 中为 0%，DESGs 中为 7.5%；P=0.5441）。在 6 个月时，DESG-1w（26.70±5.02mmHg 和 6.50±2.98cm）和 DESG-4w（20.16±5.50mmHg 和 1.54±0.98cm）的 LES 压力和 5-mBH 改善，优于 BSG（39.94±5.22mmHg 和 11.1±5.46cm）（P<0.05），DESG-4w 比 DESG-1w 更稳定（P<0.05）。DESGs 中的贲门保持更大的通畅性（DESG-1w 为 7.10±3.09mm；DESG-4w 为 9.16±3.77mm），优于 BSG（1.86±2.45mm；P<0.05）。与 BSG 相比，DESGs 中观察到的炎症反应和疤痕形成的峰值降低（P<0.05），DESG-4w 的结果优于 DESG-1w（P<0.05）。
在这个实验性狭窄模型中，与裸支架相比，雷帕霉素洗脱支架在支架放置后减少成纤维细胞增殖和组织增生方面更有效。此外，药物洗脱支架的 4 周保留导致比 1 周保留更好的结果。
