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目的:探讨内外植法修补鼓膜的成功率和对听力的影响。方法:回顾性分析2002年以来行内植法鼓膜成形术且术后随访6个月以上的74例(77耳)患者,A组44例(45耳)采用传统的内植法,B组30例(32耳)将移植膜放置在残余鼓膜与锤骨柄之间(内外植法),比较2组患者术后3个月时的听力。结果:A组鼓膜1次修补成功40耳(89.0%),语言区平均听阈改善≥10dB者23耳,手术成功率57.5%。B组鼓膜修补1次愈合28耳(87.5%),语言区平均听阈改善≥10dB者23耳,手术成功率71.9%。并发症:A组再穿孔2耳(5.9%),鼓膜内陷8耳(17.8%);B组再穿孔2耳(6.25%),钝角愈合3耳(9.38%),鼓膜内陷2耳(6.25%)。结论:将移植膜放置在残余鼓膜与锤骨柄之间可避免术后鼓膜和锤骨柄脱离,减少移植膜与鼓岬发生粘连。对鼓膜较大穿孔患者听力的改善明显优于移植膜放置在锤骨柄内侧者。
Objective: To explore the success rate of repairing eardrum and its influence on hearing by explantation. Methods: Retrospective analysis of 74 patients (77 ears) who underwent tympanoplasty and were followed up for more than 6 months since 2002, 44 cases (45 ears) in group A were treated by traditional implantation method, 30 cases in group B (32 ears) The graft was placed between the remnant tympanic membrane and malleus (internal explantation). The hearing of the two groups was compared at 3 months after operation. Results: A group of tympanic membrane repair 40 cases (89.0%), the average linguistic improvement of auditory threshold ≥ 10dB 23 ears, the success rate of 57.5%. In group B, 28 ears (87.5%) were healed one time, and the average auditory threshold in speech area was 23 ears (≥10 dB). The success rate of operation was 71.9%. In group B, 2 ears (5.9%) were perforation and 8 ears (17.8%) were retracted in group A, 2 ears (6.25%) were perforation in group A, 3 ears (9.38%) were obtuse, 6.25%). Conclusion: Placement of the graft membrane between the remnant tympanic membrane and the malleus stem avoids the detachment of the tympanic membrane and the malleus stem and reduces the adhesion between the graft membrane and the promontory. The improvement of hearing in patients with large perforation of the tympanic membrane was significantly better than that of the graft membrane placed inside the malleus.