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鼓室成形术中各种移植材料的成功率——综述

Success rates for various graft materials in tympanoplasty - A review.

作者信息

Bayram Ali, Bayar Muluk Nuray, Cingi Cemal, Bafaqeeh Sameer Ali

机构信息

Kayseri Training and Research Hospital, Department of Otorhinolaryngology, Kayseri, Turkey.

Kirikkale University, Medical Faculty, Department of Otorhinolaryngology, Kirikkale, Turkey.

出版信息

J Otol. 2020 Sep;15(3):107-111. doi: 10.1016/j.joto.2020.01.001. Epub 2020 Jan 7.

Abstract

OBJECTIVES

The aim of this paper is to review how successful each type of grafts is in tympanoplasty.

METHODS

Pubmed, Google and the Proquest Central Database at Kırıkkale University were queried using the keywords "graft", "success" "tympanoplasty", "success rate" with the search limited to the period 1955 to 2017.

RESULTS

Various types of graft materials including temporalis fascia, cartilage, perichondrium, periosteum, vein, fat or skin have been used in the reconstruction of tympanic membrane (TM) perforation. Although temporalis fascia ensures good hearing is restored, there are significant concerns that its dimensional stability characteristics may lead to residual perforation, especially where large TM perforations are involved. The "palisade cartilage" and "cartilage island" techniques have been stated to increase the strength and stability of a tympanic graft, but they may result in a less functional outcome in terms of restoring hearing. Smoking habits, the size and site of a perforation, the expertise level of the operating surgeon, age, gender, the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is.

CONCLUSION

Although temporal fascia is the most commonly used graft material for tympanoplasty, poor graft stability may cause failure. This failure is due to the inclusion of connective fibrous tissue containing irregular elastic fibers present in the grafted fascia. Cartilage grafts offer better ability to resist infection, pressure, and cope with insufficient vascular supply. This means that cartilage grafts are suitable for use in revision cases.

摘要

目的

本文旨在综述每种类型的移植物在鼓室成形术中的成功程度。

方法

使用关键词“移植物”“成功”“鼓室成形术”“成功率”在PubMed、谷歌以及基利卡莱大学的Proquest Central数据库中进行查询,搜索范围限定在1955年至2017年期间。

结果

多种类型的移植物材料,包括颞肌筋膜、软骨、软骨膜、骨膜、静脉、脂肪或皮肤,已被用于鼓膜穿孔的重建。尽管颞肌筋膜能确保听力得到良好恢复,但人们严重担忧其尺寸稳定性特征可能导致残余穿孔,尤其是在涉及大的鼓膜穿孔时。“栅栏状软骨”和“软骨岛”技术据称可增强鼓膜移植物的强度和稳定性,但就听力恢复而言,它们可能导致功能效果较差。吸烟习惯、穿孔的大小和部位、手术医生的专业水平、年龄、性别、中耳黏膜状况以及鼓膜硬化或鼓室硬化的存在,在决定移植物的成功程度方面都很重要。

结论

尽管颞肌筋膜是鼓室成形术中最常用的移植物材料,但移植物稳定性差可能导致失败。这种失败是由于移植的筋膜中包含含有不规则弹性纤维的结缔组织纤维。软骨移植物具有更好的抗感染、抗压能力,并且能应对血管供应不足的情况。这意味着软骨移植物适用于翻修病例。

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