鼓膜再生疗法治疗伴鼓膜穿孔的继发性胆脂瘤的疗效
Efficacy of Tympanic Membrane Regeneration Therapy for Secondary Cholesteatoma With Tympanic Membrane Perforation.
文献信息
| PMID | 42831390 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Shin-Ichi Kanemaru |
| 作者单位 | Department of Otolaryngology and HNS, Medical Research Institute, Hearing Disturbance and Eardrum Regeneration Center, Kitano Hospital, Public Interest Incorporated Foundation, Tazuke Kofukai, Osaka, Japan. |
| 期刊 | Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology |
| SCI 分区 | Q2 |
| IF | 1.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 探讨鼓膜（TM）再生疗法（TMRT）对伴鼓膜穿孔（TMP）的继发性胆脂瘤（SC）的疗效。
研究设计： 回顾性病例复习。
地点： 综合医院。
患者： 研究纳入38例接受TMRT的SC患者（41耳；男/女：21/17；年龄12至86岁）和33例接受传统鼓室成形术（CTP）的SC患者（33耳；男/女：15/18；年龄20至75岁）。
干预： 在TMRT过程中，使用内镜去除所有残留鼓膜，保留鼓环完整，然后完全去除胆脂瘤。对于鼓膜修复，机械性破坏鼓膜穿孔边缘，将浸有碱性成纤维细胞生长因子的明胶海绵置于鼓室内和外，并用纤维蛋白胶覆盖。该方案重复最多4次，直至完全闭合。
主要结局指标： 评估手术时间、鼓膜穿孔闭合率和听力改善。监测不良事件，包括胆脂瘤复发，至少3年。
结果： TMRT组的手术时间、鼓膜闭合率和胆脂瘤复发率分别为65分钟、100%（41/41耳）和2.4%（1/41），CTP组分别为125分钟、93.9%（31/33）和9.1%（3/33）。TMRT组和CTP组的平均听力改善分别为12.2和7.5 dB。
结论： 在SC患者中，TMRT在短至中期随访期间实现了优异的鼓膜闭合、良好的听力结局和可接受的胆脂瘤控制。TMRT可能从单纯鼓膜穿孔扩展到选定的SC病例。
英文摘要
OBJECTIVE: To investigate the effectiveness of tympanic membrane (TM) regeneration therapy (TMRT) for secondary cholesteatoma (SC) with TM perforation (TMP).
STUDY DESIGN: Retrospective case review.
SETTING: General hospitals.
PATIENTS: The study included 38 patients (41 ears) with SC (M/F: 21/17, aged 12 to 86 y) who underwent TMRT and 33 patients (33 ears) with SC (M/F: 15/18, aged 20 to 75 y) who underwent conventional tympanoplasty (CTP).
INTERVENTIONS: During TMRT, an endoscope was used to remove all of the remaining TM, leaving the annulus intact, and then the cholesteatoma was removed completely. For TM repair, the edge of the TMP was disrupted mechanically, and a gelatin sponge immersed in basic fibroblast growth factor was placed inside and outside the tympanic cavity and covered with fibrin glue. The protocol was repeated up to 4 times until closure was complete.
MAIN OUTCOME MEASURES: Operative time, TMP closure rate, and hearing improvement were evaluated. Adverse events, including cholesteatoma recurrence, were monitored for at least 3 years.
RESULTS: The surgical time, TM closure rate, and cholesteatoma recurrence rate were 65 minutes, 100% (41/41 ears), and 2.4% (1/41) in the TMRT group and 125 minutes, 93.9% (31/33), and 9.1% (3/33) in the CTP group, respectively. The average hearing improvements were 12.2 and 7.5 dB in the TMRT and CTP groups, respectively.
CONCLUSIONS: TMRT achieved excellent TM closure, favorable hearing outcomes, and acceptable cholesteatoma control during the short-to-mid-term follow-up period in patients with SC. TMRT may be expanded beyond simple TMPs to selected cases of SC.