经环甲间隙自体脂肪声带注射矫治声门闭合不全的实验研究

Autologous Fat Injection Into the Vocal Cords for Glottis Insufficiency: Experimental Study

目的 观察家兔声带自体脂肪注射后急、慢性期喉局部反应、声带大体形态及组织学转归 ,探讨这一方法在矫治声门闭合不全中的应用价值。方法 8只家兔建立声带缺损动物模型后分 4组 ,取腹部自体脂肪经环甲间隙注射入损伤侧声带 ,分别于注射后急性期 (2 4小时内 )及慢性期 (1、3、5个月 )行直接喉镜及喉组织学检查 ,观察喉局部反应、声带形态和声门闭合情况以及声带组织学改变。结果 所有家兔声带自体脂肪注射后急性期均无喉水肿发生 ;慢性期无肉芽肿、结节等改变 ;急、慢性期均未发生过敏及排斥反应。注射后 3个月内声带体积渐缩小 ,声门闭合程度略降低 ,3个月后上述声门形态改变不明显。组织学证实注射后急性期可有轻度炎症反应 ;自体脂肪能在声带组织内存活 ,3个月内可发生部分脂肪吸收 ,3个月后脂肪吸收减少 ,在声带内保持相对稳定的体积。结论 自体脂肪声带注射具有无过敏、无排斥、无异物反应等特点。注射后虽可发生部分吸收 ,但 3个月后吸收减少。该技术是一较为安全。

Objective To investigate the laryngeal reactions and histological fate of autologous fat injected into vocal cords and evaluate the value of this technique in treating glottal insufficiency.Methods Eight rabbits were divided into four groups after a unilateral mucosal excision of the vocal cord. Autologous fat in abdomen was harvested and injected into the injured vocal cord. At 24 h, 1,3and 5 months after injection, videolaryngoscopy was performed to evaluate the laryngeal reactions and glottal configuration. And then, the animals were sacrificed for histological examination.Results Videolaryngoscopy demonstrated that no obvious laryngeal edema, hypersensitivity, rejection and foreign-body reactions were noted in the acute or chronic stage of injection. A progressive decrease in bulk of the injected cord and degree of glottic closure were found within three months of injection. Histological examination of the vocal cords revealed slight acute inflammation and hemorrhage in the acute stage of injection. In all the animals, the autologous fat survived and could be identified in the cords clearly 1～5 months after injection. There was a trend that the volume of fat appeared to be slight less in the 1 and 3-month groups. But the section of 5 months showed maintenance of same volume of the injected fat as 3 months, which demonstrated the absorption of the fat did not occur after 3 months.Conclusion No hypersensitivity, rejection and foreign-body reactions were found in this study. Although some loss of fat volume was expected, it usually occurred within three months. The results suggested that autologous fat injection appeared to be a relatively safe and effective method for glottic insufficiency.