改良耳内切口下不附加切口的鼓室成形术

The tympanoplasty under modified endaural incision without accessory incision

目的 介绍在耳内切口下不附加其它切口取乳突骨膜或软骨的方法;并将骨膜、软骨膜、软骨-软骨膜复合片、颞肌筋膜修复鼓膜的手术情况和效果进行对比。方法通过耳内切口不附加切口取乳突骨膜、软骨,或通过耳后附加切口取颞肌筋膜,利用这些自体材料用于鼓室成形术。并将两种方法的相关因素进行对比。对比项目包括:手术耗时、各种材料的成功率、近期听力学效果、局麻手术率、患者对两种切口的满意率。结果不附加切口的手术方式所取用的自体组织材料可以达到和颞肌筋膜同样的听力效果、手术成功率(P=0.777和0.977);但由于不附加耳后切口,手术时间显著缩短(54.9±11.6对80.42±11.8 min,P=0.000),局麻手术率高(P=0.000),患者对手术切口的满意度高(P=0.000)。结论耳内切口可以方便地直接取乳突骨膜或是软骨用于鼓室成形术。这样可以快速、高效地完成手术,并达到更好的美容效果,节约医疗成本。

Objective To introduce the tympanoplasty with mastoid periosteum or perichondrium/ perichondrium-cartilage composite harvested under single endaural incision without additional postauricular or tragal cut,and compare some operation-associated items under incision with and without additional incision;meanwhile compare the outcomes of every tissue grafts.Methods To perform the tympanoplasty with periosteum,perichondrium／perichondrium-cartilage composite harvested by single endaural incision or with temporalis fascia harvested by endaural with additional postauricular incision and follow up to the patients.Some items,including consumed time by operation,auditory outcome,closure rate,the rate by local anesthesia,and the satisfactory rate from patients for the incision were investigated.Results The consumed time was shorter significantly in operation by single endaural incision than that of endaural with additional postauricular incision（54.9±11.6 vs 80.42±11.8 minutes,P=0.000）,as well as the satisfactory rate of patients（P=0.000） to the incision and the rate of local anesthesia（P=0.000）.The closure rate,the auditory outcomes were not different significantly among every tissue graft group（P=0.777 and 0.977 respectively）.Conclusions It is available to harvest periosteum or tragal cartilage imposed in tympanoplasty by only one endaural incision without any other additional cut.The graft tissue from single endaural incision can achieve same effects with temporalis fascia harvested from postauricular incision.