创伤性鼓膜穿孔缘鼓膜瓣的预后及转归  

Prognosis of Eardrum Flap in Traumatic Tympanic Membrane Perforation by Difference Treatment

作　　者：楼正才[1] 

机构地区：[1]浙江省义乌市中心医院,322000

出　　处：《医学研究杂志》2012年第1期75-79,共5页Journal of Medical Research

基　　金：浙江省科技基金资助项目(2009C33097)

摘　　要：目的回顾性研究外伤性鼓膜穿孔缘鼓膜瓣在穿孔愈合中的预后及转归。方法 329耳穿孔缘有鼓膜瓣的外伤性鼓膜穿孔分成3组,分别给予保守治疗、明胶海绵贴片及耳内镜鼓膜瓣修复+明胶海绵贴片治疗。评估治疗3个月后穿孔闭合率及闭合时间、治疗前后气骨导间距变化、鼓膜瓣形态学变化。结果 3个月后穿孔的成功闭合率分别是:保守治疗组94.29%(66/70)、明胶海绵贴片组98.92%(92/93)、鼓膜瓣修复组98.24%(112/114),3组没有显著统计学差异(P=0.608)。穿孔闭合耳3组听力平均提高分别是6.4±0.83dB、7.2±1.65dB和9.6±2.37dB,差异没有统计学显著性(P>0.05)。鼓膜瓣修复组及明胶海绵贴片组与保守治疗组相比,穿孔平均闭合时间有显著差异(P<0.05),但鼓膜瓣修复组及明胶海绵贴片组的穿孔平均闭合时间无显著差异(P>0.05)。保守治疗组穿孔缘鼓膜瓣在1周内坏死形成痂皮;明胶海绵贴片组治疗2～3天后鼓膜瓣缘新生鼓膜增生,鼓膜瓣轮廓不明显;鼓膜瓣修复组1周后鼓膜瓣回缩于穿孔缘。结论鼓膜外伤性穿孔的不同治疗其穿孔缘的鼓膜瓣对穿孔闭合无明显影响,贴片治疗时鼓膜瓣修复没有必要。To study the prognosis of eardrum flap in traumatic tympanic membrane （TM） pedbration retrospectivly. Methods Totally 329 patients of TM perforation were divided into three groups：conservative treatment,gelfoam patching,and and Edge - approximation plus Gelfoam Patching. Healing of perforation, hearing improvement, and complications were investigated after 3 months. Results Closure rates of the perforations in the Spontaneous Healing, Gelfoam Patching, and Edge - approximation plus Gelfoam Patc- hing were 94.29% ,98.92% , and 98.24% , respectively. The difference among them was not significant. Hearing improvement of threegroups were （6.4 ± 0.83 ） dB, （7.2 ± l. 65） dB and （9.6 ± 2.37） dB, respectively. The difference among them was not significant （ P 〉 0. 05）. Gelfoam Patching and Edge - approximation plus Gelfoam Patching significantly shortened the healing in Traumatic TM large Per- foration. However, the difference among them was not significant in the closure time. Conclusion The flap of the edge of TM perforation did not affect perforation closure. We should not repaire the flap of eardrm in patching treatment.

关 键 词：鼓膜穿孔皮瓣治疗 

分 类 号：R764.29[医药卫生—耳鼻咽喉科]