中耳粘连术腔植入硅胶支撑片的临床价值研究

Clinical Research of Silastic Sheet Implantation in the Adhesive Middle Ear Cavity

目的探索自主研发生产硅胶片植入中耳腔防止粘连性中耳炎术后粘连的用法和有效性,为实现粘连性中耳炎进行听骨链重建提供条件。方法纳入2018年5月至2019年2月因中耳病变行开放式乳突根治术治疗患者6例。术前咽鼓管功能评分量表显示5例存在咽鼓管功能不良,所有患者术中发现中耳黏膜上皮化或炎性肿胀严重,清理后鼓室黏膜全部缺损或严重损伤,植入硅胶片。术后行二期手术重建听力。分析其一般情况、术中所见黏膜情况和术前术后听力效果。结果6例患者中3例为慢性化脓性中耳炎,2例为中耳胆脂瘤,1例为鼓室体瘤。一期术后所有患者鼓膜愈合光滑平整,未见排异反应。中位随访时间12.5月后行二期手术,CT提示6例咽鼓管开放,2例形成含气鼓室,4例仍存在部分鼓室粘连,但含气改善,术中见所有患者硅胶覆盖中耳黏膜光滑,均未有病变复发,其中3例植入PORP重建听力,另外3例植入TORP。各频率气导经过二次手术均有提高,气骨导差第一次术后缩小5.64dB,第二次术后再次缩小4.98dB,其中500Hz和4000Hz二期术后气导听力较二期术前提高更明显。结论鼓室成形术中植入中耳硅胶片有助于增加鼓室含气量,改善中耳振动特性,为听骨链重建提供条件。

Objective To explore the methods of preventing adhesion after the operation for adhesive otitis media,and further to provide conditions for the ossicular chain reconstruction of adhesive otitis media.Methods A prospective study was performed on 6 patients with middle ear disease underwent open cavity mastoidectomy from May 2018 to February 2019 in our department.Five cases showed poor preoperative Eustachian tube function.Intraoperative middle ear mucosae of all cases were severe inflammatory.The middle ear mucosae were all defects or serious injury after lesions elimination,and the silastic sheets were implanted in all cases.The ossicular reconstruction was performed at the second stage surgery.The general situation,intraoperative mucosa condition and preoperative and postoperative hearing were analyzed.Results Among the 6 patients,3 were chronic suppurative otitis media,2 were middle ear cholesteatoma,and 1 was tympanic body tumor.After the first stage surgery,all patients’tympanic membranes were smooth and no rejection.The second stage surgery was performed after the median follow-up time of 12.5 months.CT scan showed that 6 patients’Eustachian tubes were open,2 had air-filled tympanum,and 4 still had partial adhesion in the tympanum,but the ventilation was improved.During second stage surgery,all the patients had smooth middle ear mucosa after the silastic sheets,and no recurrence was found.PORRs and TORPs were implanted for 3 patients,respectively.After the second stage surgery,the air conductive hearings of all frequencies were improved,the air-bone gap(ABG)decreased by 5.64dB and 4.98dB respectively after the first and second stage surgery.The air conductive hearing after the second surgery at 500Hz and 4000Hz were significantly improved compared with those before the second surgery.Conclusion Silastic sheet implanted in the middle ear can increase the air volume in the tympanoplasty,and improve the vibration char-acteristics of the middle ear,which provide conditions for ossicular chain reconstruction.