脂肪压片法修补鼓膜穿孔的临床研究

A clinical study on myringoplasty with pressed fat-patch

目的研究用耳后皮下脂肪组织压片法修补鼓膜穿孔的适应症、方法和疗效。方法对105例新鲜外伤性鼓膜穿孔、31例单纯慢性化脓性中耳炎鼓膜穿孔在显微镜或耳内镜下采用耳后皮下脂肪压片外植法、内植法行手术修补。术后用抗生素7~10天,第10~14天之间取出耳道填塞物。结果术后鼓膜穿孔闭合率在外伤组和中耳炎组分别为97.14%（102/105）和96.8%（30/31）,平均愈合时间分别为14.2天和18.4天。随访0.5~3.5年,无再穿孔者。术后1~3个月纯音测听显示语频（取0.5、1、2、4kHz）两组气导听力平均提高分别为16.3dB和18.2dB,气骨导差缩至20dB以内者分别为83.8%（88/105）和83.9%（26/31）。结论用耳后皮下脂肪组织压片法修补鼓膜穿孔可很好地克服嵌塞法不能修补鼓膜大穿孔、移植物较厚的缺点,扩大了手术适应症,优于脂肪嵌塞法。

Objective To study the indication, techniques and treatment results of myringoplasty with pressed fatpatch for tympanic membrane perforation. Methods Myringoplasty with pressed fat-patch were conducted under microscope or otoendoscope in 105 cases of traumatic tympanic membrane perforation and 31 cases of simple chronic suppurative otitis media. Antibiotics were used for 7 days and ear canal dressing removed between 10th-14th day after operation. Results The perforation closure rate was 97.1% （102 / 105） in cases with traumatic perforation and 96.8% （30 / 31） in otitis media cases, and the healing took an average of 14.2 and 18.4 days respectively. No recurrence occurred during the 0.5 ~ 3.5 years follow up period. At 1 ~ 3 months postoperative, mean pure tone audiometric threshold over 0.5, 1, 2 and 4 kHz improved by 16.3 dB and 18.2 dB, and air-bone gap ABG was closed to within 20 dB in 83.8% （88 / 105） and 83.9% （26 / 31） in traumatic perforation and otitis media cases, respetively. Conclusion Inside or outside pressed fat-patch graft is superior to fat plug graft in repairing large perforations, extending the utility of fat graft in myringotoplasty.