硅胶鼓室支撑片用于中耳手术的安全性验证  

Safety of Silastic Sheet in Middle Ear Surgery

作　　者：魏兴梅 冯国栋 陈龙云[2] 王晓喆 高志强[1] WEI Xingmei;FENG Guodong;CHEN Longyun;WANG Xiaozhe;GAO Zhiqiang(Department of Otorhinolaryngology-Head and Neck Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,PR China;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,PR China.)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院耳鼻喉科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院病理科,北京100730

出　　处：《中华耳科学杂志》2020年第3期464-468,共5页Chinese Journal of Otology

摘　　要：目的通过动物实验验证硅胶鼓室支撑片用于损伤的中耳黏膜的安全性。方法18只豚鼠(重350g,12~14周),全麻下测试听力后划开鼓膜将硅胶片修剪后放置于划伤的鼓岬黏膜表面。4周后,再次麻醉后观察鼓膜愈合情况并再次测试听力,然后处死动物、取出听泡,观察鼓室内情况,后将刮伤部位进行固定、包埋、染色,光镜下观察黏膜的炎性反应,纤维化程度和黏膜厚度,并将实验侧和对照侧进行比较。结果术后4周除1例实验侧鼓膜有一小穿孔,其余鼓膜皆完全愈合。鼓室情况实验侧和对照侧各有1例存在少量鼓室积液,其余皆未见感染、化脓、粘连等反应。实验侧术前和术后的平均听力分别为27.22±6.00 dB和30.28±5.55 dB,对照侧的为26.94±6.22 dB和27.22±7.12dB。T检验显示无论术前术后,实验侧和对照侧听力均无统计学差异(P>0.05)。实验侧和对照侧的中耳黏膜炎性反应、纤维化程度和黏膜厚度均无统计学差异。结论硅胶鼓室支撑片置入划伤的中耳黏膜未影响内耳功能以及造成额外的炎性反应。Objective To investigate the safety of silastic sheet for abraded middle ear mucosa in an animal experiment model.Methods Eighteen 12-14 weeks old guinea pigs(350g)were used.Under general anesthesia,ABR thresholds were recorded before silastic sheets were used to cover abraded middle ear mucosa through a hole in tympanic membrane(TM)on the test side while the same procedure was performed on the contralateral side without silastic sheet placement.At four weeks postoperative,the TM were examined and ABR thresholds recorded again.Animals were then sacrificed and the tympanic bulla on both test and contralateral sides harvested,stained with H&E,examined and graded under a light microscope for inflammation,fibrosis and mucosa thickness.Results All but one TM in silastic sheet treated ears healed 4 weeks after surgery.Small amount middle ear effusion was seen in one silastic sheet treated ear and one non-treated ear,respectively,with all other ears showing intact tympanum mucosa and no adhesion or infection were observed.All implanted silastic sheets showed no displacement,curling or fibrosis.The average hearing thresholds were 27.22±6.00 dB and 30.28±5.55 dB before and after surgery,respectively in silastic sheet treated ears and 26.94±6.22 dB and 27.22±7.12 dB in non-treated ears(P>0.05).The middle ear mucosa showed no significant differences between silastic sheet treated and non-treated ears as for inflammation,fibrosis and mucosa thickness.Conclusion Silastic sheet implantation in middle ears with abraded mucosa does not affect inner ear function nor causes additional inflammatory reaction.

关 键 词：硅胶片 中耳粘连 黏膜 炎性反应 

分 类 号：R764[医药卫生—耳鼻咽喉科]