耳内镜下异体真皮基质修补鼓膜大穿孔

Repair of large tympanic membrane perforation with allogenic dermal matrix under otoendoscope

目的探讨耳内镜下用异体真皮基质修补鼓膜大穿孔的可行性及效果。方法回顾性分析45例鼓膜大穿孔患者的临床资料,患者术前分别行耳内镜检查、听力学检查,有中耳感染史者行CT检查。其中术前电测听语言频率平均气骨导间距(ABG)为(31.23±1.52)dB。45例患者均在耳内镜下经外耳道径路翻起外耳道鼓膜皮瓣,用异体真皮基质内植修补鼓膜。结果术后随访6个月至2年,术后3个月时一次性穿孔愈合率91%。术后3个月复查电测听,平均ABG为(13.07±2.00)dB,与术前比较差异具有统计学意义(t=8.09,P<0.00)。结论耳内镜下异体真皮基质内植修补鼓膜大穿孔,具有微创,体表无切口,愈合率高等特点。

Objective To explore the feasibility and effect of repairing large tympanic perforation with allogenic dermal matrix under otoendoscope. Methods Clinical data of 45 patients with large tympanic membrane perforation were analyzed retrospectively. The tympanomeatal flap was elevated through the external auditory canal approach under otoendoscope,and the tympanic membrane was repaired with allogenic dermal matrix by underlay technique. All patients underwent preoperative endoscopic and audiological examinations,those with middle ear infection history received CT examination. Results All the patients were followed up of 6 months to 2 years postoperatively,and the healing rate of tympanic perforation was 91% at 3 months after operation. The mean audiometric air-bone gap（ABG） at language frequencies was（31.23± 1.52） dB before operation,and that at 3 months after operation was（13.07 ± 2.00） dB. The difference was statistically significant（t = 8.09,P〈 0.00）. Conclusion Repair of large tympanic perforation with allogenic dermal matrix under otoendoscope has the characteristics of minimal invasion,no incision on the body surface and high healing rate.