联合切口径路全翻内置法鼓膜成形术

对各种慢性化脓性中耳炎采用联合切口径路全翻内置法行鼓膜成形术１１８例，取得良好效果，介绍了联合切口、全翻外耳道皮瓣和内置移植物的操作技术，探讨了该法取得良好效果的各种因素。     

基层医院开展耳内镜下鼓膜成形术54耳的临床研究

目的探讨基层医院应用耳内镜技术开展鼓膜穿孔修补术的临床研究。方法在耳内镜下采用不同材料对鼓膜穿孔的54耳患者进行修补手术,并针对穿孔的大小和部位采用不同方法处理。结果随访3~6个月,平均3.4个月。鼓膜穿孔总愈合率为88.9%,其中脂肪92.3%、颞肌筋膜90%、软骨膜88.46%、软骨膜-软骨80%。比较差异无显著性(χ2=0.646,P>0.05),54耳的术前听力学检查均有不同程度的传导性听力下降,术后平均气导提高>10 dB者有38耳(70.4%)。结论基层医院开展耳内镜下鼓膜穿孔修补手术均能达到有效的治疗结果,适合推广应用,但移植材料要根据鼓膜穿孔大小和类型的不同合理选择。     

Novel transparent collagen film patch derived from duck’s feet for tympanic membrane perforation

Abstract

To increase healing rate of tympanic membrane (TM) perforations, patching procedure has been commonly conducted. Biocompatible, biodegradable patching materials which is not limited across cultures is needed. The authors evaluated the effectiveness of novel transparent duck’s feet collagen film (DCF) patch in acute traumatic TM perforation. This procedure was compared with spontaneous healing and paper patching. Cell proliferation features were observed in paper and DCF patches. Forty-eight TMs of 24 rats were used for animal experiment, perforations were made on each TMs, and divided into three groups according to treatment modality. Sixteen were spontaneously healed, 16 were paper patched and 16 were DCF patched. The gross and histological healing results were analyzed. Both paper and DCF patch showed no cytotoxicity, but cell proliferations were more active in DCF than paper in early stage. In animal study, the healing of TM perforations were completed within 14 days in all three groups, but found to be faster in DCF patch group than paper patch or spontaneous healing group. The DCF patches were transparent and size of DCF patches were gradually decreased, so there were no need to remove the DCF patches to check the wound status or after the completion of healing. According to this result, authors concluded that DCF patch is transparent, biocompatible and biodegradable material, and can induce fast healing in acute traumatic TM perforations.     

鼓膜大穿孔耳内镜下鼓膜成形术的临床报告

目的探讨对鼓膜大穿孔病例应用耳内镜下单纯鼓膜成形术的疗效。方法选取2015年9月-2018年1月收治的鼓膜大穿孔患者43例(46耳),耳内镜下采取耳屏软骨-软骨膜进行鼓膜成形术,对鼓膜愈合及听力情况进行评价。结果 43耳鼓膜愈合,3耳未愈合,愈合率93.5%,听力改善患者满意,1例出现迟发性面瘫,药物治疗后恢复,其余均无并发症出现。结论耳内镜下应用耳屏软骨-软骨膜修补鼓膜大穿孔操作相对简单,能抵近观察,手术成功率高,比显微镜下手术更具优势,利于年轻医师上手,值得临床推广。     

同期单双耳行鼓膜成形术临床疗效对比分析

目的：分析对比同期双耳与单耳行鼓膜成形术临床特点及治疗效果。方法选取2010年1月-2012年1月65例耳聋患者,随机分为观察组A（双耳）30例和观察组B（单耳）35例,观察分析两组的临床特点,比较两组的治疗效果。结果两组患者的年龄、高脂血症的患病率比较不存在明显差异（P＞0．05）,无统计学意义。两组术后在手术有效率和听力增益方面均无明显差异（均P＞0．05）。结论在告知患者的前提下,同期行双耳鼓膜成形术是可行的。     

鼓膜修补术94例临床分析

目的 探讨鼓膜修补术的适应证和手术方法，以提高手术效果。方法 回顾分析94例鼓膜修补术的临床资料，介绍几种手术方法、移植材料，并评价其优、缺点。结果 94耳中，鼓膜大穿孔39耳，中等大小穿孔51耳，小穿孔4耳；中耳腔干燥者80耳，潮湿者14耳；咽鼓管功能良好者73耳，差者14耳，不通者7耳。修补材料均采用自体耳屏软骨膜和颞肌筋膜。内植法19耳，术后穿孔封闭18耳，听力提高18耳；外植法24耳，术后穿孔封闭22耳，其中1耳外侧愈合，听力提高15耳,外耳道全环带蒂皮圈法46耳，术后穿孔封闭41耳，听力提高27耳；外耳道半环带蒂皮圈法5耳，术后穿孔封闭4耳，听力提高3耳。术后鼓膜穿孔闭合者85／94耳，占90．43％，再穿孔者9／94耳，占9．57％。术后听力提高10dB以上者60／94耳，占63．83％，术后听力在实用听力水平者（听力损失不超过45dB）75／94耳，占79.78％。结论 术前干耳2个月以上，良好的咽鼓管功能是耳膜修补术的重要条件。有边缘的中小穿孔，内植法较好；对于大穿孔，外耳道带蒂皮圈夹层法是一种可取的方法。术后细心检查换药十分重要。     

Pneumatization correlated to myringoplasty and tubal function

The prognostic significance of the size of mastoid air cell system in the results of myringoplasty has been a matter of debate. Fifty ears with dry central perforation following C.S.O.M. were investigated. The size of mastoid air cell system was determined with planimetry of the X-ray picture and eustachian tube function was assessed using flourescein dye and nasal endoscopy. Myringoplasty was performed in all the 50 ears and postoperative results in terms of graft take up and hearing gain were assessed. The correlation between the size of mastoid air cell system, results of myringoplasty and tubal function has been discussed. The results show no correlation between the size of mastoid air cell system, postoperative results of myringoplasty and eustachian tube function.