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刘永 (1979) 内植法鼓膜修补术. 中华耳鼻喉科杂志, 1, 17.

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  • 标题: 60例鼓膜修补术临床分析Clinical Analysis of Myringoplasty on 60 Patients Suffering from Chronic Otitis Media

    作者: 韩瑞珠, 李克巡, 周军华

    关键字: 中耳炎, 手术治疗, 鼓膜修补术, 鼓室成形术Otitis Media; Surgical Therapy; Myringoplasty; Tympanoplasty

    期刊名称: 《Asian Case Reports in Otolaryngology》, Vol.1 No.4, 2013-12-27

    摘要: 目的:探讨鼓膜修补术的适应证和手术方法,以提高手术效果。材料和方法:回顾分析2012年6月至2013年2月本人所做60例鼓膜修补术的临床资料,介绍2种手术方法、移植材料,并评价其优、缺点。60耳中,鼓膜大穿孔32耳,中等大小穿孔26耳,小穿孔2耳;中耳腔干燥者48耳,潮湿者12耳;咽鼓管功能良好者50耳,差者8耳,不通者2耳。修补材料均采用自体颞肌筋膜。内植法55耳(其中全翻内衬法2耳,余均采用外耳道半环带蒂皮圈法),夹层法5耳。结果:术后穿孔封闭49耳;移植膜脱落1耳;大穿孔修补术后,移植膜未愈合完全而变成小穿孔2耳;失访8耳。听力提高耳;术后鼓膜穿孔闭合者49/60耳,占81.66%,术后小穿孔者2/60耳,占3.33%。移植膜脱落1耳,占1.66%。术后听力提高10 dB以上者40/60耳,占66.67%。结论:术前干耳2个月以上,良好的咽鼓管功能是耳膜修补术的重要条件。有边缘的中等大小穿孔,夹层法较好,但操作难度较大。对于大穿孔,外耳道带蒂皮瓣内衬法是一种可取的方法。常规的方法移植膜内衬于锤骨柄之下,本人采取游离锤骨柄上上皮及粘膜,将移植膜前端内衬于鼓膜穿孔残缘之下,然后将移植膜铺于鼓室及锤骨柄之上,移植膜后部以鼓耳道瓣和带蒂外耳道皮瓣压迫的方法,术后随访,此种方法移植膜成活率较高。术后随访换药十分重要。 Objective: To discuss the indications and surgical methods of myringoplasty in order to advance the therapeutic effect. Methods: The clinical data of 60 cases undergoing myringoplasty between 2012 and 2013 were retrospectively analyzed. Their surgical methods and replant materials were introduced and evaluated. Results in 60 ears included: 32 ears of preoperative tympanic membrane perforation, 26 ears of medium perforation and 2 ears of small perforation; 48 ears of dry middle ear cavity, 12 ears of wet middle ear cavity; 50 ears of good function of eustachian tube, 8 ears of not good function of eustachian tube, 2 ears of closed eustachian tube. Repair materials adopt autologous temporalis fascia. In 55 ears using plant method (2 ears of all double lined method, rest ears of half ring pedicle skin ring method of external auditory canal), 5 ears use sandwich method. Result: 49 ears of postoperative perforation closed, 1 ear of membrane transplantation falling off, 2 ears of small perforation due to fascia transplantation not healed completely after repair surgery of large perforation, and 8 ears lost to follow-up. Hearing improved ear; Tympanic membrane perforation of 49/60 ears closed later, accounting for 81.66%; postoperative perforation of 2/60 ears was discovered, accounting for 3.33%. 1 ear of membrane transplantation falling off accounts for 1.66%. Postoperative hearing of 40/60 ears increased more than 10 dB, accounting for 66.67%. Conclusion: The middle ear drying over two months and the good function of pharyngotympanic tube are two essential conditions. For small perforation of eardrum, the underlay technique may be adopted, and for large perforation of the eardrum, the inlay technique or underlay technique may be adopted. Careful examination and treatment are important postoperatively.