不同鼓膜成形术治疗慢性化脓性中耳炎静止期的临床分析  

Clinical analysis on treatment of chronic suppurative otitis media with myringoplasty of different methods

作　　者：董钏[1] 李树华[1] 罗刚[1] 袁婧[1] 

机构地区：[1]绵阳市中心医院耳鼻咽喉科,四川绵阳621000

出　　处：《中国耳鼻咽喉颅底外科杂志》2016年第5期393-396,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的 探讨慢性化脓性中耳炎静止期患者采用不同鼓膜成形术的疗效分析，为手术术式选择提供参考。方法收集2010年1月～2013年12月完成鼓膜成形术，术后随访3个月且资料完整的212例患者，其中小穿孔（〈3mm）29例，中穿孔（3～6mm）53例，大穿孔（〉6ram）79例，完全穿孔51例。按照患者鼓膜穿孔大小选择不同鼓膜修补手术方法，其中脂肪修补10例，内植法（经耳道）13例，全翻内植法47例，内外植法48例，夹层法80例，外植法14例。术后3个月判断其临床疗效。结果一期愈合95．7％（203例），钝角愈合1．9％（4例），未愈合2．4％（5例）；术后对鼓膜穿孔大、小、完全穿孔患者采取不同鼓膜修补方式进行比较，患者手术前后鼓膜愈合和气导PTA提高比较，差异无统计学无意义（P〉0．05）；鼓膜中穿孔患者采取的3种修补手术方法中，鼓膜愈合数比较差异无统计学意义（P〉0．05），而对于采用夹层法和内外植法的气导PTA提高比较差异具有统计学意义（P〈0．05）。结论术者应掌握多种不同鼓膜成形术方法，根据鼓膜穿孔的大小、位置和外耳道的宽窄、曲直，灵活选用，最大程度的恢复鼓膜的完整性和功能。Objective To investigate the therapeutic effect of chronic suppurative otitis media on stationary phase with myringoplasty of different methods so as to provide reference for selection of proper surgical procedures. Methods 212 patients suffering from tympanic membrane perforation repaired with myringoplasty were included. They were all followed up 3 months postoperatively. As for the size of perforations, 29 were small （ 〈3 ram）, 53 were moderate （3 mm -6 mm）, 79 were large （ 〉6 mm）, and 51 were complete （without any remaining membrane）. A variety of surgical methods were adopted according to the size of perforations, including repair with fatty tissues in 10 cases, underlay technique （ via ear canal） in 13, whole-overturn underlay technique in 31, combined underlay and overlay technique in 35, interlay method in 80, overlay technique in 14. Their therapeutic effect was evaluated 3 months after surgery by perforation healing rate and increase of pure-tone averages （PTA）. Results Primary healing got achieved in 203 cases with a healing rate of 95.7%. The differences of above-mentioned indexes among different surgical methods for small, large and complete perforations were all statistically insignificant （all P 〉 0.05）. As for moderate perforations, the differences of perforation healing rate among three surgical methods were statistically insignificant （ all P 〉 0.05）, but the difference of increase of PTA between combined underlay and overlay technique and interlay method was statistically significant （ P 〈 0. 05 ）. Conclusion Surgeons should master different methods of myringoplasty. In order to achieve the best recovery of function and restoration of tympanic membrane integrity, proper surgical method should be adopted according to the size and location of the tympanic membrane perforation, width and merit of external auditory canal.

关 键 词：鼓膜成形术 鼓膜穿孔 全翻内植法 外植法 疗效 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]