局部塗抹5-fluorouracil對延遲天竺鼠耳膜雷射穿孔癒合之影響

Impact of Topical 5-fluorouracil on Drum Healing after Laser Myringotomy in Guinea Pig

張文源(Wen-Yuan Chang) ； 黃威雄(Wei-Hsiung Huang) ； 許權振(Chuan-Jen Hsu)

《台灣耳鼻喉頭頸外科雜誌》 38卷2期 (2003/04) Pp. 71-75

https://doi.org/10.6286/2003.38.2.71

摘要

背景：傳統的通氣導管置入術，有鼓膜硬化、慢性穿孔、聽力減退、耳漏與感染的併發症。本研究以天竺鼠雙側鼓膜實施二氧化碳雷射鼓膜切開術後，局部塗抹5-fluorouracil (5-FU)藥膏，延長鼓膜切口的通暢時間，實地觀察其效果。
方法：自2001年9月至2002年2月，以52隻健康天竺鼠，雙耳均施以二氧化碳雷射鼓膜切開術，切口大小一律為1.5mm，之後於實驗組（右耳）切口周圍塗抹5-Fu，對照組（左耳）塗抹無菌生理食鹽水。術後每兩天逐隻觀察紀錄雙耳鼓膜情況，密集觀察所有天竺鼠鼓膜切。癒合時間、耳漏或化膿情形。最後依左右鼓膜切口癒合天數、耳漏或化膿之有無，用t-test進行統計分析。
結果：本實驗52隻天竺鼠，雷射鼓膜切開術後死亡2隻，後續觀察又有2隻發生化膿性耳漏，屬明顯感染所致，予以剔除，僅餘48隻天竺鼠列入統計分析。實驗組與對照組平均癒合時間為12.23±5.20天與12.08±4.74天。清澈性耳漏，在實驗組有7耳(14.6%)、對照組有12耳(25%)，其平均癒合時間分別為17.00±7.09天與12.67±5.02天。乾燥耳的平均癒合時間，實驗組為11.41±4.42天、對照組為11.89±4.70天。以上癒合時間並無統計學差異。若依據乾燥耳（77耳）或耳漏耳（19耳）來比較，癒合時間分別是11.64±4.53天和14.26±6.06天，具有統計學差異。
結論：雷射鼓膜切口局部塗抹5-Fu藥膏，初步實驗結果並無法有效延長切口通暢時間。

並列摘要

BACKGROUND: Myrigotomy with ventilation tubes placement is performed for the management of otitis media with effusion. Unfortunately, the procedure carries with it a finite risk for long-term complications including tympanosclerosis, chronic perforation, hearing loss and formation of granulation tissue. As these disadvantages, laser myringotomy was suggested as an alternative treatment. We investigated the use of CO2 laser myringotomy in conjunction with topical 5-FU to delay healing and prolong the patency of the myringotomy.
METHODS: We used 52 adult guinea pigs weighting 400g and anesthetized with Zoletil (10mg/kg). After anesthesia, the laser myringotomy (1.5mm in diameter) was performed in all ears in the anterior-inferior quadrant of the eardrum under an operating microscope (Leica) with Sharplan 20C CO2 laser (1watt, 0.2 sec pulse duration, single pulse mode). Then, we applied 5-FU cream to the perforation edge of laser myringotomy of right ears (experimental side) and sterile saline solution to that of left ear (control side). The tympanic membranes were examined with otomicroscopy every 2 days for 2 weeks, then twice a week for another 2 weeks. After a follow-up of 4 weeks, we calculated the patency rate of laser myringotomy for the bilateral ears. The t-test was used to test for a difference in duration of myringotomy patency between the 5-FU treated ear (experimental) and the sterile saline treated ear (control).
RESULTS: After operation, 2 animal died from anesthesia. Two additional guinea pigs developed purulent otorrhea due to infection and were excluded from this study. The mean duration of myringotomy patency was found to be 12.23 days for all experimental ears whereas it was 12.08 days for all control ears. Clear otorrhea was noted postoperatively in 7 ears (14.6%) of the experimental ears and 12 ears (25%) of the control ears. The mean duration of myringotomy patency was 17.00 and 12.68 days for experimental and control ears, respectively. In dry ear, the mean duration of myringotomy patency was 11.41 and 11.89 days for experimental and control ears, respectively. The t-test showed that there was no significant difference in the mean durations of myringotomy patency between the 5-FU treated ears and the control ears.
CONCLUSION: Topical 5-FU cream has not obvious effect on prolonging the duration of myringotomy patency in the guinea pigs.

並列關鍵字

laser ； myringotomy ； 5-FU