耳内镜下鼓膜修补术67例分析

鼓膜修补术属耳科常见手术,该手术通常在显微镜下进行。我科2004年5月～2008年9月开展硬性耳内镜下鼓膜修补术治疗慢性中耳炎陈旧性鼓膜穿孔和外伤性鼓膜穿孔67例,取得满意效果,报道如下。     

耳内镜下鼓膜修补术

我科从2004年6月-2007年3月对32例慢性单纯型中耳炎及外伤性鼓膜穿孔患者，应用耳内镜行鼓膜修补术，取得满意效果。报告如下。     

耳内镜下鼓膜修补术的观察

目的 探讨耳内镜在鼓膜修补术中的实用性;方法 在耳内镜下利用自体耳屏软骨膜或同种异体筋膜对63例患者行鼓膜修补术;结果 经3～8个月随访,一次手术治愈率88.9％,总治愈率达95.2％;结论 耳内镜下鼓膜修补术是一种安全可靠、操作及要求较为简单、费用低、微创的鼓膜修补方法。     

耳内镜下自体脂肪鼓膜修补术的临床应用分析

鼓膜穿孔可引起患耳听力下降,并增加中耳感染和后天继发性胆脂瘤型中耳炎的风险,近年来临床上对于单纯鼓膜修补有采用贴补法或自体、异体筋膜组织在耳显微镜下修补.20世纪末,耳内镜技术在中耳、耳神经外科及耳颅底外科辅助手术中得到了有效的发展,近年来国内该类技术的相关报道逐渐增多,我科近2年来对患者采用耳内镜技术行自体脂肪鼓膜修补术,均取得良好的疗效,现将临床治疗效果及治疗体会报告如下.     

耳内镜下鼓膜修补术治疗鼓膜穿孔的临床疗效

鼓膜修补术是临床治疗鼓膜穿孔、提高听力的唯一有效方法。临床治疗鼓膜穿孔的方法很多,如耳内镜下行内植法、外植法、夹层法等,疗效不一。我科自2005年3月-2008年3月行耳内镜下鼓膜修补术治疗鼓膜穿孔45例,效果满意,现报道如下。1资料与方法1.1临床资料本组鼓膜穿孔患者45例,均为单耳发病,其中男13例,女32例;年龄20-45岁,     

耳内镜下自体脂肪鼓膜修补术疗效分析

目的 探讨耳内镜下自体脂肪鼓膜修补的疗效。方法 回顾性分析128例患者行自体脂肪鼓膜修补术,自体脂肪取自耳垂或腹部,对于鼓膜紧张部大穿孔一次修补不成功者,再次或多次行自体脂肪鼓膜修补术。结果 一次性鼓膜修补成功120 例,两次修补成功6例,3次修补成功2例,总治愈率100%,术后6个月复查电测听,言语频率听阈恢复到平均（21.4±8.6）dB,骨、气导差缩小至（10.2±4.6）dB。结论 耳内镜下自体脂肪鼓膜修补术适合于鼓膜紧张部中央型穿孔,视野清晰,操作准确,患者创伤小,恢复快,对于鼓膜紧张部大穿孔,一次修补穿孔未愈者,可再次或多次行脂肪修补术。     

耳内镜下内衬法与夹层法鼓膜修补术的疗效观察

目的 对耳内镜下内衬法和夹层法完成慢性化脓性中耳炎(CSOM)患者鼓膜修补术进行疗效观察.方法 回顾性分析2019年6月-2021年6月收治的经耳内镜内衬法和夹层法行鼓膜修补的CSOM患者的临床资料,共66例CSOM患者入组观察,随机分为两组由同一术者分别以内衬法(33例)和夹层法(33例)完成Ⅰ型鼓室成形术.比较其鼓...     

耳内镜下同种异体羊膜鼓膜修补术的疗效观察

目的:探讨耳内镜下同种异体羊膜鼓膜修补术的临床疗效。方法:回顾性分析在第四军医大学唐都医院行耳内镜下同种异体羊膜鼓膜修补术患者43例(43耳)的临床资料,观察鼓膜穿孔的愈合情况及听力改善情况。结果:43耳中有41耳鼓膜完全愈合,穿孔愈合率95.3%。复查纯音测听,语言频率气导平均听阈较术前提高10dB。随访1～4年,未见再穿孔及其他并发症发生。结论:耳内镜下鼓膜修补术适用于言语频率听阈在40dB以内的单纯鼓膜修补,不仅能修补紧张部中央性穿孔,而且对大部分有残余鼓膜的边缘性穿孔也可修补。人羊膜是鼓膜修补的理想材料。     

耳内窥镜下鼓膜修补术

自 2 0 0 0年 6月至 2 0 0 1年 9月在耳内窥镜下行鼓膜修补术 32例 ( 37耳 ) ,效果满意 ,报告如下。1　材料与方法1.1　设备　德国ＷＯＬＦ公司产耳内窥镜及监视系统 ,声导抗为丹麦产ＡｕｔｏｍａｔｉｃＩｍｐｅｄａｎｃｅＡｕｄｉｏｍｅｔｅｒＡＴ - 2 2型 ,听力计为ＹＯＹＡＧＥＲ5 2 2型。1.2　临床资料　病例选择标准 :按鼓膜成形术手术适应证选择病例 ,其中男 14例 ( 16耳 ) ,女 18例 ( 2 1耳 ) ,年龄 14～ 6 0岁 ,病程 10个月～ 2 5年 ;要求鼓膜中央性穿孔 ,周围有 1～ 2ｍｍ以上残边 ;纯音测听为传导性聋 ,言语频率听阈 10～ 2 0ｄＢ…     

耳内镜在鼓膜修补术中的应用(附96例报告)

自1967年Mer首先运用内镜行中耳检查以来，内镜在耳科及耳神经外科临床中的应用得到不断发展。我科自2000年10月～2003年12月在耳内镜下应用自体耳屏软骨膜或自体颞肌筋膜行鼓膜修补术共96例(136耳)，取得了令人满意效果，现报道如下。     

A comparative study of endoscope assisted myringoplasty and micrsoscope assisted myringoplasty

Objective  To determine the advantages and disadvantages of the endoscope as compared to the microscope in myringoplasty surgery and to compare the results of both groups. Methods  Between January 2003 and September 2006, 100 patients underwent myringoplasty, 50 were endoscope assisted and 50 were microscope assisted. Results of surgery were compared at the end of six months post operation. Results  In the endopscope group 82% of patients had a successful outcome and in the microscope group 86% of patients had a successful outcome. Conclusion  In myringoplasty surgery the endoscope has several advantages and a few disadvantages. The surgical outcome of endoscope assisted myringoplasty was comparable to the conventional microscope assisted myringoplasty, but in terms of cosmesis and post operative recovery patients in the endoscope group had better results.     

脂肪组织压片修补中大型鼓膜穿孔52例临床分析

目的 探讨耳内镜下自体耳后皮下脂肪组织压片修补中大型鼓膜穿孔的临床疗效。方法 回顾性分析耳内镜下应用自体耳后皮下脂肪组织压片修补中大型鼓膜穿孔52例(52耳)患者的临床资料,观察鼓膜穿孔的愈合及听力改善情况。结果 随访6～12个月,52例均未出现面瘫、味觉减退等手术并发症。52耳中49耳穿孔完全闭合,总治愈率94.2% (49/52),平均听力提高(14.7±3.1)dB;其中,外伤性穿孔31耳,治愈率96.8% (30/31),平均听力提高(14.3±1.6)dB;慢性中耳炎陈旧性穿孔21耳,治愈率90.5% (19/21),平均听力提高(15.4±4.4)dB。结论 脂肪组织压片可用于修补中大型鼓膜穿孔,疗效可靠,愈合率高。此技术优于脂肪嵌入法,扩大了脂肪组织修补鼓膜穿孔的临床应用。     

内镜下鼓膜成形术

目的评价内镜下修补干性鼓膜中、小穿孔的效果并与传统的烧灼法作对照。方法按完全随机法将鼓膜干性中央性中、小穿孔130耳分为两组,第一组100耳接受内镜下同种异体颞肌筋膜鼓膜成形术(内镜组),另30耳采用传统的40%三氯醋酸烧灼法进行修补(对照组)。比较两组间术后3个月鼓膜穿孔完全愈合的耳数以及术后6个月的语言频率纯音听阈的差异。结果术后3个月,内镜组鼓膜穿孔完全愈合率为91/100,较对照组的20/30高(P<0.01),术后6个月,两组鼓膜穿孔完全愈合者的骨-气导差在10dB以内的占90.1%。结论使用内镜修补鼓膜穿孔具有明显的优势,可代替手术显微镜且更容易通过狭窄或弯曲的外耳道,该手术是一种简单易行、安全有效的方法。     

Failures in myringoplasty

Summary We analyzed those failures occurring in 417 myringoplasties. Forty-four drum re-perforations were found (10.6%), half of which occurred immediately after operation. Causes of these early failures included necrosis in the middle of the graft without infection (10 ears) and blunting of the anterior margins of the graft (7 ears). Infection was the most common cause of re-perforations in the later failures. Re-perforations also occurred more frequently when larger perforations were closed in contrast to repair of small ones. We found that other pre-operative factors (dry or wet ear, site of the perforation) or grafting technique (underlay or overlay) did not affect the graft take-rate. Adhesive eardrums were found in 23 ears (5.5%). These were more common when ears were infected pre-operatively, when middle ear mucosa was removed during the primary operation, or when squamous epithelium was present on the tympanic mucosa. Lateralization of the grafted eardrum was found in two cases (0.5%), both of which had been operated on using the sandwich technique.     

内外植法与内植法鼓膜成形术的近期对比分析

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≥10 dB者23耳,手术成功率57.5%.B组鼓膜修补1次愈合28耳(87.5%),语言区平均听阈改善≥10 dB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.     

耳后进路Over-Under法鼓膜修补术60例

目的 探讨鼓膜大穿孔合并外耳道狭窄手术修补方法。方法 对60例（62耳）鼓膜大穿孔合并外耳道狭窄病例行耳后进路Over Under法鼓膜修补术,随访0.5～1年,观察鼓膜穿孔愈合率及术后听力变化。结果 60例（62耳）鼓膜大穿孔病例,穿孔愈合58耳（占93.5%）,听力提高53耳（占85.5%）,无鼓膜外侧愈合及皮片胆脂瘤发生。结论 耳后进路Over-Under法鼓膜修补术是鼓膜大穿孔合并外耳道狭窄病例合适的手术方式。耳后进路能提供良好的暴露,有利于制作鼓膜移植床;Over-Under法能较为方便地安放移植膜并提供较高的稳固性,避免鼓膜与鼓岬粘连。     

Fat plug myringoplasty

Fat plug myringoplasty is a technique described to repair small dry central tympanic membrane perforations. It is a simple office procedure with minimal morbidity to the patient. The present study is a prospective review of 18 patients who underwent 20 fat plug myringoplasty procedures over three and a half year penod. The success rate of 90% closure of tympanic membrane was achieved at an average of six months follow up. The patient selection criteria have to be adhered strictly to gain good outcome. The study concludes that fat plug myringoplasty is a simple, quick and minimally invasive procedure which can be done as OPD procedure resulting in a safe and dry ear.     

The effects of the incision types in myringoplasty operations on cosmesis

There is no study based on objective measurements about the cosmetic results of myringoplasty operation in medical literature. This study aims to show the differences in the auriculomastoid angle between the operations which were done with postauricular and endaural incisions. The auriculomastoid angle of 20 patients having had postauricular myringoplasty operation were measured both preoperative and postoperative periods. The auriculomastoid angles of 17 patients having had endaural myringoplasty operation were also measured in both preoperative and postoperative periods. Also, the patients were asked whether there was a change in the shape of their ears. It was observed that the increase of the auriculomastoid angles of the patients who had myringoplasty by postauricular incision was statistically significant when compared to the ones having had the operation by endaural incision. Also, the patients who had myringoplasty operation by postauricular incision realized the change in their ears significantly when compared to the other group. In this study, esthetically better results were observed in the myringoplasty operations done by endaural incision than the ones done by postauricular incision. When deciding on the incision type, this should be considered.     

鼓膜修补材料研究进展

鼓膜穿孔是耳科常见疾病,选择合适的材料修补穿孔,重建完整的鼓膜可达到提高患者听力及恢复鼓膜屏障的目的。多年来耳科医师尝试了多种材料,从自体材料筋膜、脂肪、软骨膜、软骨等,到各种同种异体材料、异种材料,然而所有的移植材料都有一定的局限性。组织工程学技术通过恰当的支架、生物分子及细胞制造的人工鼓膜是目前鼓膜移植材料邻域研究的新进展,具有巨大的潜力。