中耳手术填塞材料的研究与应用进展

Middle Ear Packing Materials: the Advances in Research and Application

中耳手术原则为彻底清除中耳腔内病灶,并且重建有效的传音结构。现已明确多种因素可影响术后效果,其中包括中耳填塞材料的选择与使用。中耳填塞材料主要作用为术后对听骨与鼓膜移植物等中耳传音结构提供支撑作用,并保持含气的中耳腔,同时能够促进术后止血。虽然中耳填塞材料已使用了70余年,但研究发现许多材料可导致中耳术腔粘连、纤维化以及成骨化等不良反应,致使听骨链固定,甚至影响术后听力。因此,目前仍缺乏一种理想的中耳填塞材料,并且中耳手术填塞材料的选择与使用也缺乏统一标准。随着现代医学和材料科学的进一步发展,许多新型填塞材料展现出良好的术后效果,并且最新研究发现中耳手术中不进行中耳填塞能促进术后早期听力康复。因此,本文将就不同类型中耳填塞材料的临床应用及近年来的研究成果进行总结。

The principle of middle ear surgery is to completely remove the lesion in the middle ear cavity and re-construct an effective acoustic structure. It is clear that a variety of factors can influence the postoperative outcomes, in-cluding the selection and use of middle ear packing materials. The main functions of a middle ear packing material is to support the middle ear acoustic structure including the ossicles and tympanic membrane grafts postoperatively, to main-tain the middle ear cavity with pneumonization, and to promote posto,perative hemostasis. Although middle ear packing materials have been used for over 70 years, some materials have been reported to be associated with adverse reactions such as adhesions, fibrosis and neo-osteogenesis in the middle ear cavity, thereby resulting in ossicular chain fixation and postoperative hearing impairment. Hence, there still lacks an ideal middle ear packing material at present, and the uniform standard of packing material selection and utilization remains unclear as well. With recent development in mod-ern medicine and material science, novel packing materials have been introduced with good postoperative outcomes. Moreover, recent studies demonstrate that middle ear surgery without middle ear packing can promote postoperative hearing rehabilitation at early stages. This article will summarize the clinical application of various types of middle ear packing materials as well as current research results.