不同修补技术在较大鼓膜穿孔患者中的治疗效果及对听阈、鼓膜愈合的影响  

Therapeutic Effects of Different Repair Techniques on Patients with Large Tympanic Membrane Perforations and Their Impact on Hearing Threshold and Tympanic Membrane Healing

作　　者：郭伟霞 康丽利 陈伟东 刘男[3] 王国光 冀宏斌[3] 张艳艳[3] GUO Weixia;KANG Lili;CHEN Weidong;LIU Nan;WANG Guoguang;JI Hongbin;ZHANG Yanyan(Department of Otolaryngology,Head and Neck Surgery,the First Hospital of Handan City,Handan,Hebei 056002,China;Department of Ophthalmology,the First Hospital of Handan City,Handan,Hebei 056002,China;Department of Otorhinolaryngology,the First Hospital of Handan City,Handan,Hebei 056002,China;Department of Otorhinolaryngology,the 981th Hospital of Joint Logistics Force of the PLA,Chengde,Hebei 067000,China)

机构地区：[1]邯郸市第一医院耳鼻咽喉头颈外科,河北邯郸056002 [2]邯郸市第一医院眼科,河北邯郸056002 [3]邯郸市第一医院耳鼻喉科,河北邯郸056002 [4]解放军联勤保障部队第九八一医院耳鼻喉科,河北承德067000

出　　处：《临床误诊误治》2024年第10期81-86,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫生健康委员会课题(20231918)。

摘　　要：目的探讨不同修补技术在较大鼓膜穿孔(TMP)患者中的治疗效果及对听阈、鼓膜愈合的影响。方法选取2022年1月至2023年2月120例较大TMP,按照随机数字表法分为3组,各40例。A组采取筛状软骨-软骨膜技术修补,B组采取软骨膜-软骨岛修补,C组采取栅栏软骨-软骨膜技术修补,术后均使用碱性成纤维细胞生长因子凝胶治疗。比较3组鼓膜愈合情况、围术期指标、手术前后听力情况[500、1000、2000、4000 Hz纯音听阈(PTA)、气-骨导差(ABG)平均值]、耳闷及并发症发生情况。结果A组鼓膜愈合率高于B组、C组,术中出血量少于B组、C组,手术时间、耳屏愈合时间、住院时间、术后干耳时间短于B组、C组(P<0.05)。A组术后1、3、6个月PTA、ABG平均值低于B组、C组(P<0.05);A组术后6个月耳闷程度低于B组、C组(P<0.05);A组并发症总发生率较B组、C组降低(P<0.05)。B组与C组上述指标比较差异均无统计学意义(P>0.05)。结论筛状软骨-软骨膜技术治疗较大TMP,能缩短手术时间,减少术中出血量,促进鼓膜愈合,改善耳闷,提高听力,并降低并发症风险。Objective To investigate the therapeutic effects of different repair techniques on patients with large tympanic membrane perforations(TMP)and their impact on hearing threshold and tympanic membrane healing.Methods A total of 120 patients with large TMP from January 2022 to February 2023 were selected and divided into three groups according to a random number table method,with 40 cases in each group.Group A was treated with cribriform cartilage-perichondrium repair,group B with perichondrium-cartilage island repair,and group C with palisade cartilage-perichondrium repair.All three groups were treated with basic fibroblast growth factor gel after surgery.The healing of the tympanic membrane,perioperative indicators,hearing before and after surgery[500,1000,2000,4000 Hz pure tone audiometry(PTA),average air-bone gap(ABG)],ear stuffiness,and complications were compared among the three groups.Results The healing rate of the tympanic membrane in group A was higher than that in group B and group C,and the intraoperative blood loss was less than that in group B and group C.The duration of operation,healing time of the tragus,length of hospitalization,and postoperative dry ear time were shorter than those in group B and group C(P<0.05).The average values of PTA and ABG in group A at 1,3,and 6 months after surgery were lower than those in group B and group C(P<0.05),and the degree of ear stuffiness in group A at 6 months after surgery was lower than that in group B and group C(P<0.05).The total incidence of complications in group A was lower than that in group B and group C(P<0.05).There was no significant difference in the above indicators between group B and group C(P>0.05).Conclusion The cribriform cartilage-perichondrium technique used for larger TMP can shorten the duration of operation,reduce intraoperative bleeding,promote tympanic membrane healing,improve ear stuffiness and hearing,and reduce the risk of complications.

关 键 词：鼓膜穿孔 筛状软骨-软骨膜技术 鼓膜愈合 听力 耳闷 纯音听阈 气-骨导差 并发症 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]