鼓膜再生の中耳手術への応用:─低侵襲中耳手術の開発─  [in Japanese] Applications of Tympanic Membrane Regeneration for Middle Ear Surgery:–Development of minimally invasive middle ear surgery–  [in Japanese]

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Author(s)

    • 金丸 眞一 Kanemaru Shin-ichi
    • 公益財団法人田附興風会医学研究所北野病院耳鼻咽喉科・頭頸部外科|公益財団法人先端医療振興財団先端医療センター病院耳鼻咽喉科鼓膜再生担当部門|公益財団法人先端医療振興財団臨床研究情報センター Department of Otolaryngology, Head and Neck Surgery, The Tazuke Kofukai Medical Research Institute, Kitano Hospital|Department of Otolaryngology, Institute of Biomedical Research and Innovation Hospital|Translational Research Informatics Center, Foundation for Biomedical Research and Innovation
    • 金井 理絵 Kanai Rie
    • 公益財団法人田附興風会医学研究所北野病院耳鼻咽喉科・頭頸部外科|公益財団法人先端医療振興財団先端医療センター病院耳鼻咽喉科鼓膜再生担当部門 Department of Otolaryngology, Head and Neck Surgery, The Tazuke Kofukai Medical Research Institute, Kitano Hospital|Department of Otolaryngology, Institute of Biomedical Research and Innovation Hospital

Abstract

<p>鼓膜再生療法は、皮膚外切開や自己組織の採取を伴わない組織工学的手法による再生医療として非常に有効な治療であるが、その適用にはいくつかの必須項目を満たす必要がある。鼓膜再生の処置に鼓膜穿孔縁の新鮮創化があるが、これには鼓膜穿孔縁が顕微鏡下で直視できなければ行えない。また、鼓膜穿孔の原因の大半は慢性中耳炎で、多くの場合、鼓室や鼓膜に軽度湿潤し、完全な乾燥状態でないため鼓膜再生の適応ではない。これらの症例に対して、前者では外耳道の拡大や内視鏡の使用。また、後者では、経鼓膜的に鼓室内の洗浄・清掃を行うことで適用症例の拡大を図ってきた。これまで、鼓室形成術や鼓膜形成術を施行せざるを得なかった症例に対しても、その一部は鼓膜再生を併用した低侵襲の本治療法が有効であると思われる。</p>

<p>Tissue engineered regeneration of the tympanic membrane (TM) is a very useful and minimally invasive treatment that does not require skin incision nor the harvesting of autologous tissue. Moreover, with this treatment we can achieve optimal hearing improvement with little air-bone gap. For successful application of this treatment, however, several conditions should be met. For example, we limited the adaptation of this treatment to patients with a dry TM perforation and those in which it was easy to visualize the entire TM with a microscope.</p><p>In order to increase the number of patient candidates for this treatment, we attempted to apply this regenerative procedure to patients with wet TM perforations and/or those in which it was difficult to observe the TM perforation edge due to a narrow external auditory canal.</p><p>For patients in the former category, we repeatedly washed the tympanic cavity through the perforation using saline prior to the regenerative procedure. For patients with the latter condition, we performed this regenerative procedure with the use of an endoscope and/or after enlargement of the external auditory canal. With these procedures, we achieved 80% regenerative rates even in previously excluded patients. The combination of these new procedures for regenerative treatment of the TM reduces the need for invasive surgeries such as tympanoplasty and myringoplasty.</p>

Journal

  • Otology Japan

    Otology Japan 27(2), 131-134, 2017

    Japan Otological Society

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