耳内镜下耳屏软骨-软骨膜鼓膜成形术的手术技巧及疗效分析

Surgical techniques and curative effect analysis of myringoplasty with auricular cartilage-perichondrium under otoscope

目的探讨耳内镜下耳屏软骨-软骨膜鼓膜成形术的手术技巧及应用。方法回顾性分析我院2018年5月~2019年9月收治的63例(63耳)鼓膜穿孔患者的临床资料,所有患者均采用自体耳屏软骨-软骨膜作为移植材料,在耳内镜下行内植法完成鼓膜成形术。结果663例患者术后均随访半年以上,其中59例(93.65%)术后鼓膜完全愈合,形态佳;4例鼓膜未愈合,主要是因为术后再次流脓,导致鼓膜前下方裂隙样穿孔。术后3个月复查听力,气导听阈平均下降16 dB,气骨导差平均缩小7.3dB,随访半年,愈合的鼓膜及听力无明显变化。结论对单纯鼓膜穿孔患者在耳内镜下应用耳屏软骨-软骨膜行鼓膜成形术是一种操作简便、安全有效、易于掌握的手术方法,尤其对基层医院初学者,掌握一定的手术技巧可进一步提高成功率,也为进行中耳复杂手术打下良好的基础。获得耳屏软骨-软骨膜是方便的、切口隐蔽、创伤小、抗感染力强及成活率高,用于鼓膜成形术远期效果好。

Objective To investigate the surgical techniques and application of myringoplasty with auricular cartilageperichondrium under otoscope.Methods A total of 63 patients with tympanic membrane perforation in our hospital between May 2018 and September 2019 were treated with auricular cartilage-perichondrium as graft material to complete myringoplasty.Results All of 63 patients were followed up for more than half a year after operation,and 59 cases were healed completely(93.55%).Hearing was reviewed 3 months after operation.The average of air conduction hearing threshold among speech frequencies decreased by 16 dB,and the average of air-bone conductivity decreased by 7.3 dB.Conclusion It is a simple,safe and effective and easy-to-master surgical method for patients with simple tympanic membrane perforation.Especially for beginners in primary hospitals,mastering some surgical techniques can further improve their success rate,and also lay a good foundation for complicated operation of middle ear.The auricular cartilage-perichondrium has the advantage of convenient operation,concealed incision,small trauma,strong anti-infectivity and high survival rate,so it has good long-term effect for myringoplasty.