翻瓣式鼓膜外耳道瓣夹层法修补完全或近完全鼓膜穿孔的临床观察

Interlay tympanoplasty with tympanomeatal flap for almost complete and complete tympanic membrane perforation through the ear canal under the microscope

目的探讨显微镜下经耳道对近完全和完全鼓膜穿孔,采用翻瓣式鼓膜外耳道瓣夹层法实施鼓膜成形术技术方法及效果;方法回顾性分析2015年1月~2019年12月46例接受滋养血管蒂在前翻瓣式鼓膜外耳道瓣夹层法鼓膜成形术的鼓膜大穿孔患者。术前和术后6月纯音测听检查,随访观察移植成功率、并发症和听力结果;结果共纳入46例患者,其中男17例,女29例。平均年龄为49.1±6.6岁。随访时间6~12个月。结论鼓膜穿孔愈合成功率46例,1例发生再穿孔。术后发生并发症外耳道上皮囊肿1例。移植物无发生内陷、外移或钝角愈合情况,术前和术后气导听阈分别为39.2±7.0和24.1±4.5 dB,术后均有明显改善,有统计学意义(P<0.001)。在0.5、1、2和3 kHz时,气骨道差变化(闭合)分别为12.8±3.1、10.2±2.7、5.7±2.2和4.0±1.8 dB,平均改善7.4±2.6dB,有统计学意义(P<0.001)。结论采用具有滋养血管蒂的鼓膜外耳道瓣夹层法鼓膜成形术是一种非常成功的手术技术,特别适用于所有较大的鼓膜穿孔。成功率高,听力效果好。

Objective To investigate the perforation of near and complete tympanic membranes through the ear canal under the microscope,using the flap-type external tympanic valve dissection method to implement the tympanoplasty technique and its effects.Method By retrospective analysis of 46 patients with large perforation of the tympanic membrane who underwent anterior tympanic external ear canal valve dissection tympanoplasty from January 2015 to December 2019.Pure tone audiometry before and after the surgery for 6 months,together with follow-up observation of transplantation success rate,complications as well as hearing results.Consequences There are patients included,male 17 cases,female 29 cases;and the average age is 49.1±6.6.The follow-up time is 6~12 months.The success rate of tympanic membrane perforation was 46 cases,and recurrence occurred in 1 case.Postoperative complications occurred in 1 case of external ear canal cyst.There were no insets,outward shifts,or obtuse angle healing of the graft.The preoperative and postoperative air conduction hearing thresholds were 39.2±7.0 and 24.1±4.5 dB,which were significantly improved after the surgery and were statistically significant(P<0.001).At 0.5,1,2 and 3 kHz,the changes in air-bone tract difference(closed)were 12.8±3.1,10.2±2.7,5.7±2.2,and 4.0±1.8 dB,and the average improvement was 7.4±2.6 dB.statistically significance(P<0.001).Conclusion External tympanic ear canal valve dissection method tympanoplasty with nourishing vascular pedicle is quite a successful surgery technique,which is especially suitable for all the relatively larger tympanic membrane perforations.The success rate is high and the auditory effect is excellent.