外耳道袖套皮瓣+舌状筋膜瓣技术在鼓膜重建中的应用  

Sleeve and Tongue Fascia Grafts in Repair of Large Tympanic Membrane Perforations

作　　者：万苡辰 孙建军 WAN Yichen;SUN Jianjun(Department of Otorhinolaryngology Head and Neck Surgery,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院耳鼻咽喉头颈外科,北京102206

出　　处：《中华耳科学杂志》2025年第1期84-88,共5页Chinese Journal of Otology

摘　　要：目的研究外耳道袖套皮瓣-舌状筋膜瓣技术修复鼓膜大穿孔的应用价值。方法回顾性选取2020年6月至2024年6月在北京大学国际医院施行的袖套-舌形瓣鼓室成形手术患者73例,穿孔面积占鼓膜截面积50%~75%的大穿孔66例,穿孔面积大于鼓膜截面积75%的特大穿孔7例,观察患者的鼓膜愈合情况与手术前-后听力学指标。结果应用该技术重建鼓膜的愈合率达94.52%(69/73例),术后纯音测听(pure tone audiometry,PTA)较前提高,PTA提升中位数8.75(1.25,16.25)dB;术后气骨导差(air-bone gap,ABG)较术前缩小,ABG缩小中位数7.5(0.63,13.75)dB。鼓膜大穿孔和特大穿孔的愈合率无显著性差异(P=0.338)。结论外耳道袖套皮瓣-舌形筋膜瓣技术兼顾了局部血运、耳道成形、鼓膜形态以及与耳道的解剖关系,显现出良好的鼓膜愈合率和听力学改善,为临床复杂鼓膜的重建提供了一种新选择。Objective To report use of sleeve and tongue fascia grafts in the repair of large tympanic membrane perforations.Methods Conducted data from patients who underwent tympanoplasty during June 2020 to June 2024 at the Department of Otolaryngology,Peking University International Hospital,were retrospectively reviewed,including 66 with large perforations(50%~75%across the tympanic membrane)and 7 with extremely large perforations(>75%of the tympanic membrane).Eardrum healing and audiology indexes before and after the repair were observed.Results Graft uptake was seen in 69 of the 73 cases(94.52%).Median pure tone audiometry(PTA)improvement was 8.75 dB(1.25,16.25),with reduced postoperative air-bone gap(ABG)(median=7.5 dB(0.63,13.75)).Healing rate was not significantly different between large and extremely large perforations(P=0.338).Conclusion Sleeve and tongue fascia grafts are a reliable alternative that an otologist can resort to when dealing with large tympanic membrane perforations,with satisfying healing rate and acoustic improvement.

关 键 词：慢性化脓性中耳炎 鼓膜穿孔 鼓室成形术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]