耳内镜下鼓室成形术后鼓膜中小穿孔再修补42例临床分析

Repairment using ear endoscope for small perforation of tympanic membrane after traditional tympanoplasty

目的：探讨在耳内镜下鼓室成形术后鼓膜穿孔再修补的临床疗效。方法回顾性分析42例鼓室成形术后鼓膜中小穿孔行耳内镜下再修补术患者的临床资料，小穿孔选用耳垂脂肪压片作为修复物，中等穿孔选用耳屏软骨膜，观察鼓膜穿孔的愈合及听力改善情况。结果小穿孔1次修补成功占82．76％（24／29），中等穿孔1次修补成功占61．54％（8／13）；9例经2次以上修补成功。修补成功6个月后检测听力（语言频率），气导均值提高20．03 dB（t ＝1．98，P ＜0．05），气骨导差均值缩小19．82 dB（t ＝1．86，P ＜0．05），差异均有统计学意义。结论耳内镜下鼓室成形术后鼓膜中小穿孔再修补，成功率较高，愈合后听力改善明显，手术简单，患者依从性高。

Objective To investigate the clinical efficacy of repairment using ear endoscope for small perfo-ration of the tympanic membrane after traditional tympanoplasty.Methods A retrospective analysis of 42 cases of repairment using ear endoscope for small perforation of the tympanic membrane after traditional tympanoplasty was investigated.Adipose tablet of earlobe to repair small perforation or perichondrium of hircus for medium perforation was used.Results The success rate after one repairment of small perforation was 82.76%（24 /29）.The success rate for medium perforation was 61.54%（8 /13）.9 cases received the repairment for 2 times or even more to heal the tym-panic membrane.The mean improvement of air conduct at language frequency was 20.03dB by 6 months after the successful operations （t =1.98,P 〈0.05）and air bone guide.The mean difference between the air conduct and bone conduct decreased as much as 19.82dB （t =1.86,P 〈0.05）with statistical significance.Conclusion The success rate was high to repair the perforation using ear endoscope after traditional tympanoplasty.The hearing was improved obviously and the patients were very compliant.