筋膜外植法鼓室成形术的手术体会

Experience in overlay tympanoplasty

目的探讨筋膜外植法在鼓室成形术中的应用及价值。方法回顾分析筋膜外植法鼓室成形术63耳，随访观察患者的外耳道宽敞度、鼓膜形态及听力恢复情况。结果本组病例包括中耳胆脂瘤25耳，慢性化脓性中耳炎38耳。手术方式分别为筋膜外植法鼓室成形术、筋膜外植法鼓室成形术＋完壁式乳突根治术和筋膜外植法鼓室成形术＋开放式乳突根治术三种类型，中耳胆脂瘤和慢性化脓性中耳炎患者实施三种手术的数量分别为4、17、4耳和19、18、1耳。术后切口全部Ⅰ期愈合。随访0．5～3．5年，外耳道宽敞，鼓膜形态良好，听力提高或维持术前水平，未有听力下降者。按时随访者未发现有明显并发症。结论筋膜外植法鼓室成形术具有操作流程规范、术野暴露充分、病变清除彻底等优点，在慢性中耳炎的外科治疗中具有积极意义。

Objective To explore the experience and value of overlay tympanoplasty. Methods Sixty-three ears with overlay tympanoplasty were reviewed and followed up for the external auditory canal, tympanic membrane and hearing. Results The diseases of the patients included middle ear cholesteatoma in 25 ears and chronic suppurative otitis media in 38 ears. The surgical techniques involved three kinds： overlay tympanoplasty, overlay tympanop]asty with canal wall up mastoidectomy and overlay tympanoplasty with canal wall down mastoidectomy. In middle ear eholesteatoma and suppurative otitis media patients, the case received the three techniques are 4, 17, 4 ears and 19, 18, 1 ears respectively. All patients gained stage Ⅰ incision cure. Followed up for 0.5 to 3.5 years respectively, the external auditory canal was wide and tympanic membrane gained a good shape. The hearing in all case kept intact or increased while heating decrease did not occur. Complications were free in patients with punctual visit. Conclusions Overlay tympanoplasty has positive significance in treating the chronic otitis media with the merits of standard procedure, sufficient operative field and thorough erosion elimination.