鼓室成形术后新鼓膜的形态变化与影响因素

Postoperative morbidity of graft tympanic membrane in tympanoplasty and the relevant factors

目的:探讨鼓室成形术后新鼓膜在不同阶段的形态变化,以及影响其变化的相关因素与对策。方法:对120耳鼓室成形术病例,分别观察术后1～3个月、4～6个月、6～24个月及2年以上的新鼓膜变化情况,分析影响其变化的相关因素,并进行相关处理。结果:术后2周抽出外耳道纱条后见新鼓膜前下边缘出现裂隙4耳;1～3个月再感染穿孔2耳;4～6个月可疑咽鼓管功能不良24耳,功能未恢复4耳;6个月～2年鼓膜萎缩13耳。术后总继发穿孔10耳(8.33％)。结论:新鼓膜前下边缘裂隙是早期鼓膜穿孔的主要表现;鼓室及咽鼓管鼓口粘膜病变严重是新鼓膜穿孔和影响移植物成活的主要原因。咽鼓管导管吹张是改善鼓室通气、提高听力的方法之一。新鼓膜功能及形态多在3个月后趋于稳定。

Objective: To investigate the morbidity and configuration of graft (temporalis fascia) tympanic membrane as well as their pertinent factors in different stages after tympanoplasty so as to find out the measures to improve the graft morbidity. Method: 120 ears undergone tympanoplasty with medial graft techniques were observed. The postoperative grafts were followed up in 2 weeks, 1-3 months, 4-6 months, 6-24 months and o-ver 2 years respectively. The pertinent factors influencing the grafts growths and its functions were analyzed. Result: There were 4 grafts occurred crannies after 2 weeks, 2 cases occured infection in middle ear and had reperfo-ration after 1-3 months, 24 cases with catheterization were found ineffective after 4 -6 months and 13 grafts were found atrophy after 6 months to 2 years followed up after operation respectively. There were total 10 (8. 33%)ears developed perforation again in 2 years. Conclusion: The cranny in anterioinferior border of the grafts is one of the main risky factor for the reperforation in new tympanic membrane in the early stage. The cases with severe pathosis in mucosa in tympanic cavity should be followed up intimately. Eustachian catheterization was one of the effective methods to the tubal dysfunction. The graft tympanic membrane function and configuration will become stabilized in three months postoperatively.