开放式乳突切开+鼓室成形术中乳突填塞材料的应用进展

doi:10.6040/j.issn.1673-3770.0.2021.301

摘要/Abstract

摘要： 开放式乳突切开+鼓室成形术是一种治疗中耳胆脂瘤和慢性化脓性中耳炎等疾病的有效外科手术技术,旨在彻底清除病灶,从而达到干耳、促进病灶引流、避免颅内外并发症发生的目的。但手术遗留的大乳突空腔可能导致术耳反复流脓、术后需定期清理痂皮、与温度变化有关的前庭功能紊乱、继发术腔感染和隐形助听器佩戴不方便等问题,严重影响患者的生活质量。因此,乳突缩窄术对提高开放式乳突切开+鼓室成形术后疗效是非常重要的。随着医学技术的进步和材料科学的不断发展,越来越多的材料被临床医生应用到乳突缩窄术的临床实践当中,但各种材料的取材方式、组织量、是否容易存活和吸收等特点各不相同,各有优缺点。因此,论文就乳突缩窄术在开放式乳突切开+鼓室成形术中的应用及乳突填塞材料的选择进行综述。

关键词: 开放式乳突切开, 鼓室成形术, 乳突缩窄术, 乳突腔重建, 填塞材料

Abstract: Mastoidectomy canal wall down with tympanoplasty is an effectively surgical technique for the treatment of diseases such as middle ear cholesteatoma and chronic suppurative otitis media. It aims to completely remove the lesions, so as to achieve dry ears, promote drainage of the lesions and avoid intracranial and external complications. However, the large mastoid cavity left by the operation may cause repeated purulence of the surgical ear, regular scab removal after the operation, vestibular dysfunction related to temperature changes, infection of the surgical cavity and inconvenient wearing of invisible hearing aids, which all seriously affect the patients' quality of life. Therefore, mastoid reduction surgery is very important to improve the treatment effect of mastoidectomy canal wall down with tympanoplasty. With the advancement of medical technology and the continuous development of materials science, more and more materials are used in the clinical practice of mastoid reduction surgery by clinicians, but the way of taking various obliteration materials, the amount of tissue, whether it is easy to survive and absorb and other characteristics are different, each has advantages and disadvantages. Therefore, this article will review the application of mastoid reduction surgery in mastoidectomy canal wall down with tympanoplasty and the selection of mastoid obliteration materials.

Key words: Mastoidectomy canal wall down, Tympanoplasty, Mastoid reduction surgery, Mastoid cavity reconstruction, Obliteration materials

中图分类号:

R764.9+2

朱俊,聂儒雅综述李国义审校. 开放式乳突切开+鼓室成形术中乳突填塞材料的应用进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 111-116.

ZHU Jun, NIE RuyaOverview,LI GuoyiGuidance. The advances in application of mastoid obliteration materials in mastoidectomy canal wall down with tympanoplasty[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(6): 111-116.

参考文献

[1] 秦贺, 孙建军. 乳突开放术腔的重建[J]. 中华耳科学杂志, 2012, 10(2): 270-272. doi:10.3969/j.issn.1672-2922.2012.02.030.
[2] Blake CJ. The value of the blood-clot as a primary dressing in mastoid operations[J]. J Laryngol Rhinol Otol, 1906, 21(11): 545-555. doi:10.1017/s175514630017828x.
[3] Portmann M, Portmann D. Management of open and closed cavities in otology[J]. Rev Laryngol Otol Rhinol(Bord), 1990, 111(2): 181-183.
[4] 李陈, 王冰, 张韩, 等. 中耳胆脂瘤手术治疗进展[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(10): 952-956. doi:10.13201/j.issn.2096-7993.2021.10.020. LI Chen, WANG Bing, ZHANG Han, et al. Advances in the surgical treatment of cholesteatoma of the middle ear[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2021, 35(10): 952-956. doi:10.13201/j.issn.2096-7993.2021.10.020.
[5] 仇弋戈, 罗洪伟, 唐春霞, 等. 骨粉被覆单蒂肌瓣乳突填塞对前庭功能的影响[J]. 中国耳鼻咽喉头颈外科, 2019, 26(1): 31-33. doi:10.16066/j.1672-7002.2019.01.008. QIU Yige, LUO Hongwei, TANG Chunxia, et al. Impact of single-pedicle muscle flap with bone pate on vestibular function after mastoid obliteration[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2019, 26(1): 31-33. doi:10.16066/j.1672-7002.2019.01.008.
[6] 张运波, 习国平, 郭成军, 等. 乳突骨膜瓣修复乳突根治术后术腔[J]. 中华耳科学杂志, 2010, 8(3): 282-284. doi:10.3969/j.issn.1672-2922.2010.03.013. ZHANG Yunbo, XI Guoping, GUO Chengjun, et al. Repairing mastoidectomy cavity by mastoid periosteum flap[J]. Chinese Journal of Otology, 2010, 8(3): 282-284. doi:10.3969/j.issn.1672-2922.2010.03.013.
[7] 杨睿, 康文艺, 樊迎春, 等. 双U形带蒂肌骨膜瓣在外耳道后壁重建及乳突腔填塞中的应用[J]. 中国中西医结合耳鼻咽喉科杂志, 2016, 24(2): 96-98. doi:10.16542/j.cnki.issn.1007-4856.2016.02.005. YANG Rui, KANG Wenyi, FAN Yingchun, et al. Reconstruction of the double U style postauricular musculo-periosteal for mastoid obliteration and canal wall down mastoidectomy[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2016, 24(2): 96-98. doi:10.16542/j.cnki.issn.1007-4856.2016.02.005.
[8] Kaur N, Sharma DK, Singh J. Comparative evaluation of mastoid cavity obliteration by vascularised temporalis myofascial flap and deep temporal fascial-periosteal flap in canal wall downmastoidectomy[J]. J Clin Diagn Res, 2016, 10(12): MC08-MC11. doi:10.7860/JCDR/2016/21490.9121.
[9] 邱恩惠, 邱连升, 李志春. 乳突根治术腔3种处理方法的临床分析[J]. 福建医科大学学报, 2015, 16(4): 267-269.
[10] 夏寅. 乳突根治术-House与Fisch比较[J]. 中华耳科学杂志, 2017, 15(1): 9-13. doi:10.3969/j.issn.1672-2922.2017.01.003. XIA Yin. Mastoidectomy: house versus fisch techniques[J]. Chinese Journal of Otology, 2017, 15(1): 9-13. doi:10.3969/j.issn.1672-2922.2017.01.003.
[11] 冯国栋, 吴海燕, 杨华, 等. 枕部皮下肌组织瓣填塞开放式乳突根治腔的干耳效果[J]. 中华耳科学杂志, 2015, 10(2): 301-303. doi:10.3969/j.issn.1672-2922.2015.02.025. FENG Guodong, WU Haiyan, YANG Hua, et al. Mastoid obliteration with occipital myosubcutaneous flap in open cavity mastoidectomy[J]. Chinese Journal of Otology, 2015, 10(2): 301-303. doi:10.3969/j.issn.1672-2922.2015.02.025.
[12] 徐志勇, 冀丽梅, 魏芳芳, 等. 颞浅筋膜瓣用于乳突填塞及外耳道重建远期疗效观察[J]. 河北北方学院学报(自然科学版), 2017, 33(8): 24-26. doi:10.3969/j.issn.1673-1492.2017.08.006. XU Zhiyong, JI Limei, WEI Fangfang, et al. Long-term observation of application of superficial temporal fascial flap to mastoidotympanectomy and reconstruction of external ear canal[J]. Journal of Hebei North University(Natural Science Edition), 2017, 33(8): 24-26. doi:10.3969/j.issn.1673-1492.2017.08.006.
[13] 董吕华, 毛华杰, 赵波. 耳后带蒂肌骨膜瓣及自体骨粉在开放式乳突根治术腔填塞术中的应用研究[J]. 中国耳鼻咽喉头颈外科, 2017, 24(8): 427-428, 430. doi:10.16066/j.1672-7002.2017.08.014.
[14] Leatherman BD, Dornhoffer JL. The use of demineralized bone matrix for mastoid cavity obliteration[J]. Otol Neurotol, 2004, 25(1): 22-25. doi:10.1097/00129492-200401000-00005.
[15] 吕宏光, 高晗, 刘伟. 乳突根治术后同种异体肋软骨中耳重建71例报告[J]. 临床耳鼻咽喉科杂志, 2000, 10(10): 442-443. doi:10.3969/j.issn.1001-1781.2000.10.004. LV Hongguang, GAO Han, LIU Wei. Reconstruction for posterior wall of external meatus and sound transmission apparatus after radical Mastoidectomy[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2000, 10(10): 442-443. doi:10.3969/j.issn.1001-1781.2000.10.004.
[16] 马荣昌, 李大军, 李武杰. 乳突腔同种异体牙充填在开放式鼓室成形术中的应用[J]. 临床耳鼻咽喉科杂志, 2003, 17(10): 591-592,595. doi:10.3969/j.issn.1001-1781.2003.10.006. MA Rongchang, LI Dajun, LI Wujie. The application of mastoid obliteration with homograft tooth in open method tympanoplasty[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2003, 17(10): 591-592,595. doi:10.3969/j.issn.1001-1781.2003.10.006.
[17] 梁海荣, 虞幼軍, 林枫, 等. 同种骨在乳突术腔消减技术中的临床应用[J]. 齐齐哈尔医学院学报, 2016, 37(10): 1285-1287. LIANG Hairong, YU Youjun, LIN Feng, et al. Clinical application of allogeneic bone abatement techniques in mastoid cavity surgery[J]. Journal of Qiqihar Medical University, 2016, 37(10): 1285-1287.
[18] Linthicum FH Jr. The fate of mastoid obliteration tissue: a histopathological study[J]. Laryngoscope, 2002, 112(10): 1777-1781. doi:10.1097/00005537-200210000-00013.
[19] 陈雪生, 王威, 陶静, 等. 耳后多种自体中胚层软组织及皮质骨粉填充乳突修复耳道后壁在开放式手术中的临床应用[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 18-22. doi:10.6040 / j.issn.1673-3770.0.2014.177. CHEN Xuesheng, WANG Wei, TAO Jing, et al. Application of mastoid-cavity obliteration and ear canal posterior-wall renovation with mesodermal-tissue graft of postauricular region and mastoid cortex-bone pate in canal wall-down tympanoplasty[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2014, 28(5): 18-22. doi:10.6040 / j.issn.1673-3770.0.2014.177.
[20] Askar SM, Saber IM, Omar M. Mastoid reconstruction with platelet-rich plasma and bone pate after canal wall down mastoidectomy: a preliminary report[J]. Ear Nose Throat J, 2021, 100(7): 485-489. doi:10.1177/0145561319879789.
[21] El-Anwar MW, El-Ahl MA, Zidan AA, et al. Topical use of autologous platelet rich plasma in myringoplasty[J]. Auris Nasus Larynx, 2015, 42(5): 365-368. doi:10.1016/j.anl.2015.02.016.
[22] Marques LF, Stessuk T, Camargo IC, et al. Platelet-rich plasma(PRP): methodological aspects and clinical applications[J]. Platelets, 2015,26(2):101-113. doi: 10.3109/09537104.2014.881991.
[23] Dorion RP, Hamati HF, Landis B, et al. Risk and clinical significance of developing antibodies induced by topical thrombin preparations[J]. Arch Pathol Lab Med, 1998, 122(10): 887-894.
[24] Skoulakis C, Koltsidopoulos P, Iyer A, et al. Mastoid obliteration with synthetic materials: a review of the literature[J]. J Int Adv Otol, 2019, 15(3): 400-404. doi:10.5152/iao.2019.7038.
[25] Sorour SS, Mohamed NN, Abdel Fattah MM, et al. Bioglass reconstruction of posterior meatal wall after canal wall down mastoidectomy[J]. Am J Otolaryngol, 2018, 39(3): 282-285. doi:10.1016/j.amjoto.2018.03.007.
[26] Vos J, de Vey Mestdagh P, Colnot D, et al. Bioactive glass obliteration of the mastoid significantly improves surgical outcome in non-cholesteatomatous chronic otitis media patients[J]. Eur Arch Otorhinolaryngol, 2017, 274(12): 4121-4126. doi:10.1007/s00405-017-4757-7.
[27] Bernardeschi D, Pyatigorskaya N, Russo FY, et al. Anatomical, functional and quality-of-life results for mastoid and epitympanic obliteration with bioactive glass s53p4: a prospective clinical study[J]. Clin Otolaryngol, 2017, 42(2): 387-396. doi:10.1111/coa.12748.
[28] de Veij Mestdagh PD, Colnot DR, Borggreven PA, et al. Mastoid obliteration with S53P4 bioactive glass in cholesteatoma surgery[J]. Acta Otolaryngol, 2017, 137(7): 690-694. doi:10.1080/00016489.2017.1279346.
[29] Munukka E, Leppäranta O, Korkeamäki M, et al. Bactericidal effects of bioactive glasses on clinically important aerobic bacteria[J]. J Mater Sci Mater Med, 2008, 19(1): 27-32. doi:10.1007/s10856-007-3143-1.
[30] Pérez-Tanoira R, Kinnari TJ, Hyyrynen T, et al. Effects of S53P4 bioactive glass on osteoblastic cell and biomaterial surface interaction[J]. J Mater Sci Mater Med, 2015, 26(10): 246. doi:10.1007/s10856-015-5568-2.
[31] Drago L, de Vecchi E, Bortolin M, et al. Antimicrobial activity and resistance selection of different bioglass S53P4 formulations against multidrug resistant strains[J]. Future Microbiol, 2015, 10(8): 1293-1299. doi:10.2217/FMB.15.57.
[32] Mahendran S, Yung MW. Mastoid obliteration with hydroxyapatite cement: the Ipswich experience[J]. and, 2004, 25(1): 19-21. doi:10.1097/00129492-200401000-00004.
[33] Ridenour JS, Poe DS, Roberson DW. Complications with hydroxyapatite cement in mastoid cavity obliteration[J]. Otolaryngol Head Neck Surg, 2008, 139(5): 641-645. doi:10.1016/j.otohns.2008.07.020.
[34] Hussain A, Ram B, Hilmi OJ. Reconstruction of mastoid cavity with hydroxyapatite cement and postauricular flap[J]. Laryngoscope, 2002, 112(3): 583-585. doi:10.1097/00005537-200203000-00032.
[35] Wong RK, Gandolfi BM, St-Hilaire H, et al. Complications of hydroxyapatite bone cement in secondary pediatric craniofacial reconstruction[J]. J Craniofac Surg, 2011, 22(1): 247-251. doi:10.1097/SCS.0b013e3181f7b7db.
[36] Lee HB, Lim HJ, Cho M, et al. Clinical significance of β-tricalcium phosphate and polyphosphate for mastoid cavity obliteration during middle ear surgery: human and animal study[J]. Clin Exp Otorhinolaryngol, 2013, 6(3): 127-134. doi:10.3342/ceo.2013.6.3.127.
[37] Kakigi A, Taguchi D, Takeda T. Mastoid obliteration using calcium phosphate bone paste with an artificial dermis soaked with basic fibroblast growth factor: preliminary clinical report[J]. Auris Nasus Larynx, 2009, 36(1): 15-19. doi:10.1016/j.anl.2008.01.006.
[38] Cho SW, Cho YB, Cho HH. Mastoid obliteration with silicone blocks after canal wall down mastoidectomy[J]. Clin Exp Otorhinolaryngol, 2012, 5(1): 23-27. doi:10.3342/ceo.2012.5.1.23.
[39] Elbary MEA, Nasr WF, Sorour SS. Platelet-rich plasma in reconstruction of posterior meatal wall after canal wall down mastoidectomy[J]. Int Arch Otorhinolaryngol, 2018, 22(2): 103-107. doi:10.1055/s-0037-1602694.
[40] Faramarzi M, Kaboodkhani R, Roosta S, et al. Application of amniotic membrane for covering mastoid cavity in canal wall down mastoidectomy[J]. Laryngoscope, 2019, 129(6): 1453-1457. doi:10.1002/lary.27638.
[41] Koizumi NJ, Inatomi TJ, Sotozono CJ, et al. Growth factor mRNA and protein in preserved human amniotic membrane[J]. Curr Eye Res, 2000, 20(3): 173-177.
[42] Favaron PO, Carvalho RC, Borghesi J, et al. The amniotic membrane: development and potential applications - A review[J]. Zuchthygiene, 2015, 50(6): 881-892. doi:10.1111/rda.12633.
[43] Fairbairn NG, Randolph MA, Redmond RW. The clinical applications of human amnion in plastic surgery[J]. J Plast Reconstr Aesthet Surg, 2014, 67(5): 662-675. doi:10.1016/j.bjps.2014.01.031.
[44] Ozkaya O, Egemen O, Ye??塂ilada A, et al. The effect of nonpreserved human amniotic membrane on the survival of ischaemic skin flaps in rats[J]. J Plast Reconstr Aesthet Surg, 2012, 65(12): 1700-1705. doi:10.1016/j.bjps.2012.06.013.
[45] 许教远, 李军政, 车翠微, 等. 脱细胞异体真皮基质在开放性乳突切开中的应用[J]. 中国实用医药, 2015, 10(16): 22-24. doi:10.14163/j.cnki.11-5547/r.2015.16.011. XU Jiaoyuan, LI Junzheng, CHE Cuiwei, et al. Application of acellular dermal matrix in open mastoidectomy[J]. China Practical Medicine, 2015, 10(16): 22-24. doi:10.14163/j.cnki.11-5547/r.2015.16.011.
[46] 曹琳, 朱富高, 李文娟, 等. 异种(牛)脱细胞真皮基质联合耳甲腔成形术在开放性乳突根治术中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(7): 507-510. doi:10.13201/j.issn.1001-1781.2018.07.007. CAO Lin, ZHU Fugao, LI Wenjuan, et al. The application of cattle acelluar dermal matrix xenograft associate with conchoplasty in the open mastoidectomy[J]. Journal of Clinical Otorhinolaryngology Head andNeck Surgery, 2018, 32(7): 507-510. doi:10.13201/j.issn.1001-1781.2018.07.007.
[47] 刘亚, 崔鑫, 刘卓慧, 等. 异种脱细胞真皮基质在开放式乳突根治术的临床应用[J]. 昆明医科大学学报, 2020, 41(3): 35-40. doi:10.3969/j.issn.1003-4706.2020.03.006. LIU Ya, CUI Xin, LIU Zhuohui, et al. Clinicalapplication of xenogeneic acellular dermal biofilm in canal wall down mastoidectomy[J]. Journal of Kunming Medical University, 2020, 41(3): 35-40. doi:10.3969/j.issn.1003-4706.2020.03.006.
[48] 陈晓红, 李伟, 李海同, 等. 颞骨脑脊液漏27例的外科治疗总结[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(11): 998-1003. doi:10.13201/j.issn.2096-7993.2021.11.008. CHEN Xiaohong, LI Wei, LI Haitong, et al. Surgical management of 27 cases with temporal bone cerebrospinal fluid leakage[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2021, 35(11): 998-1003. doi:10.13201/j.issn.2096-7993.2021.11.008.

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