异种脱细胞真皮基质在开放式乳突根治术的临床应用

Clinical Application of Xenogeneic Acellular Dermal Biofilm in Canal Wall Down Mastoidectomy

目的探讨开放式乳突根治术应用异种(牛)脱细胞真皮基质生物膜在促进术腔上皮化及抑制术腔肉芽增生的作用。方法收集昆明医科大学第一附属医院耳鼻咽喉科2017年10月至2018年9月期间因慢性中耳炎或中耳胆脂瘤行开放式乳突根治术(由同一术者进行手术)的患者。分为试验组(A组,异种脱细胞真皮基质生物膜组)40例,共45耳,其中乳突腔伴自体组织填塞(A1)组21耳,不伴自体组织填塞(A2)组24耳;对照组(B组,颞肌筋膜组)37例,共40耳,其中乳突腔伴自体组织填塞(B1)组21耳,不伴自体组织填塞(B2)组19耳。逐一记录术后术腔上皮化时间,干耳时间,术腔肉芽增生情况及随访6个月以上眩晕等并发症发生率;同时于术后4周及6个月时分别以生理盐水术腔注射法测量术腔容积,计算容积差值(术后4周术腔容积值与6个月术腔容积值差值)。两组患者在术前耳流脓时间、眩晕发作、术后4周术腔容积均无统计学差异(P>0.05)。术后两组之间数值分别行两独立样本t检验,差异有统计学意义(P<0.05)。结果A、B两组术后干耳时间分别为[(21.36±5.54)d,(43.93±12.15)d,P<0.01]。A、B两组术后术腔完全上皮化时间分别为[(27.65±8.19)d,(56.32±18.62)d,P<0.01]。A组术后均未发生术腔肉芽增生(0/45,0.00%),术后6个月时仍发生眩晕者1例(1/40,2.50%;该例患者为A1组);B组术后术腔呈明显新鲜肉芽增殖者15例(15/40,37.50%),术后6个月时仍发生眩晕者6例(6/37,16.22%;其中B1组5例,B2组1例)。两组按有无自体组织填塞对应分组计算术后4周与6个月时术腔容积差值:A1与B1组容积差值分别为[(0.35±0.16)mL,(1.13±0.37)mL,P<0.01];A2与B2组容积差值分别为[(0.78±0.21)mL,(0.93±0.35)mL,P>0.05]。结论异种(牛)脱细胞真皮基质生物膜应用于开放式乳突根治术可明显加速术腔上皮化,缩短术后干耳时间,减少术后眩晕发生率。当乳突腔旷置时,应用异种(牛)脱细胞真皮基质生物膜能减少术腔肉芽及瘢痕形成而维持术后术腔容积稳定,从而降低由于术后肉芽增殖、术腔缩小而导致病变复发的潜在发生率。

Objective To investigate the effect of Xenogeneic Acellular Dermal Biofilm(XADB)on the promotion of re-epithelialization of the mastoid cavity and inhibition of granulation tissue proliferation in Canal Wall Down(CWD)mastoidectomy.Methods The patients admitted into the hospital from October 2017 to September2018 and undergone CWD mastoidectomy for chronic otitis media or middle ear cholesteatoma(with the surgery performed by the same surgeon)were enrolled in this study.The patients were divided into the experimental group(groupA,XADB group,n=40)and the control group.In the experimental group,45 ears were included,including 21 ears of mastoid cavity with autologous tissue filling(group A1)and 24 ears without autologous tissue filling(group A2).In the control group(group B,temporal fascia group,n=37),40 ears were included,including 21 ears of mastoid cavity with autologous tissue filling(group B1)and 19 ears without autologous tissue filling(group B2).Time for re-epithelialization and dry ear,granulation tissue proliferation in the operation cavity and the incidence of complications such as vertigo after 6-month follow-up were recorded.At the same time,saline was injected both 4 weeks and 6 months after the operation.The volume of the operation cavity was measured by the cavity injection method and the volume difference was measured(the difference between the volume value of the operation cavity 4 weeks and 6 months after the operation).There was no significant difference between the two groups in the duration of ear purulence,vertigo attack and postoperative cavity volume(P>0.05).Two independent sample t-tests were performed in the two groups post-operatively and there was significant difference(P<0.05).Results The time for dry ear of group A and group B was(21.36±5.54)d and(43.93±12.15)d(P<0.01).The time for re-epithelialization of group A and group B was(27.65±8.19)d and(56.32±18.62)d(P<0.01).There was no granulation tissue proliferation(0/45,0.00%)in group A and one patient in A1 group who developed vertigo 6 months after surgery(1/40,2.50%).Obvious granulation tissue proliferation in the operation cavity was found in 15 cases(15/40,37.50%)in group B,with 6 cases of vertigo(6/37,16.22%)6 months after the operation(5 cases in group B1 and 1 in group B2).According to the presence or absence of autologous tissue filling,the volume difference of the operative cavity were measured 4 weeks and 6 months after the operation.The volume difference of group A1 and group B1 were(0.35±0.16)mL and(1.13±0.37)mL(P<0.01).The volume difference of A2 and B2 groups were(0.78±0.21)mL and(0.93±0.35)mL(P>0.05).Conclusions The application of XADB in CWD can significantly promote re-epithelialization of the mastoid cavity,shorten the time of dry ear and reduce the incidence of vertigo.When the mastoid cavity is not filled,the application of XADB can reduce the granulation tissue proliferation and scar formation in the operation cavity and maintain the stability of the postoperative operative volume,thereby reducing the potential incidence of the recurrence of lesions due to granulation tissue proliferation and reduction of the mastoid cavity.