Vavin V V, Kuznetsova D A, Nazhmudinov I I, Davudov Kh Sh
National Medical Research Center for Otorhinolaryngology of the FMBA of Russia, Moscow, Russia.
Pavlov First Saint Petersburg State Medical University, Department of Clinical Laboratory Diagnostics with a Course in Molecular Medicine, Saint Petersburg, Russia.
Vestn Otorinolaringol. 2020;85(2):78-83. doi: 10.17116/otorino20208502178.
Despite the existing modern high-tech methods of examination and a variety of surgical treatment methods, the problem of diagnosis, treatment and rehabilitation of patients with chronic post-intubation cicatricial stenosis of the larynx and trachea still requires further study. Improving the understanding and correction of cellular, molecular genetic and biochemical disorders in a chronic wound is a key condition for increasing the efficiency of diagnosis, individual prognosis of the clinical course and the conduct of adequate therapeutic and preventive measures for post-intubation cicatricial laryngotracheal stenoses. In this regard, it seemed appropriate to analyze the existing etiopathogenetic factors of pathological wound healing in chronic post-intubation cicatricial stenosis of the larynx and trachea. Our attempt to summarize the available literature data demonstrated that laryngotracheal scars are a fibro-proliferative disease caused by aberrant wound healing after a damaging effect on the tissues of the larynx and trachea. The article describes the most pathogenetically significant healing, repair, and scarring factors in post-intubation laryngotracheal stenoses, including transforming growth factor β1, vascular growth factor A, type I and III collagen, and matrix metalloproteinases. An assessment of the features of the diagnostic and prognostic significance of these markers will increase the effectiveness of the treatment of patients with chronic cicatricial stenosis of the larynx and trachea, and will also serve as a prerequisite for the development of strategies for diagnostic, treatment, prophylactic and rehabilitation measures that will improve the quality of medical care and the quality of life of patients with chronic cicatricial stenosis of the larynx and trachea.
尽管现有的现代高科技检查方法和多种手术治疗方法,但喉气管插管后慢性瘢痕性狭窄患者的诊断、治疗和康复问题仍需进一步研究。提高对慢性伤口中细胞、分子遗传和生化紊乱的认识并加以纠正,是提高喉气管插管后瘢痕性狭窄诊断效率、临床病程个体预后以及采取适当治疗和预防措施的关键条件。在这方面,分析喉气管插管后慢性瘢痕性狭窄中病理性伤口愈合的现有病因学因素似乎是合适的。我们总结现有文献数据的尝试表明,喉气管瘢痕是一种纤维增生性疾病,由喉气管组织受到损伤后异常伤口愈合引起。本文描述了插管后喉气管狭窄中最具致病意义的愈合、修复和瘢痕形成因素,包括转化生长因子β1、血管生长因子A、I型和III型胶原以及基质金属蛋白酶。评估这些标志物的诊断和预后意义特征,将提高喉气管慢性瘢痕性狭窄患者的治疗效果,也将为制定诊断、治疗、预防和康复措施策略提供前提条件,从而提高医疗护理质量和喉气管慢性瘢痕性狭窄患者的生活质量。