耳内切口下鼓膜成形术的经验及不同自体组织移植材料比较  

Tympanoplasty through Endaural Incision,Surgical Experience and Comparison of Four Autograft Tissues

作　　者：樊韵平[1] 冯韶燕[1] 陈舒琳[1] 夏文彤[1] 

机构地区：[1]中山大学附属第五医院耳鼻咽喉科,广东珠海519020

出　　处：《中山大学学报（医学科学版）》2011年第3期359-363,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省珠海市科技项目(PC20081046)

摘　　要：【目的】介绍在耳内切口下取耳甲部位对应的乳突骨膜用于鼓膜成形术的方法经验并与其它3种常用自体组织移植材料进行对比。【方法】总例数为184耳,包括单纯耳内切口168耳,耳内切口附加耳后切口16耳(均为颞骨筋膜修补);移植自体材料分成4组并对比:乳突骨膜(99耳)、软骨膜(21耳)、软骨-软骨膜复合片(48耳)、颞肌筋膜(16耳)。对比项目包括手术用时、局麻手术率、鼓膜I期愈合率和愈合质量;以及单纯鼓膜成形术中各组病例的听力学结果(分为优良、成功、有效和无效4级)、新鼓膜愈合时间等并进行统计分析。【结果】四组中愈合率分别为92.9%、85.7%、87.5%、97.9%。其它观察指标也相近。在对单纯I型成形术的对比中,各组病例在上述4个听力分级中的分布没有统计学差异(P=0.777);骨膜组手术用时显著低于其它各组(P=0.000);愈合时间则各组间没有统计学差异(P=0.294),但以软骨复合片组愈合时间最长。【结论】耳内切口下用乳突骨膜用于鼓室成形术有一定的优点,如手术时间短,省略了耳后附加切口。不同材料在听力学预后等方面没有明显的差异,可以做为鼓膜成形术的一种选择。[Objectives] To summarize the surgical experience of myringoplasty with mastoid periosteum and through endaural incision,and compare the corresponding items between periosteum and other three common used autograft tissues in the process of myringoplasty.[Methods] A total of 184 ears were operated through endaural incision,168 of them were through simple endaural incision,and 16 of them were through the endaural combined with post-auricular incision（all the 16 ears were repaired with temporalis fascia）.The used grafted tissue were consisted of mastoid periosteum（99 ears）,cartilage perichondrium（21 ears）,tragal cartilage-perichondrium（48 ears）,and temporalis fascia（16 ears）.The compared items were the closure rates of tympanic membrane（TM） perforation,quality of the new building TM,recurrent perforating rates,auditory outcomes（staged as good,successful,effective,invalid and only the ears with simple myringoplasty were compared）,the consumed time on operation,the percentage of local anesthesia.[Results] The closure rates of four tissue-groups were 92.9%,85.7%,87.5%,and 97.9%,respectively.The auditory outcomes were compared statistically only between the subjects to whom myringoplasty were operated（48,15,22,and 12 patients,respectively）,the distributing frequency between the four tissue-groups according to the auditory stage is not different significantly in statistics（P = 0.777）;But the consumed time is shorter significantly in periosteum group than the other three（P = 0.000）;the healing time was not different significantly between the four tissue-groups（P = 0.294）,but it is longest in the cartilage-perichondrium composite group.[Conclusion] Myringoplasty through endaural incision owns some advantages such as shorter operative time and less surgical trauma than postauricular one;and the periosteum used for graft has the similar closure rate and healing outcomes with other common used autografts,and the stages of audiology outcome which was evaluated by short-term follow up

关 键 词：鼓膜成形术 鼓室成形术 骨膜 中耳炎 手术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]