夹层法鼓膜成形术远期疗效的相关因素探讨

Long-term results and an analysis of surgically related factors in myringoplasty with sandwich method

目的探讨夹层法鼓膜成形术远期疗效的相关影响因素。方法回顾性研究1999年1月至2003年12月北京同仁医院住院行颞肌笳膜夹层法修补鼓膜穿孔的205例（223耳）患者的临床资料，年龄12～65岁，平均34．3岁；病程1个月～25年，平均16．1个月。观察指标包括年龄、性别、病因、病程、干耳时间、手术径路、穿孔部位、穿孔大小、鼓室状况、鼓膜是否有硬化斑。术后随访2年以上用SPSS12．0软件包进行数据管理、统计方法为Logstic回归。结果随访2～5年鼓膜愈合212耳，远期鼓膜愈合率为95．1％。其中，鼓膜色泽与形态正常、无其他并发症者186耳，远期手术成功率为83．4％。经多因素Logistic回归分析，依据OR值显示可能影响手术成功的相关因素依次为：穿孔大小（OR=1．900）、病程（OR=1．003）、干耳时间（OR=0．908）。对术前纯音测听检查为传导性聋175耳分析显示：术后气骨导差（听力级）的平均值较术前降低7．0dB。结论鼓膜穿孔越小、病程越短、在一定时间范围内干耳越久，远期发生并发症的可能性越小，对手术成功越有利。鼓膜内陷钙化常为晚期并发症，也是造成修补失败的重要原因之一。

Objective To evaluate the effect of the prognostic factors on long-term surgical outcome in myringoplasty. Methods Retrospective cohort 205 patients （223 ears） with sandwich temporal fascia myringoplasty were analyzed using the multiple logistic regression analysis. The charts of inpatients had undergone myringoplasty before at least 2 years between January 1999 and November 2003 at Beijing Tongren Hospital. Postoperative follow-up rate was 78.2%. Their ages ranged from 12 to 65 years （ mean = 34. 3 years）. Their durations of disease ranged from 1 month to 25 years （mean = 16.07 months）. The effect of prognostic factors on myringoplasty were investigated by variables noted from patients＇ files such as age,sex, causes of disease, duration of disease, period of dry ear of disease, operation types, places of tympanic membrane perforation, size of tympanic membrane perforation, status of middle ear and status of eardrum. Results There were 11 ears with reperforation of eardrum at the last follow-up. Successful closure of the tympanic membrane perforation was obtained in 95. 1% of the ears （212 ears）with 2 to 5 years follow-up. There were 26 ears with other complications at the last follow-up. Operations were successful in 186 patients. The overall take rate of the myringoplasty was 83.4%. Multiple logistic regression analysis （ward） was subsequently carried out on these prognostic factors on overall take rate of the myringoplasty and yielded the following classification. Relative importance of the predictive variables was as follows： size of tympanic membrane perforation （ OR = 1. 900）, duration of disease （OR=1.003 ） and period of dry ear of disease （ OR = 0. 908）. Hearing outcomes： the average air-bone gap improvement was 7. 0 dB and the average air conduction improvement was 6. 8 dB for all 175 myringoplasty procedures. Conclusions A long term follow-up was important. Late atelectatic pocket was a late complication and a cause of failure. A relatively smaller tympanic membrane perforation, a relatively shorter duration of disease and a relatively longer period of dry ear of disease were found to be significant prognostic factors positively influencing the success rate of myringoplasty.