空鼓室技术在鼓膜修补手术中的临床应用

高滢; 许珉; 张青

doi:10.13201/j.issn.1001-1781.2019.02.017

空鼓室技术在鼓膜修补手术中的临床应用

- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安, 710004)
基金项目:
陕西省重点研发计划项目 (No:2017SF-182)

西安市科技计划项目[No:2017119SF/YX013 ③ ]

详细信息

通讯作者: 张青,E-mail:zhqent@163.com

中图分类号: R764

收稿日期: 2018-07-26

Technique of "empty tympanometry" in myringoplasty surgery

- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China

More Information

Corresponding author: ZHANG Qing, E-mail: zhqent@163.com

Received Date: 26 July 2018

摘要

摘要: 目的:将传统的夹层法鼓膜修补技术进行改良,在鼓膜修补时将中鼓室旷置不进行任何填塞与支撑称为“空鼓室技术”。探讨“空鼓室技术”在鼓膜成形手术中的临床应用价值。方法:回顾性分析2012-03-2015-12期间因慢性化脓性中耳炎由同一术者采用“空鼓室技术”夹层法修补鼓膜共56例(59耳)患者的临床资料。在传统夹层法修补鼓膜时中鼓室不填充明胶海绵及其他支撑材料,利用残余鼓膜纤维层做支撑,将颞肌筋膜夹在纤维层与上皮层之间。统计学分析术后6个月患耳鼓膜穿孔愈合率和听力恢复程度。结果:所有患者鼓膜穿孔愈合良好且无再穿孔发生,愈合率为100%。所有患者术后随访时间为15~60个月。术后56耳(95%)听力提高,3耳(5%)听力无明显变化,无患者自觉听力下降,无耳闷塞感,无再穿孔。术后气导平均听阈(34.4±16.8) dB HL较术前(43.6±14.0) dB HL提高(P<0.01),骨气导差(15.7±10.9) dB HL较术前(23.0±7.7) dB HL也有明显提高(P<0.01)。结论:“空鼓室技术”夹层法鼓膜修补愈合率高,无再穿孔发生,无术后耳闷感,听力提高效果显著,值得推广应用。
- 鼓膜修补 /
- 治疗 /
- 夹层法
Abstract: Objective:To improve the traditional mesenteric tympanic membrane repair technique.The tympanic membrane is placed in the tympanic membrane without any tamponade and support.To explore the clinical application value of "empty tympanometry" in tympanoplasty.Method:A retrospective analysis of clinical data from 56 patients (59ears) with tympanic membrane repaired by the same surgeon from March 2003to 2015-12was performed, all patients underwent the same procedure using the "empty tympanometry" sandwich method.In the traditional sandwich method to repair the tympanic membrane, the tympanic cavity is not filled with gelatin sponge and other supporting materials, and the residual tympanic membrane layer is used as a support to sandwich the temporalis fascia between the fibrous layer and the epithelial layer.Statistical analysis of the healing rate of ear tympanic membrane perforation and the degree of hearing recovery at 6months after surgery.Result:The hearing of 56ears (95%) improved postoperative, no obvious difference in 3ears (5%).All the patient did not feel hearing loss and ear fullness, so does reperforation.All of the perf healing well (100%) and showed no recurrence of perforation.Postoperative airway mean hearing threshold (34.4±16.8) dB HL was lower than preoperative (43.6±14.0) dB HL (P<0.01).Air-Bone Gap (ABG) of post-operation (15.7±10.9) dB HL was lower than pre-operation (23.0±7.7) dB HL (P<0.01).Conclusion:The "empty ME cavity technique" has a high healing rate and no incidence of the second perforation, also improved hearing commendably.The technical could be popularized and applied widely.
- myringoplasty /
- therapy /
- sandwich-graft method

HTML全文

参考文献(8)

[1]	SINKKONEN ST, JERO J, AARNISALO AA.Tympanic membrane perforation[J].Duodecim, 2014, 130:810-818.
[2]	龚树生, 熊伟.慢性中耳炎的规范化诊治[J].临床耳鼻咽喉头颈外科杂志, 2017, 31 (16):1221-1224.
[3]	马芙蓉, 柯嘉.慢性化脓性中耳炎的分型与诊断治疗进展[J].临床耳鼻咽喉头颈外科杂志, 2017, 31 (16):1225-1227.
[4]	韩宇, 陈俊, 岳波, 等.54例分期鼓室成形术的随访分析[J].临床耳鼻咽喉头颈外科杂志, 2017, 31 (16):1251-1253.
[5]	PATIL B C, MISALE P R, MANE R S, et al.Outcome of Interlay Grafting in Type 1 Tympanoplasty for Large Central Perforation[J].Indian J Otolaryngology Head Neck Surg, 2014, 66:418-424.
[6]	王正敏.耳显微外科学[M].上海:上海科技教育出版社, 2004:121-124.
[7]	中耳炎临床分类和手术分型指南[J].中华耳鼻咽喉头颈外科杂志, 2013, 48 (1):5-5.
[8]	JANG C H, PARK H, CHO Y B, et al.The effect of anti-adhesive packing agents in the middle ear of guinea pig[J].Int J Pediatr Otorhinolaryngol, 2008, 72:1603-1608.