自体脂肪组织在鼓膜修补术中的应用观察

Application and observation of autologous adipose tissue in tympanic membrane neoplasty

目的观察用白体脂肪组织修补鼓膜小穿孔及中等穿孔的临床效果，探讨应用自体脂肪组织修补鼓膜穿孔的方法及临床适应证。方法回顾分析65例慢性化脓性中耳炎及外伤性鼓膜中小穿孔病例，其中小穿孔病例57例，穿孔直径≤3mm；中等穿孔8例，穿孔直径在3～5mm，平均语频气导32．5dB。在全身麻醉或局部麻醉下，通过手术显微镜或耳内镜采用自体耳垂脂肪组织或耳内切口处脂肪组织对57例鼓膜小穿孔，8例鼓膜中等穿孔进行嵌塞法修补，术后使用抗生素5～7d，第14—21天取出外耳道填塞物，术后1、3月复查并行听力检查。观察比较自体脂肪组织对鼓膜小穿孔及中等穿孔修补的临床效果。结果应用自体脂肪组织进行鼓膜穿孔修补术中57例鼓膜小穿孔修补全部愈合，愈合率100％（57／57）；8例鼓膜中等穿孔修补5例愈合，3例修补失败，愈合率62．5％（5／8）。愈合病例语频气导平均提高17dB，未愈合病例听力无改变。结论应用自体脂肪组织嵌塞法修补鼓膜小穿孔效果显著，操作简便快捷，愈合率高，对中等鼓膜穿孔的修补效果欠佳，穿孔愈合率较低。因而，慢性化脓性中耳炎及外伤性鼓膜小穿孔病例可以作为应用自体脂肪组织进行嵌塞法修补的临床适应证。

Objective To observe the clinical effects the autologous adipose tissue on the repair of small and medium tympanic membrane perforation, and discuss its approach and clinical applicability. Methods A retrospective analysis on the treatment of small and medium tympanic membrane perforation was carried out in 65 cases of chronic purulent otitis or trauma. The small perforation in 57 patients was less than or equal to 3 mm;the middle perforation in 8 patients was 3 to 5 mm. The average air conduction was 32.5 dB. Under the general anesthesia or local anesthesia, the embedded repair was performed with the autologous adipose tissue or inner ear adipose tissue by the operating microscope or endoscope. The antibiotics were used for 5 to 7 days. The packing materials in external auditory canal were taken away in 14 to 21 days. The hearing test was performed in 1 to 3 months. The clinical outcome of autologous adipose tissue repairs was assessed. Re- sults The small perforations in 57 cases were entirely repaired, with a rate of 100% （57/57） ;5 in 8 cases of middle perforation recovered, with a rate of 62.5 % （ 5/8 ）. The average air conduction in the cured patients increased by 17 dB, but the hearing was not improved in the failed cases. Conclusion The autologous adipose tissue has significant effects on the repair of small tympanic membrane perforation, the operation is easy, but not very fit for the medium tympanic membrane perforation. The small perforations induced by chronic purulent otitis media and trauma can be the clinical indication of tympanic membrane neoplasty with autologous adipose tissue repair.