软骨-颞肌筋膜复合物鼓室成形术修补鼓膜次全穿孔疗效观察

Effect of cartilage-temporalis fascia composite tympanoplasty for subtotal tympanic membrane perforation

目的探讨软骨-颞肌筋膜复合物鼓室成形术修补鼓膜次全穿孔的疗效。方法选择2015年6月至2018年6月南方科技大学盐田医院收治的80例(80耳)慢性化脓性中耳炎伴鼓膜次全穿孔患者为研究对象,所有患者行鼓膜修补术,根据移植材料分为软骨-颞肌筋膜复合物组和颞肌筋膜组,每组40例(40耳)。所有患者术后随访6个月,术后3、6个月复诊时行鼓膜检查,观察鼓膜位置、活动度及是否穿孔和感染等;分别于术前和术后6个月进行纯音测听检查,测听检查均在同一隔声室由同一人操作。结果软骨-颞肌筋膜复合物组患者术后1个月鼓膜活动差、稍厚,术后3个月鼓膜解剖形态基本正常,术后6个月40例患者鼓膜均愈合,鼓膜愈合率为100.0%(40/40)。颞肌筋膜组患者术后1个月鼓膜活动差,术后3个月鼓膜解剖形态基本正常,术后6个月时鼓膜愈合38例,鼓膜裂隙状穿孔2例,鼓膜愈合率为95.0%(38/40)。2组患者术后6个月鼓膜愈合率比较差异无统计学意义(χ^2=2.051,P>0.05)。2组患者术前气骨导差比较差异无统计学意义(t=-0.645,P>0.05),2组患者术后6个月气骨导差均显著小于术前(t=15.173、13.684,P<0.05),2组患者术后6个月气骨导差比较差异无统计学意义(t=0.439,P>0.05)。结论采用软骨-颞肌筋膜复合物鼓膜成形术修补鼓膜次全穿孔可获得较高的鼓膜愈合率和良好的听力效果;软骨-颞肌筋膜复合物既减小了移植物的质量,又强化了颞肌筋膜的韧性,二者联合使用是修补鼓膜大穿孔的另一选择。

Objective To evaluate the effect of cartilage-temporalis fascia composite tympanoplasty for subtotal tympanic membrane perforation.Methods Eighty patients(80 ears)with chronic suppurative otitis media complicated with subtotal tympanic membrane perforation admitted to the Yantian Hospital,Southern University of Science and Technology from June 2015 to June 2018 were selected as the study subjects.All patients underwent tympanoplasty and were divided into cartilage-temporalis fascia composite group and temporalis fascia group according to graft materials,with 40 patients(40 ears)in each group.All patients were followed up for 6 months after treatment.The position,activity,perforation and infection of the tympanic membrane were observed at 3 and 6 months after treatment.Pure tone audiometry was performed before and 6 months after operation.The audiometry was performed by the same person in the same sound-proof chamber.Results In the cartilage-temporalis fascia composite group,the tympanic membrane activity was poor and slightly thicker at one month after surgery,the anatomical morphology of the tympanic membrane was basically normal at 3 months after surgery,the tympanic membrane healed in all 40 patients at 6 months after surgery,with a healing rate of 100.0%(40/40).In the temporalis fascia group,the patients had poor tympanic membrane activity at one month after surgery,and the anatomical morphology of the tympanic membrane was basically normal at 3 months after surgery,and 38 patients had tympanic membrane healing and 2 patients had tympanic membrane fissure perforation at 6 months after surgery,and the tympanic membrane healing rate was 95.0%(38/40).There was no significant difference between the two groups in the healing rate of eardrum at 6 months after operation(χ^2=2.051,P>0.05).There was no statistically significant difference in the preoperative gas-bone gap between the two groups(t=-0.645,P>0.05).The a gas-bone gap at 6 months after operation was significantly lower than that before operation in the two groups(t=15.173,13.684;P<0.05).There was no statistically significant difference in the gas-bone gap between the two groups at 6 months after operation(t=0.439,P>0.05).Conclusion Cartilage-temporalis fascia composite tympanoplasty for subtotal perforation of the tympanic membrane can obtain a higher healing rate and better hearing effect.The cartilage-temporalis fascia composite can reduce the mass of the graft and enhance the toughness of the temporalis fascia.The combination of the two is an alternative to repair the larger perforation of the tympanic membrane.