Department of Surgery, The University of Auckland, Auckland, New Zealand.
Int Forum Allergy Rhinol. 2015 Apr;5(4):310-7. doi: 10.1002/alr.21470. Epub 2015 Feb 12.
Numerous topical agents have been used intraoperatively to enhance postoperative mucosal healing or reduce scar formation. However, the histological effects of many of these treatments have not been well described. This study investigates the impact of topical mometasone furoate, acitretin, lactoferrin, and Silastic sheet (Medtronic) on sinus mucosal healing in a rabbit model.
Forty-eight New Zealand white rabbits underwent defined, localized stripping of a bilateral region of maxillary sinus mucosa. One of 6 treatments was placed in 1 maxillary sinus, and the treatment carrier was applied contralaterally (0.1% mometasone furoate, 0.25% and 0.5% acitretin, lactoferrin, Silastic, and no treatment; n = 8 each group). Rabbits were euthanized after 2 weeks and histological sections were examined with light microscopy.
Treatment with acitretin 0.25% and 0.5% improved cilial recovery by 0.9 ± 0.5 (p = 0.003) and 0.5 ± 0.5 (p < 0.05), respectively. Acitretin 0.25% treatment also significantly reduced collagen in healing mucosa (5.1% ± 4.8%, p = 0.04). Conversely, rabbits treated with mometasone furoate 0.1% were more likely to have reduced cilial and goblet cell recovery. Intergroup comparisons demonstrated a significant improvement in cilial recovery scores with both acitretin doses compared with mometasone furoate (p < 0.05) and less collagen deposition in rabbits treated with placebo gel over Silastic (p < 0.05). Mucosa directly underlying a blood clot had a lower cilia score and impaired epithelial recovery (p < 0.001).
Intraoperatively applied agents have the potential to significantly affect wound healing. Acitretin improved cilial recovery and reduced collagen deposition.
许多局部应用药物已被用于术中以增强术后黏膜愈合或减少瘢痕形成。然而，许多这些治疗方法的组织学效果并未得到很好的描述。本研究通过兔模型研究了局部应用莫米松糠酸酯、阿维 A 酯、乳铁蛋白和 Silastic 片（美敦力）对鼻窦黏膜愈合的影响。
48 只新西兰白兔接受了双侧上颌窦黏膜的明确局部剥离。每只兔的一侧上颌窦接受 6 种治疗方法之一的治疗，治疗载体应用于对侧（0.1%莫米松糠酸酯、0.25%和 0.5%阿维 A 酯、乳铁蛋白、Silastic 以及无治疗；每组 8 只）。2 周后处死兔子，并用光学显微镜检查组织学切片。
阿维 A 酯 0.25%和 0.5%的治疗组纤毛恢复分别提高了 0.9 ± 0.5（p = 0.003）和 0.5 ± 0.5（p < 0.05）。阿维 A 酯 0.25%的治疗还显著减少了愈合黏膜中的胶原（5.1% ± 4.8%，p = 0.04）。相反，接受莫米松糠酸酯 0.1%治疗的兔子更有可能减少纤毛和杯状细胞的恢复。组间比较显示，与莫米松糠酸酯相比，阿维 A 酯的两种剂量均显著提高纤毛恢复评分（p < 0.05），并且在 Silastic 上使用安慰剂凝胶的兔子胶原沉积减少（p < 0.05）。直接位于血栓下方的黏膜纤毛评分较低，上皮恢复受损（p < 0.001）。
术中应用的药物有可能显著影响伤口愈合。阿维 A 酯可改善纤毛恢复并减少胶原沉积。
