软骨-软骨膜复合体重建鼓膜的组织学变化  

The Postoperative Outcome of the Cartilage-perichondrium Complex Reconstructed Tympanic Membrane Perforation in Guinea Pig

作　　者：丁栋[1] 许为青[1] 汪银凤[1] 万光伦[1] 

机构地区：[1]安徽医科大学附属安徽省立医院耳鼻咽喉头颈外科,合肥230001

出　　处：《听力学及言语疾病杂志》2016年第3期251-254,共4页Journal of Audiology and Speech Pathology

基　　金：2013年安徽省卫生厅医学科研课题计划(13zc042)资助

摘　　要：目的探讨软骨-软骨膜复合体修补鼓膜穿孔后其软骨厚度及软骨膜内血管密度的变化。方法45只雄性豚鼠随机分为A、B、C三组,每组15只,每只豚鼠分别于左侧耳制作鼓膜穿孔模型后立即采用同侧耳甲腔软骨-软骨膜复合体植入修补鼓膜,植入前先测量并记录植入复合体的厚度,分别观察术后2周(A组)、6周(B组)及12周(C组)植入复合体的厚度、软骨膜内血管密度;另取B组5只豚鼠的右耳(对照组)行鼓膜穿孔造模,不行鼓膜修补术。结果 A、B、C三组豚鼠左耳鼓膜穿孔平均愈合时间为3.8±0.84天,对照组鼓膜穿孔自愈时间为7.2±0.84天;A、B、C三组软骨-软骨膜复合体植入前厚度分别为0.199±0.023、0.198±0.017、0.193±0.021mm,三组间差异无统计学意义(P>0.05),而植入后2周(A组)植入体厚度为0.227±0.024mm,较植入前增厚,植入后6周(B组)植入体厚度为0.191±0.016mm,较植入前无变化(P>0.05),但较植入后2周(A组)变薄(P=0.016),植入后12周的C组植入体厚度为0.169±0.017mm,较植入前明显变薄(P<0.05),且较植入后2周(A组)、6周(B组)厚度变薄(P=0.00);植入后第2、6周,软骨膜单位面积中血管数量分别为13.28±2.49、7.71±2.49个,第2、6周时重建鼓膜的组织学结构为鳞状上皮层、纤维-软骨膜层、软骨层、粘膜层,第12周时为鳞状上皮层、软骨层及粘膜层。结论耳廓软骨-软骨膜复合体重建鼓膜的愈合时间短于鼓膜自行愈合的时间;植入后复合体的厚度较植入前先增厚再变薄,软骨膜层血管数量表现为先增加后减少;重建鼓膜最终组织学分层与正常鼓膜组织学结构相似。Objective To observe the thickness and histologic changes of cartilage--perichondrium complex （CP） and vascular density changes in perichondrium after repairing perforated eardrum. Methods Forty-five male guinea pigs were randomly divided into three groups, and were used to create left TM perforation. The left cavum conchae cartilage--perichondrium was immediately used to repair the perforation. The observation time for group A was two weeks, group B was six weeks and group C was twelve weeks. The thickness of the composite was measured before and after the implantation. The histologic changes of implants and the vascular change in perichondri were observed. Results The healing time for the left ear was 3.8±0.84 , and the right ear 7.2±0.84. The thickness of the composite for group A increased by 14.4% （P〈0.05）. There was no significant change in the thickness of group B after implantation（P〈0.05）. Group C decrease by 14.2% （P〈0.05）. After implantation, the thickness of cartilage in group C was decreased by 34.2% compared to that in group A（P〈0.05）. At the 2nd week in postimplantation, the number of vessels within the unit area of fiber--perichondrium was up to 13.28±2.49, while the above number reached to 7.71±2.49 at the 6th week after implantation. The final histological structure of recon-structed tympanic membrane at the 2nd week and 6th week was composed of squamous epithelial layer, fibrous- perichondrium layer, cartilaginous layer and mucous layer. The above histological structure at 12th week was composed of squamous epithelial layer, cartilaginous layer and mucous layer. Conclusion The healing time of the recon-structed tympanic membrane is shorter than the time spent on healing on its own. The thickness of the composite in post--implantation in three groups first increased and then decreased compared to that in pre--implantation. The number of blood vessels of fiber--perichondrium in the reconstructed tympanic membrane first increased and then re- duced. The layers of fi

关 键 词：鼓膜穿孔 软骨-软骨膜 组织学 豚鼠 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]