内外植法与内植法鼓膜成形术的近期对比分析

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1、·433··I临床研究·内外植法与内植法鼓膜成形术的近期对比分析余万东1戴艳红1陈峰1覃道芬1丁小琼1[摘要]目的：探讨内外植法修补鼓膜的成功率和对听力的影响。方法：回顾性分析2002年以来行内植法鼓膜成形术且术后随访6个月以上的74例(77耳)患者，A组44例(45耳)采用传统的内植法，B组30例(32耳)将移植膜放置在残余鼓膜与锤骨柄之间(内外植法)，比较2组患者术后3个月时的听力。结果：A组鼓膜1次修补成功40耳(89．0％)，语言区平均听阈改善≥10dB者23耳，手术成功率57．5％。B组鼓

2、膜修补1次愈合28耳(87．5％)，语言区平均听阈改善≥10dB者23耳，手术成功率71．9％。并发症：A组再穿孔2耳(5．9％)，鼓膜内陷8耳(17．8％)；B组再穿孔2耳(6．25％)，钝角愈合3耳(9．38％)，鼓膜内陷2耳(6．25％)。结论：将移植膜放置在残余鼓膜与锤骨柄之间可避免术后鼓膜和锤骨柄脱离，减少移植膜与鼓岬发生粘连。对鼓膜较大穿孔患者听力的改善明显优于移植膜放置在锤骨柄内侧者。[关键词]鼓膜成形术；鼓膜[中国分类号]R764．9[文献标志码]A[文章编号]1001—1781(2

3、008)10—0433—03Comparativeevaluationofover-undermyringoplastyandunderlaymyringoplastyforrepairingtympanicmembraneperforationsHEWandongDAIYanhongCHENFengQlNDaofenDINGXiaoqiong(DepartmentofOtolaryngology，theAffiliatedDrumTowerHospital，MedicalSchoolofNan—j

4、ingUniversity，Nanjing，210008，China)AbstractObjective：Toevaluatetheeffectofover-undermyringoplastytechniqueonrepairingtympanicmembraneperforationregardingwiththerateofperforationclosure，thefrequencyofpostoperativecomplicationsoccurrenceandthelevelofhear

5、ingimprovement．Method：Inthisretrospectivestudy，atotalof74patients(77ears)underwentmyringoplastyandhadbeenfollowedupforover6months，whichwasperformedbyme目．nsoftheunderlaytechniquein44patients(45ears)andover-undertechniquein30patients(32ears)fromJan2002to

6、Jan2007．Intheunderlaygroup，thegraftedmembranewasplacedmedialtOtheremainingdrumandthemanubriumofthemalleus．Intheover-undergroup．thegraftedmembranewasplacedundertheremainingdrumandoverthemalleus．Comparativelyevaluatetheeffectoftheunderlaytechniqueandthat

7、oftheover-underlaytechniqueonre—pairingtympanicmembraneperforation．Result：TherateofperforationclosureandhearingimprovementintheUS+derlaygroupof45earswas89．0％and57．5％respectively，whilethatintheover-undergroupof32earswere87．5％and71．9％respectively．Theair-

8、bonegapdecreasedby4．9dBintheunderlaygroup，whileitdecreasedby9．7dBinover-undergroup．Aftermorethan6monthsoffollowing-up，thefrequencyofpostoperativeatelecta—sisoftheunderlaygroupandtheover-undergroupwas17．80Aand6．z5％respectively．Meanwhile，