软骨-软骨膜复合体重建鼓膜的组织学变化

发布时间：2018-03-31 20:59

本文选题：鼓膜穿孔　切入点：软骨-软骨膜　出处：《安徽医科大学》2016年硕士论文

【摘要】：目的1.比较鼓膜穿孔后,植入软骨-软骨膜复合体重建鼓膜的时间与鼓膜自行愈合时间的差异是否有统计学意义。2.探讨应用软骨-软骨膜复合体作为植入体重建鼓膜过程中,软骨-软骨膜复合体厚度的变化趋势。3.观察软骨-软骨膜复合体用于鼓膜穿孔修补重建鼓膜术中,其不同愈合时期,重建鼓膜的组织学结构及其纤维-软骨膜层血管密度的变化,并了解不同时期血管数量的差异有无显著性。方法研究对象均来源于安徽省立医院动物实验中心饲养豚鼠,共选取45只雄性健康杂色豚鼠(200-250g),所有研究对象的饲养、管理及实验过程均符合国际科学技术委员会发布的《实验动物管理条例》、卫生部发布的《医学实验动物管理实施细则》和安徽医科大学实验动物理论委员会章程,实验用豚鼠全身无明显畸形,耳廓反射正常,耳内镜下检查外耳道及鼓膜均正常。将45只雄性豚鼠随机分为A、B、C三组,每只豚鼠分别在显微镜下行左侧耳鼓膜穿孔术,术后立即采用耳甲腔软骨-软骨膜复合体作植入体修补同侧穿孔鼓膜,其中B组5只豚鼠的右耳行鼓膜穿孔造模,不行鼓膜修补术。分别观察A组(2周)、B组(6周)及C组(12周),记录各组研究对象鼓膜愈合时间,测量不同愈合时期植入的软骨-软骨膜复合体重建鼓膜的厚度,观察显微镜下植入复合体的组织学形态,并在显微镜下记录纤维-软骨膜层血管数量的多少。所得数据应用计算机SPSS16.0分析软件对数据进行统计处理。结果1.经过观察,左耳鼓膜愈合时间为3.8±0.84天,右耳鼓膜穿孔自行愈合时间为7.2±0.84天,左耳鼓膜愈合时间较右耳明显缩短,差异有统计学意义(P0.05);2.三组中植入后复合体的厚度变化为A组(0.227±0.024mmm),较植入前增大14.4%,差异有统计学意义(P0.05)；B组(0.191±0.016mm),软骨厚度较植入前无显著变化(P0.05),且较A组术后两周时厚度降低,组间差异有统计学意义(P0.05);C组(0.169±0.017mm)较植入前减小14.2%,差异有统计学意义(P0.05),且与A组相比减少34.2%,组间差异显著(P0.05);3.重建鼓膜中纤维-软骨膜层血管密度：植入后第2周,纤维-软骨膜层单位面积中血管数量(13.28±2.49)个,植入后第6周,单位面积中血管数量(7.71±2.49)个,植入后第12周,单位面积内鲜有血管存在,且各组间单位面积血管数量差异均有统计学意义(P0.05)。第2周和第6周时重建鼓膜的组织学结构为鳞状上皮层、纤维-软骨膜层、软骨层和粘膜层。第12周时为鳞状上皮层、软骨层和粘膜层。结论植入体重建鼓膜的愈合时间短于鼓膜白行愈合的时间；三组中植入后复合体的厚度较植入前呈先增大后减小的变化；重建鼓膜中纤维-软骨膜层血管数量表现为先增加后减少；重建鼓膜最终组织学分层与正常鼓膜组织学结构相似。从组织学的角度,软骨-软骨膜复合体是一种适宜的鼓膜修补材料。
[Abstract]:Objective 1. To compare the difference between the time of reconstruction of tympanic membrane and the time of self-healing of tympanic membrane after tympanic membrane perforation. 2. To explore the use of chondrochondral complex as body weight in the process of tympanic membrane reconstruction. The change trend of chondrochondrochondral complex thickness. 3. To observe the effect of chondrochondrochondral complex on tympanic membrane repair and reconstruction in different healing stages. The histological structure of the reconstructed tympanic membrane and the changes of vascular density of fibrous chondrocyte layer were studied. Methods the subjects of the study were collected from the animal experimental center of Anhui Provincial Hospital to raise guinea pigs. A total of 45 male healthy heterochromatic guinea pigs were selected for feeding. The management and experimental process are in accordance with the regulations on the Management of Laboratory Animals issued by the International Commission of Science and Technology, the rules for the implementation of the Management of Medical Laboratory Animals issued by the Ministry of Health, and the articles of association of the Committee on Experimental Animal Theory of Anhui Medical University. There were no obvious deformities, normal auricle reflex and normal external auditory meatus and tympanic membrane under endoscope in guinea pigs. Forty-five male guinea pigs were randomly divided into three groups, the left ear tympanic membrane perforation was performed under microscope, and 45 male guinea pigs were randomly divided into three groups. The tympanic membrane of ipsilateral perforated tympanic membrane was repaired with the chondrochondrochondral complex of the auricular cavity immediately after operation, and the tympanic membrane perforation was made in the right ear of 5 guinea pigs in group B. No tympanic membrane repair was performed. The tympanic membrane healing time was recorded in group A (2 weeks) and group C (6 weeks), and the thickness of cartilage chondrochondral complex implanted in different healing period was measured. The histological morphology of the implanted complex was observed under the microscope, and the number of fibrochondrocytes was recorded under the microscope. The data were statistically processed by computer SPSS16.0 software. Results 1. The healing time of tympanic membrane was 3.8 卤0.84 days in left ear and 7.2 卤0.84 days in right ear. The healing time of tympanic membrane in left ear was significantly shorter than that in right ear. In group A, the thickness of complex was 0.227 卤0.024 mm ~ (-1), which was increased by 14.4mm ~ (-1) than that before implantation. The difference was statistically significant (P < 0.05). The thickness of cartilage in group B was not significantly changed compared with that before implantation (P 0.05mm), and the thickness of cartilage was lower than that of group A at two weeks after implantation, and the thickness of cartilage was lower than that of group A at two weeks after implantation, and the thickness of cartilage in group B was significantly lower than that in group A at two weeks after implantation. There was a significant difference between the two groups (P 0.05 卤0.017 mm). The difference was statistically significant (P 0.05 卤0.169 卤0.017 mm), and the difference was significant compared with group A (P 0.05). The vascular density of fibrous chondrochondral layer in the reconstructed tympanic membrane was significantly lower than that in group A at 2 weeks after implantation. There were 13.28 卤2.49 vessels per unit area of fibrous chondrochondral layer and 7.71 卤2.49 vessels per unit area at the 6th week after implantation. At the 12th week after implantation, there were few vessels in the unit area. The histological structure of the reconstructed tympanic membrane was squamous epithelium layer, fibrochondral layer, chondroid layer and mucosal layer at the 2nd and 6th week, and squamous epithelium layer at the 12th week. Conclusion the healing time of the tympanic membrane was shorter than that of the white tympanic membrane in the three groups, and the thickness of the complex increased first and then decreased in the three groups. The number of fibrochondral lamina vessels in the reconstructed tympanic membrane increased first and then decreased. The final histological stratification of the reconstructed tympanic membrane was similar to that of the normal tympanic membrane. Cartilage-chondrochondral complex is a suitable material for tympanic membrane repair.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R764.9

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