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鼓室成形术手术时机选择的临床体会

Clinical experience of timing selection for tympanoplasty
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摘要 目的回顾性分析慢性化脓性中耳炎干湿耳患者行鼓室成形术后的鼓膜穿孔愈合和听力改善情况。方法根据患者鼓室黏膜情况,将40例慢性化脓性中耳炎患者分为干耳组和湿耳组,比较两组患者的一般情况,包括性别、年龄、病程、切口方式及移植材料,比较观察两组患者的鼓膜穿孔愈合和听力改善情况。结果干耳组和湿耳组在性别、年龄、病程、鼓膜穿孔大小、切口方式及移植材料的选择上差异均无统计学意义(P值均>0.05)。干耳组和湿耳组鼓室成形术后的鼓膜初期愈合良好,愈合率均为100%。中长期随访中发现干耳组术后3个月、6个月各1例患者发生鼓膜愈合后再穿孔。湿耳组术后3个月1例患者鼓膜愈合后再穿孔。余患者鼓膜形态及位置恢复良好,无明显内陷、外移情况。两组患者术后鼓膜愈合情况经Kruskal-Wallis秩和检验分析,P值为0.905,大于0.05,差异无统计学意义。干耳组术后气导听力改善值为(10.66±5.47)dB HL,湿耳组术后气导听力改善值为(10.03±4.09)dB HL,两组听力改善值经Mann-Whitney U秩和检验分析,P值为0.637,大于0.05,差异无统计学意义。结论湿耳组可获得与干耳组近似的手术效果及术后听力改善。对湿耳组患者进行术前两周左右外耳道、中耳条件的控制对手术成功至关重要。对鼓室成形术后患者进行个体化随访,可降低鼓膜再穿孔的机率。 Objective The healing of tympanic membrane perforation and hearing improvement in dry and wet ear patients with chronic suppurative otitis media after tympanoplasty were retrospectively analyzed.Methods According to the tympanic mucosa of patients,40 patients with chronic suppurative otitis media were divided into dry ear group and wet ear group.The general conditions of patients in the two groups were compared,including gender,age,course of disease,incision method and transplantation materials,and the healing of tympanic membrane perforation and hearing improvement of patients in the two groups were compared.Results There were no significant differences between dry ear group and wet ear group in gender,age,course of disease,perforation size of eardrum,incision style and selection of transplantation materials(all P>0.05).The initial healing of the tympanic membrane after tympanoplasty was good in both dry ear group and wet ear group,and the healing rate was 100%.In the medium and long-term follow-up,it was found that 1 patient in the dry ear group had tympanic membrane healing and perforation at 3 months and 6 months respectively.Three months after operation,1 patient’s tympanic membrane in the wet ear group perforated again after healing.The shape and position of the tympanic membrane in other patients recovered well,without obvious invagination or displacement.Kruskal-Wallis rank sum test was used to analyze the healing of postoperative tympanic membrane between the two groups,and the P value was 0.905,greater than 0.05,with no statistical significance.The postoperative air-conduction hearing improvement value of the dry ear group was(10.66±5.47)dB HL,and that of the wet ear group was(10.03±4.09)dB HL.Analysis of the postoperative air-conduction hearing improvement value of the two groups by Mann-Whitney U rank sum test showed that the P value was 0.637,greater than 0.05,and the difference was not statistically significant.Conclusions The wet ear group was similar to the dry ear group in surgical effect and postoperative hearing improvement.The control of the external auditory canal and middle ear conditions for the wet ear group about two weeks before surgery is very important for the success of the operation.Individualized follow-up of patients after tympanoplasty can reduce the probability of tympanic membrane reperforation.
作者 朱晓燕 郭清华 王姣 杨明 邢光前 ZHU Xiaoyan;GUO Qinghua;WANG Jiao;YANG Ming;XING Guangqian(Department of Otorhinolaryngology,Nanjing Integrated Traditional Chinese and Western Medicine Hospital,Nanjing University of Chinese Medicine,Nanjing,Jiangsu,210014,China)
出处 《中国中西医结合耳鼻咽喉科杂志》 2023年第4期245-248,共4页 Chinese Journal of Otorhinolaryngology in Integrative Medicine
关键词 慢性化脓性中耳炎 鼓室成形术 鼓膜穿孔 Chronic suppurative otitis media tympanoplasty tympanic membrane perforation
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