摘要
目的探讨鼓膜边缘缺失的鼓膜成型方法和注意点。方法 39例(48耳,19例男性),均年龄50.92岁(范围26-83岁),病程均12.5年(范围10-20年)。鼓环部分或大部分缺失。术前平均气骨导差(ABG)30.16±8.76d B(范围13-55d B),气导(AC)43.64±11.03d BHL(范围22-72d BHL),骨导(BC)13.68±9.47d BHL(范围1-39d BHL)。2006-2013年间手术。一些如保护残余鼓膜前下方关键点被覆上皮和移植的骨膜顶嵌入等确保愈合方法。以及减少电钻噪声刺激、减少听骨位移等预防感音功能受损技术方法。结果 48耳随访12月以上。穿孔全部愈合。无面瘫、眩晕、耳鸣等并发症。术后AC27.56±12.19d BHL,GAP12.39±8.54d B与术前相比,U值分别为6.77和10.06,都>u0.01=2.57,p<0.01,差异都有极显著性意义。术后BC13.9±9.95d BHL,与术前相比,U值=0.11<u0.05=1.96,p>0.05,差异没有显著性意义。术后GAP缩小到10d B以内23耳(48%),11-20d B者16耳内(33%)。AC除5耳(10%)外都在40d B以内。结论如果操作技术得当。
Objective To report results of myringoplasty for tympanic membranes with marginal perforations. Methods Thirty nine cases （48 ears） treated between 2006 and 2013 were reviewed, including 19 males （mean age=50.92 years, rang？ing from 26 to 83 years） with a mean disease course of otitis media of 12.5 years. All patients presented with tympanic mem？brane perforation affecting part or the entire rim. Mean pre-operation air-bone gap （ABG） was 30.16 ± 8.76 （13-55） dB, with mean air conduction （AC） threshold at 43.64±11.03（22-72）dB HL and mean bone conduction （BC） threshold at 13.68±9.47 （1-39）dB HL. Key surgical techniques included preservation of skin flap anterior and inferior to the tympanic membrane and application of periosteum graft medial to the tympanic membrane. Disturbance to the ossicles and use of drilling were mini？mized to prevent sensorineural hearing damage. Results All 39 cases were followed up for over 12 months and showed healed perforations. There was no postoperative facial palsy, vertigo or tinnitus. Post-operation AC was 27.56 ± 12.19 dB HL with a GAP of 12.39 ± 8.54 dB, significantly improved compared with pre-operative （U= 6.77 and 10.06, respectively, 〉u 0.01, p0.05）. At follow up, ABG was 10 dB or less in 23 ears（48%）, and between 11 and 20 dB in 16 ears（33%）;and AC was at 40 dB HL or less in all but 5 ears （10%）. Conclusion With appropriate techniques, repair can be completed successfully with satisfactory results for tympanic membrane perforation with completely or partially missing rim.
出处
《中华耳科学杂志》
CSCD
北大核心
2014年第4期590-592,共3页
Chinese Journal of Otology
关键词
鼓膜穿孔
中耳炎
鼓室成形术
Drum perforation Ootitis media Tympanoplasty
