异体真皮基质与自体耳屏软骨-软骨膜在鼓膜修补中临床研究分析

Clinical Analysis of Allograft Dermal Matrix and Autogenous Tragus Complex Cartilage-Perichondrium in Tympanic Membrane Repair

【目的】对比分析脱细胞真皮基质与耳屏软骨-软骨膜在鼓膜修补中的疗效及组织病理学差异。【方法】74例慢性化脓性中耳炎患者分成两组,A组脱细胞真皮基质作为鼓膜修补材料,共23例,B组耳屏软骨-软骨膜复合物作为修补材料,共51例。收集两组患者鼓膜表面血管生长时间以及修补鼓膜完全上皮化时间,比较两组的差别。收集两种材料送病理科行组织切片,对比观察两者之间的差异。【结果】两组术后鼓膜愈合率均为100%,差异无统计学意义(P>0.05)。术后可见表面血管爬生时间A组为(3.74±1.05)周,B组为(2.22±0.42)周,B组血管爬生更快,且两组之间差异有统计学意义(t=6.70,P<0.01);鼓膜上皮化时间A组为(5.35±0.98)周;B组为(4.00±0.53)周,2组上皮化更快,且两组之间差异无统计学意义(t=6.19,P<0.01)。病理见A组仅为胶原纤维,无血管以及细胞等活性成分,B组为致密软骨膜与软骨组织,其中大量存在血管,细胞结构以及成骨细胞等。【结论】脱细胞真皮基质可作为鼓膜穿孔的修补材料,但由于脱细胞真皮基质缺少细胞活性因子,新生鼓膜愈合时间相对自体组织材料较长。

【Objective】To compare and analyze the efficiency and histopathological difference of acellular dermal matrix(ADM)and autogenous tragus complex cartilage-Perichondrium in tympanic membrane repair.【Methods】A total of 74 patients with chronicsuppurative otitis media were divided into two groups.ADM was used as tympanic membrane repair material in total of 23 cases of Group A,while tragus complex cartilage-Perichondrium was used in total of 51 cases of Group B.Both the time-costing of angiogenesis on the surface of tympanic membrane and the time-costing of complete epithelization of repaired tympanic membrane were collected and compared between the two groups.The two kinds of materials were collected and sent to pathology department for tissue section,to observe the difference between them.【Results】The healing rate of tympanic membrane was 100% in both groups,and there was no statistical significance(P>0.05).The time-costing of angiogenesis was(3.74±1.05)weeks in Group A and(2.22±0.42)weeks in Group B,The difference between groups was significant(t=6.70,P<0.01);the time-costing of tympanic membrane epithelization was(5.35±0.98)weeks in Group A and(4.00±0.53)weeks in Group B,and there was statistical significance between the two groups(t=6.19,P<0.01).Pathology showed that Group A contained only collagen fibers,without blood vessels and cells,and Group B,there were dense perichondrium and cartilage tissue,in which there were a large number of blood vessels,cellular structures and osteoblasts【.Conclusions】Acellular dermal matrix can be used to repair tympanic membrane perforation.Because of lacking of cytokines,the healing time of new tympanic membrane is longer than that of autologous tissue.