不同技术和材料在鼓膜修补术的应用

目的 探讨耳内镜、手术显微镜技术联合不同材料对特点各异的鼓膜穿孔行鼓膜成形术的临床应用效果。方法 针对不同大小及位置的鼓膜穿孔患者109例109耳，选择性地采用耳内镜下脂肪组织鼓膜成形术(31耳)、软骨膜鼓膜成形术(43耳)和显微镜颞肌筋膜鼓膜成形术(35耳)，比较三组患者的治疗效果。结果 全部患者随访6～18个月，三组鼓膜穿孔愈合率分别为90.3%、90.7%和91.4%；手术前后平均听阈均有提高，差异有统计学意义（P＜0.05)。 结论 针对不同鼓膜穿孔的特点有选择性地应用手术显微镜或耳内镜技术，以及不同来源的移植材料进行鼓膜成形术，均能达到有效的治疗结果；对中央型的穿孔应用耳内镜下脂肪、软骨膜材料能达到微创目的。

Application of different techniques and materials to myringoplasty

ObjectiveT o evaluate the outcomes of myringoplasty for various specific kinds of perforations of the ear drum via endotoscope or operating microscope with different materials. Methods 109 patients(109 ears) with perforations of the ear drum were recruited from November 2007 to March 2009 . The patients were divided into 3 groups according to the size and position of perforations of the ear drum: 31 accepted myringoplasties with a fat plug , 43 accepted perichondrium via endotoscope, and 35 accepted fascia musculares via an operating microscope. Results After a follow up of 6~18 months, the healing rates of perforations of the ear drum in the three groups were 90.3 %, 90.7% and 91.4%, respectively. Average pure-tone hearing thresholds improved significantly after operation in each group（P＜0.05). Conclusions According to the size and position of perforations of the ear drum, we can select endotoscope or operating microscope and different materials for myringoplasty. For central type of perforations, the application of endotoscope with fat plug or perichondrium is reliable and minimally invasive.