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目的:探讨慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部中央性大穿孔患者的病变特点及处理方法。方法:慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部中央性大穿孔患者147例,其中101例不伴乳突病变者行鼓室成形术;46例伴乳突病变者,在进行鼓室成形术的同时进行乳突开放术。结果:147例中有142例(96.6%)一期愈合。术后3个月纯音听力骨气导差平均为(16.6±10.9)dBHL。结论:慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部大穿孔的患者,术前颞骨高分辨CT检查及术中详细探查是必须的。确保术后咽鼓管、上鼓室、鼓窦,特别是后两者的引流通畅是提高疗效的关键。应用软骨软骨膜复合物行鼓膜重建或上鼓室、后鼓室及鼓膜的联合重建,对鼓膜紧张部中央性大穿孔的患者不失为一种切实可行的治疗方法。
Objective: To investigate the characteristics and treatment of chronic suppurative otitis media (simple type, stationary phase) patients with central perforation of tympanic membrane tension. Methods: A total of 147 patients with chronic suppurative otitis media (simple type, quiescent) and central perforation of the tympanic membrane were involved. One hundred and one patients underwent tympanoplasty without mastoid lesions. Forty-six patients with mastoid lesions underwent tympanometry Plasty at the same time mastoid surgery. Results: In 147 cases, 142 cases (96.6%) were healed in one time. Three months after the operation, pure tone audiometry had an average of (16.6 ± 10.9) dBHL. CONCLUSIONS: In patients with chronic suppurative otitis media (simple type, quiescent phase) with large perforation of tympanic membrane, preoperative temporal bone high resolution CT examination and intraoperative exploration are necessary. To ensure that postoperative eustachian tube, upper tympanic cavity, sinus, especially after the two drainage is the key to improving efficacy. The application of cartilage and perichondrium composite reconstruction of the tympanic membrane or the reconstruction of the upper tympanic cavity, posterior tympanic membrane and tympanic membrane, after the central tympanic membrane perforation of the central perforation of the patient may be a viable treatment.