鼓室成形术332耳分析

A Review of 332 Tympanopasties

对１９８５～１９９５年间所作的３３２耳（２８６例）鼓室成形术进行了总结，分析了病变类型、手术方法、修复组织的选择和治疗效果，认为外耳道带蒂皮瓣加自体颞筋膜法修补完全性大穿孔，既解决了移植膜固定的困难，又保证了能尽快地建立了血液循环，且无钝角愈合，成功率高。听骨链鼓室成形的手术方法主要取决于听骨链受损程度和手术者的习惯，其效果与患者术前的咽鼓管功能、鼓室内病变程度、听骨链动度、两窗的功能及术前听力损失程度和性质有显著关系。强调听力的提高与移植组织的种类无明显关系，自体移植材料在目前为最好的，可作为首选。

tympanoplasties(in 286 patients)performed in this department in the past ten years were reviewed,of which 298 were simple and 34 were mixed tympanoplasty.Hearing was improved in 263 ears(88.26%),of which 106 regained normal hearing.Graft materials,procedure were analyzed.Meatal skin flap rotation and autologous temporalis fascia was shown to be most effective in repair of total perforation of the tympanic membrane,with easier fixation,better blood supply to the graft,less chance of blunt TM angle and higher success rate.Choices of graft for ossicular reconstruction depended more upon the pathology of the ossicles and the operator's custom.Postoperative hearing was not necessarily related to the type of graft,but seemed to associate with the middle ear pathology,eustachian tube function,ossicle mobility,involvement of the two windows and the nature of preoperative hearing impairment.