人工鼓膜修补材料的应用与发展

背景：目前鼓膜修补材料仍在不断更新和发展,疗效及疗程各不相同。所以如何选择鼓膜修补材料成为鼓膜修复的关键。目的：评价人工鼓膜修补材料的性能和应用,寻找合理的鼓膜替代物。方法：采用电子检索的方式,在万方数据库（http：//www.wanfangdata.com.cn/）及Medline数据库（http：//www.ncbi.nlm.nih.gov/pubmed/）中检索1999-01/2010-12有关修补材料应用于鼓膜穿孔的研究文章,关键词为＂鼓膜修补,组织工程,生物材料＂,排除重复研究、普通综述或Meta分析类文章,筛选纳入20篇文献进行评价。结果与结论：鼓膜穿孔的修复有贴补搭桥法和手术修补法两种。用于鼓膜穿孔的贴补材料有许多种,如鸡蛋衣、棉片、塑料薄膜、淀粉海棉、羊胎膜等等,以上材料也只能是作为一种支架的作用促进穿孔愈合,无促细胞生长的作用。手术修补鼓膜疗效比较确切,需要用颞肌筋膜或乳突骨膜等修补,创伤较大是其缺点,另外手术费较贵。随着医学和组织工程技术的发展,各种合成生物材料相继出现。目前国内使用的鼓膜修补材料有生物蛋白海绵、异种胶原生物膜、组织工程鼓膜、脱细胞真皮基质黏膜组织补片等。虽然自体材料、异体材料、合成生物材料是目前临床上大量使用的鼓膜修补材料,但由于其存在各自不可避免的缺点,鼓膜穿孔修复材料仍需进一步开发。

Application and development of artificial tympanic membrane materials

BACKGROUND：Tympanic membrane repair materials continue to update and develop,and their efficacy and treatment course vary.How to select a proper tympanic membrane repair material is the key to tympanic membrane repair.OBJECTIVE：To evaluate the performance and application of artificial tympanic membrane repair materials to find a reasonable alternative to the tympanic membrane.METHODS：An electronic search of Wanfang and Medline databases were done to find articles about tympanic membrane perforation using the keywords of ＂tympanic membrane repair,tissue engineering,biomaterials＂.Repetitive articles,review and Meta analysis were excluded,and 20 articles were included.RESULTS AND CONCLUSION：There are two methods for tympanic membrane repair：patch-bonded bypass method and surgical repair.Bonded repair materials for the tympanic membrane are various,such as egg coats,cotton sheets,plastic films,starch sponge,sheep fetal membranes.These materials can only be used as scaffold to improve perforation healing without promoting effects on cell growth.The surgical repair using temporal fascia or mastoid periosteum is more precise in the repair of tympanic membrane perforation,but big trauma and expensive cost are its disadvantages.At present,the tympanic membrane repair materials used in China include fibrin sponge,heterologous collagen membrane,tissue engineered tympanic membrane,acellular dermal matrix mucosa.Although autologous materials,allograft materials,synthetic materials are widely used in clinical tympanic membrane repair,but because of their inevitable shortcomings,tympanic membrane perforation repair materials needs further development.