耳屏软骨环-软骨膜在开放式鼓室成形术中的应用

Application of the tragus cartilage ring with perichondrium in open-ended tympanoplasty

目的:探讨用耳屏软骨环 软骨膜在开放式鼓室成形术中的应用及其治疗的远期效果。方法:用耳 屏软骨环 软骨膜对38例慢性化脓性中耳炎患者行开放式鼓室成形术,并于术后2周,1、3、6个月,1、3年进行追 踪观察。结果:术后2周时,Ⅰ期愈合34例,鼓膜前下方出现裂隙2例,中耳感染2例,再次手术治愈,追踪观察 3年成功率100%;3～6个月时所有移植的新鼓膜形态完整,6个月～3年有2例鼓膜出现萎缩斑。听力情况:术 前平均气导为(45.66±8.40)dBHL,骨气导差距为(26.05±8.15)dBHL;术后1个月分别为(31.58±7.45)dB HL和(19.61±6.41)dBHL;3个月分别为(26.18±7.02)dBHL和(12.63±7.59)dBHL;6个月为(23.55± 7.70)dBHL和(10.79±5.52)dBHL。术后听力1个月较术前显著提高,术后3个月较术后1个月显著提高(均 P<0.01);但术后6个月,1、3年与术后3个月比差异无统计学意义(均P>0.05)。结论:采用耳屏软骨环 软骨 膜行鼓室成形术,取材方便,手术操作便利;修复移植的新鼓膜形态接近正常,保持了听力的稳定、持久,是理想的 移植材料,对提高鼓室成形术的质量及成功率具有重要意义。

Objective:To investigate the effect of the applicaton of tragus cartilage ring with perichondrium in open-ended tympanoplasty and it's long-term results.Method:The tympanic membrane perforations were treated by the surgery of open-ended tympanoplasty. The tragus cartilage ring with perichondrium autograft in 38 patients with otitis media were adopted in the operation from 1995 to 2000. After operation,the patients were followed up in 2 weeks, 1 month, 3 months,6 months,1 year and 3 years.Result:Of 38 cases,4 faied but the othershealed in one stage. The successful rate was 89.47%.After 2 weeks,among the 4 cases,2 had grafts crannies and 2 cases were infected.But when they accepted the second operation and after a following up of three years,the successful rate was 100%.Grafts were atrophy in 2 cases after 6 months to 3 years.Before the operation the average air conduction hearing was (45.66±8.40)dB HL and the difference between bone and air was less to ( 26.05± 8.15)dB HL.From 1 months to 3 years after the operation,the air conduction and bone conduction ware respectively ( 31.58± 7.45)dB HL and ( 19.61± 6.41)dB HL in 1 month,( 26.18± 7.02)dB HL and ( 12.63± 7.59)dB HL in 3 months,( 23.55± 7.70)dB HL and ( 10.79± 5.52)dB HL in 6 months,and ( 23.42± 6.99)dB HL and ( 11.05± 5.95)dB HL in 1 years,keeping at limits of ( 23.95± 6.69)dB HL and 10.53± 5.43 dB HL in 3 years.There were significant differences between pre-operation and post-operation in 1 month,and 3 months. But there were no significant differences after operation in 6 months,1 year,3 years and 3 months.Couclusion:The tragus cartilage ring with perichondrium is of great importance to increase the guality of tympanoplasty and effective rate owing to its reliable technigue and material collection.