耳内镜下软骨膜-软骨岛在鼓膜修补术中应用的效果分析

Effect of perichondrium-cartilage island in tympanoplasty

目的探讨耳内镜下软骨膜-软骨岛在鼓膜修补术中应用的疗效。方法回顾性分析2017年1月~2018年7月86例行鼓膜修补术的慢性中耳炎静止期患者,按随机数字表法随机分为观察组和对照组。观察组43例,使用软骨膜-软骨岛移植物行鼓膜修补术;对照组43例,使用全厚软骨-软骨膜移植物行鼓膜修补术。对比两组术前穿孔部位、穿孔大小、手术后鼓膜愈合率、术后6个月平均气导听阈及气骨导差。结果对照组鼓膜愈合35例(81.4%),再穿孔8例(18.6%);观察组鼓膜愈合41例(95.3%),再穿孔2例(4.7%),两组鼓膜愈合率比较,差异有统计学意义(χ^2=5.237,P<0.05)。术后6个月纯音听阈检查,对照组平均气导听阈(33.54±4.81)dB HL,骨气导差(14.05±5.72)dB HL;观察组平均气导听阈(28.84±2.53)dB HL,骨气导差(9.40±2.77)dB HL,两组听力均较术前提高,两组间比较平均气导听阈和气骨导差的差异均有统计学意义(t=5.347、4.516,P均<0.05)。结论耳内镜下软骨膜-软骨岛行鼓膜修补术鼓膜愈合率高,术后听力改善更显著,是一种有效的鼓膜修补方法。

OBJECTIVE To investigate the effect of perichondrium-cartilage island in type I tympanoplasty.METHODS A retrospective analysis of 86 patients with chronic otitis media with tympanoplasty from January 2017 to July 2018 was randomly divided into observation group and control group by random number table.Observation group:43 cases were used.Tympanic angioplasty with cartilage-cartilage island graft,control group:43 patients underwent tympanoplasty with a full-thick cartilage-chondral graft.The tympanic membrane healing rate and the mean air conduction threshold and air-bone conduction difference after operation were compared between the two groups.RESULTS In the control group,43 cases(81.4%)were tympanic membrane and 8 cases(18.6%)were perforated.In the observation group,41 cases(95.3%)were tympanic membrane healing,and 2 cases(4.7%)were re-perforated(χ^2=5.237,P<0.05).The average hearing of the pure tone hearing threshold was 6 months after operation.The average air conduction hearing of the control group was(33.54±4.81)dB HL,and the mean air-bone gap was(14.05±5.72)dB HL,the average air conduction hearing of the observation group was(28.84±2.53)dB HL.The mean air-bone gap was(9.40±2.77)dB HL.The mean pure tone and air-bone gap of the observation group were significantly improved(t=5.347,4.516,P<0.05).CONCLUSION The endoscopic peritoneal-cartilage island tympanoplasty has a better tympanic membrane healing rate and improved audiological effects.It is an effective tympanic membrane repair method.