The technique and application of individualized tympanic membrane flap in the repair of tympanic membrane under endoscopy ear surgery
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摘要: 目的 探讨耳内镜下个性化皮瓣制作的技巧及其临床应用。 方法 回顾性分析中国人民解放军总医院耳鼻咽喉头颈外科医学部耳内镜外科2022年10月—2023年8月行全耳内镜下鼓膜修补术患者的临床资料，所有入组患者均由同一名熟练耳内镜外科手术医生独立完成。收集患者的一般情况、病史以及鼓膜穿孔范围、穿孔大小、是否需要鼓室探查、皮瓣厚度、鼓室病变范围、皮瓣制作方式、术后康复情况等。 结果 个性化耳道鼓膜皮瓣的制作需要考虑鼓膜穿孔位置、皮瓣厚度、耳道弯曲度或狭窄程度以及鼓室内病变范围等多种因素，皮瓣制作方式并不影响术后远期康复效果，但能有效避免不必要的耳道皮瓣损伤，提高手术效率。 结论 科学的皮瓣制作对提高手术效率、增强手术信心具有重要意义。Abstract: Objective To investigate the technique of personalized flap making under otoscopy and its clinical application. Methods The clinical data of patients who underwent 301 Military Hospital myringoplasty in the Department of otoendoscopic surgery, Department of Otorhinolaryngology, head and neck surgery, Department of Otorhinolaryngology, from October 2022 to 2023 August were analyzed retrospectively, all enrolled patients were performed independently by the same skilled otoendoscopic surgeon. The patients' general condition, medical history, tympanic membrane perforation scope, perforation size, need for tympanic cavity exploration, thickness of skin flap, tympanic cavity lesion scope, skin flap making method and postoperative rehabilitation were collected. Results Many factors such as the location of tympanic membrane perforation, the thickness of the skin flap, the degree of curvature or stricture of the ear canal and the extent of the lesion in the tympanic cavity should be considered in the manufacture of the individualized tympanic membrane skin flap, the way of skin flap making does not affect the long-term postoperative rehabilitation, but it can effectively avoid unnecessary ear canal skin flap injury and improve the operation efficiency. Conclusion Scientific flap fabrication is important for improving surgical efficiency and enhancing surgical confidence.
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Key words:
- otoendoscope /
- tympanoplasty /
- ear meatus tympanic flap
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表 1 多种影响因素下的皮瓣选择
皮瓣类型 穿孔大小 鼓室探查 耳道情况 Butterfly法 小穿孔 否 尚可 Butterfly法和/或A型皮瓣 小穿孔 是 尚可 A型皮瓣 后方中等及以下穿孔 否 尚可 B型皮瓣 后方中等及以下穿孔 是 尚可 C型皮瓣 下方中等及以下穿孔 否 尚可 B型皮瓣 下方中等及以下穿孔/大穿孔 是 尚可 D型皮瓣 下方中等及以下穿孔/大穿孔 是 窄/弯 
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