栅状软骨用于鼓室成形术的临床研究

Clinical Study of Railing-like Cartilage Tympanoplasty

目的 对传统的鼓室成形术即Ｗｕｌｌｓｔｅｉｎ术式做进一步改进。方法 采用自体耳廓基底部软骨剪成１～１．５ｍｍ细条状，紧贴听小骨及鼓环成栅栏状排列，外覆以外耳道转移皮瓣及残余鼓膜，治疗慢性化脓性中耳炎鼓膜穿孔４０例（４２耳）。结果 随访半年～８年未见胆脂瘤复发及其它并发症发生，移植鼓膜全部愈合。纯音听力提高叨－４０ｄＢ和／或骨、气导差小于１０ｄＢ共４１耳（９７．６２％），听力无明显提高者１耳（２．３８％）。结论 改进的术式便于手术操作，取材方便，对提高鼓室成形术的质量及成功率具有重要的意义。

Objective To improve the result of traditional tympanoplasty(Wullstein's method). Methods The cartilage was obtained from the basal pelt of the auricle of patient and cut into slender slips about 1 mm to 1.5 mm in length, arrange the cartilage like railings closely next to the auricular-ossicles and the tympanic ring, and then cover the operated part with the basal skin flap and the remained upper skin of the tympanic membrane on the base of the external auditory canal. By using this method, 40 cases(42 ears) were treated for conductive deafness resulted from chronic suppurative otitis media. Results During 6 months to 8 years' observation, no cholesteatoma and other complications were found, and all of the transplanted tympanic membranes healed. 41 ears were found to have hearing improvement on pure tone audiometry, increased above 30-40 dB and to have the difference between bone and air conduction less than 10 dB. The total effective rate reached to 97. 62%. The hearing of 1 ear, amounting to 2.38%, had no distinct effect. Conclusion It tunrs out that the improved operational method is of great importance to increase the quality of tympanoplasty and effective rate, owing to its reliable technique and material collection.