CAJ | 학술논문

背景：喉软骨组织缺损发病率较高，患者发病后主要以疼痛、肿胀、功能障碍等为主。目前，临床上对于喉软骨组织损伤更多的以修复手术治疗为主，常规材料虽然能够有效的改善患者症状，但是长期疗效欠佳。近年来，软骨组织工程在临床上研究相对较多，但是在耳鼻咽喉科实际使用相对较多。 　　目的：探讨聚羟基烷酸酯聚合物负载软骨细胞在同种异体喉软骨缺损修复中的效果。 　　方法：将聚羟基丁酸酯与聚羟基己酸酯共聚物材料设为细胞外基质，采用组织工程技术制备细胞-材料复合物，将初级组织工程软骨组织直接移植于兔甲状软骨缺损的修复，或将初级组织工程软骨组织体内植入一定时期形成较成熟组织工程软骨再应用于甲状软骨缺损的修复。实验设单纯聚羟基丁酸酯与聚羟基己酸酯共聚物材料修复组和单纯软骨细胞修复组进行对照，对甲状软骨缺损修复效果进行大体和组织学评价。 　　结果与结论：初级组软骨在电镜扫描下能够看见软骨细胞表现为串珠状，培养4周后能够看见大量胶冻形状的基质。在电子显微镜下进行观察结果显示：细胞分布在复合材料表面和海绵状空隙中，显示多个类圆形小突起；入选新西兰兔均取得手术成功，并且手术后并未出现呼吸困难、进食困难等现象；实验初级组织工程软骨组1只兔出现短暂喘鸣；实验较成熟组织工程软骨组1只动物术后2周死于腹泻。大体测试负载软骨细胞的聚羟基丁酸酯与聚羟基己酸酯共聚物有一定硬度。皮下植入4周后成熟细胞表现为白色片状，材料具有弹性。植入后4，8周两组修复区与原有软骨间光滑平淡，但是修复区域则色发黄。单纯聚羟基丁酸酯与聚羟基己酸酯共聚物材料修复组和单纯软骨细胞修复组修复区均凹陷，仅见结缔组织。实验组兔不良反应发生率显著低于对照组(P <0.05)。结果证实，聚羟基烷酸酯聚合物负载软骨细胞移植修复同种异体喉软骨缺损效果较好。揹景：喉軟骨組織缺損髮病率較高，患者髮病後主要以疼痛、腫脹、功能障礙等為主。目前，臨床上對于喉軟骨組織損傷更多的以脩複手術治療為主，常規材料雖然能夠有效的改善患者癥狀，但是長期療效欠佳。近年來，軟骨組織工程在臨床上研究相對較多，但是在耳鼻嚥喉科實際使用相對較多。 　　目的：探討聚羥基烷痠酯聚閤物負載軟骨細胞在同種異體喉軟骨缺損脩複中的效果。 　　方法：將聚羥基丁痠酯與聚羥基己痠酯共聚物材料設為細胞外基質，採用組織工程技術製備細胞-材料複閤物，將初級組織工程軟骨組織直接移植于兔甲狀軟骨缺損的脩複，或將初級組織工程軟骨組織體內植入一定時期形成較成熟組織工程軟骨再應用于甲狀軟骨缺損的脩複。實驗設單純聚羥基丁痠酯與聚羥基己痠酯共聚物材料脩複組和單純軟骨細胞脩複組進行對照，對甲狀軟骨缺損脩複效果進行大體和組織學評價。 　　結果與結論：初級組軟骨在電鏡掃描下能夠看見軟骨細胞錶現為串珠狀，培養4週後能夠看見大量膠凍形狀的基質。在電子顯微鏡下進行觀察結果顯示：細胞分佈在複閤材料錶麵和海綿狀空隙中，顯示多箇類圓形小突起；入選新西蘭兔均取得手術成功，併且手術後併未齣現呼吸睏難、進食睏難等現象；實驗初級組織工程軟骨組1隻兔齣現短暫喘鳴；實驗較成熟組織工程軟骨組1隻動物術後2週死于腹瀉。大體測試負載軟骨細胞的聚羥基丁痠酯與聚羥基己痠酯共聚物有一定硬度。皮下植入4週後成熟細胞錶現為白色片狀，材料具有彈性。植入後4，8週兩組脩複區與原有軟骨間光滑平淡，但是脩複區域則色髮黃。單純聚羥基丁痠酯與聚羥基己痠酯共聚物材料脩複組和單純軟骨細胞脩複組脩複區均凹陷，僅見結締組織。實驗組兔不良反應髮生率顯著低于對照組(P <0.05)。結果證實，聚羥基烷痠酯聚閤物負載軟骨細胞移植脩複同種異體喉軟骨缺損效果較好。
배경：후연골조직결손발병솔교고，환자발병후주요이동통、종창、공능장애등위주。목전，림상상대우후연골조직손상경다적이수복수술치료위주，상규재료수연능구유효적개선환자증상，단시장기료효흠가。근년래，연골조직공정재림상상연구상대교다，단시재이비인후과실제사용상대교다。 　　목적：탐토취간기완산지취합물부재연골세포재동충이체후연골결손수복중적효과。 　　방법：장취간기정산지여취간기기산지공취물재료설위세포외기질，채용조직공정기술제비세포-재료복합물，장초급조직공정연골조직직접이식우토갑상연골결손적수복，혹장초급조직공정연골조직체내식입일정시기형성교성숙조직공정연골재응용우갑상연골결손적수복。실험설단순취간기정산지여취간기기산지공취물재료수복조화단순연골세포수복조진행대조，대갑상연골결손수복효과진행대체화조직학평개。 　　결과여결론：초급조연골재전경소묘하능구간견연골세포표현위천주상，배양4주후능구간견대량효동형상적기질。재전자현미경하진행관찰결과현시：세포분포재복합재료표면화해면상공극중，현시다개류원형소돌기；입선신서란토균취득수술성공，병차수술후병미출현호흡곤난、진식곤난등현상；실험초급조직공정연골조1지토출현단잠천명；실험교성숙조직공정연골조1지동물술후2주사우복사。대체측시부재연골세포적취간기정산지여취간기기산지공취물유일정경도。피하식입4주후성숙세포표현위백색편상，재료구유탄성。식입후4，8주량조수복구여원유연골간광활평담，단시수복구역칙색발황。단순취간기정산지여취간기기산지공취물재료수복조화단순연골세포수복조수복구균요함，부견결체조직。실험조토불량반응발생솔현저저우대조조(P <0.05)。결과증실，취간기완산지취합물부재연골세포이식수복동충이체후연골결손효과교호。
BACKGROUND:Laryngeal cartilage defect has a higher incidence, mainly presenting with pain, sweling, and dysfunction after onset. Currently, surgical treatment is the most used in clinical treatment of laryngeal cartilage defect. Although conventional materials can effectively improve symptoms, there is a poor long-term efficacy. In recent years, there are many clinical studies on cartilage tissue engineering, but less about the actual use in the otorhinolaryngology department. OBJECTIVE:To investigate the effect of polyhydroxyalkanoate polymer carrying chondrocytes on the repair of alogeneic laryngeal cartilage defects. METHODS:Poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHH) served as the extracelular matrix. Tissue engineering technology was used to prepare cel-material composite. Primary tissue-engineered cartilage tissue was transplanted directly into rabbit thyroid cartilage defect (experimental group A), or implanted into a more mature tissue-engineered cartilage for the repair of thyroid cartilage defect (experimental group B). In the experiment, PHBHH group and simple chondrocyte group were set as controls. Repairing effects on thyroid cartilage defect were evaluated through gross and histological observation. RESULTS AND CONCLUSION:Chondrocytes in the primary tissue-engineered cartilage tissues were beaded under scanning electron microscope, and after 4 weeks of culture, a large amount of jely-shaped substrates were visible. Findings from electron microscope observation showed that the cels were distributed on the surface of composite material and cavernous voids, displaying a plurality of smal round projections. Surgical treatment was successful in al the rabbits, and there was no dyspnea and eating difficulties after surgery. One rabbit appeared to have brief wheezing in the experimental group A, two rabbits died of diarrhea in the experimental B group at 2 weeks after surgery. PHBHH composite carrying chondrocytes had certain hardness. At 4 weeks after subcutaneous implantation, mature cels were shaped as white sheets, and the material had elasticity. After 4 and 8 weeks, the space between repair zone and original cartilage tissue was smooth and plain, but the repair zone was colored yelow. In the simple PHBHH and chondrocyte groups, the repair zones were both depressed, only the connective tissues could be seen. Rabbits in the two experimental groups showed less adverse reactions compared with the two control groups (P < 0.05). These findings indicate that PHBHH composite carrying chondrocytes has better effects to repair alogeneic laryngeal cartilage defects.