耳软骨在中耳手术中的应用

目的 探讨软骨在中耳手术中的应用,以拓展手术范围,改善手术疗效。方法 (1)用自体软骨进行鼓膜修补;(2)在乳突根治术后应用软骨重建外耳道后壁;(3)治疗粘连性中耳炎。结果 (1)软骨组的鼓膜愈合率为93.4％,颞肌筋膜组为80％。两组的听力结果无显著性差异。(2)应用软骨重建外耳道后壁的43耳中有40耳一期愈合(93％),干耳时间平均为4.19+1.00周。对照组干耳时间平均为5.54+1.83周。二者有显著性差异。(3)41耳粘连性中耳炎术后平均骨气导差为27.9+10.7dB。共有18耳(43.9％)术后骨气导差<20dB。有26耳术后提高>15dB。术后24耳(56％)的鼓室接近正常。结论 (1)软骨是修补鼓膜穿孔的一种好材料。(2)应用软骨同时修补鼓膜并重建外耳道后壁,不仅能够缩短干耳时间,改善听力,而且免除了二次手术,明显改善了病人的生活质量。(3)应用软骨治疗粘连性中耳炎疗效有所提高,但要严格选择手术适应症。

Application of auricular cartilage in the middle ear surgery

Objective: To study the application of auricular cartilage in the middle ear surgery. Method: (1) Ninty one cases of large tympanic membrane perforation were repaired with auricular cartilage. (2) reconstruction of tympanic membrane and posterior wall of external ear canal with auricular cartilage after mastoidectomy. (3) Fourty one c'ases of adhesive otitis media (AOM) were undergone tympanoplasty. The adhesive ear drum and the other processes in middle ear were inserted and reconstructed with cartilage. Result: (1) The closurerate 92. 4% in cartilage group and 80% in temporal fascia group. There no statistic significant in hearing improvement between this two groups. (2) Fourty cases were healed in one stage in all of 43 cases(93% ) . Postoperative period to be a dry ear was significantly shorter in the reconstruction group than in the canal - wall - down and open group (t-test, t =3.98, <0.01) . (3) Postoperative average A - B gap were 27. 9 + 10. 7dB. The A - B gap of 18 cases(43. 9% ) were less than 20dB. 24 cases(56% ) become a nearly normal tympanum. Conclusion: (1) The auricular cartilage - perichondium pallisade technique is an ideal methode for the healing of tympanic membrane perforation. (2) The auricular cartilage is a good material for the reconstruction of posterior wall of the external auditory canal. Its can not only reduce the time of drying ear, improve the hearing results, but also avoid the second operation. The quality of the patients life can be improved. (3) The AOM can treatment with tympnoplasty. But the indication must be carefully selected.