前壁外耳道－鼓膜瓣应用于开放式鼓室成形术31例

目的：探讨前壁外耳道－鼓膜瓣应用于开放式鼓室成形术中，能否提高鼓膜修补成功率和手术疗效。方法对慢性化脓性中耳炎及中耳胆脂瘤伴中、下鼓室自行封闭患者66例（66耳），予开放式鼓室成形术治疗，其中31例术中应用前壁外耳道－鼓膜瓣内植法鼓室成形（前瓣组），35例应用软骨和筋膜内植法鼓室成形（软骨组），测定术前及术后6个月气导（AC）、气骨导差（ABG），比较两组的临床疗效。结果前瓣组成功率为96．8％（30／31），软骨组88．6％（31／35），两组比较差异无统计学意义（P ＞0．05）；前瓣组有效率为88．46％，软骨组为65．52％，两组比较差异有统计学意义（P ＜0．05），即前瓣组优于软骨组。结论伴有中、下鼓室封闭的慢性中耳炎患者，行开放式鼓室成形术中应用前壁外耳道－鼓膜瓣鼓室成形能提高筋膜成活率，术后鼓膜穿孔率低，较好成形鼓室，并能同期听力重建，提高听力。

Application of anterior wall of external auditory canal ardrum flap for open tympanoplasty in 31 patients

Objective To investigate the application of anterior wall of external auditory canal-eardrum flap in open tympanoplasty to improve tympanic molding.Methods 66 patients （66 ears）with chronic suppurative otitis media or middle ear cholesteatoma accompanied with self sealing of mesotympanum and hypotympanum underwent open tympan-oplasty.31 cases were applied with anterior wall of external auditory meatus-eardrum flap （Anterior flap group）and 35 cases were treated with cartilage and fascia inner-transplanted method （Cartilage group）.Air conduction （AC）and air bone gap （ABG）were performed six months before and after surgery.The clinical effect of the two groups were Com-pared.Results The success rates were 96.8%（30 /31）and 88.6%（31 /35）in anterior flap group and cartilage group respectively （P 〉0.05 ）,while the effective rates were 88.46% and 65.52% correspondingly in the two groups （P 〈0.05）.Conclusion For the patients with chronic suppurative otitis media accompanied with sealing of mesotympanum and hypotympanum,anterior wall of external auditory canal eardrum flap in open tympanoplasty can improve fascia sur-vival and reduce perforation rate of tympanic membrane,with satisfying tympanic molding,simultaneous auditory reha-bilitation,hearing improvement and good clinical effect.