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目的 介绍在耳内切口下不附加其它切口取乳突骨膜或软骨的方法;并将骨膜、软骨膜、软骨-软骨膜复合片、颞肌筋膜修复鼓膜的手术情况和效果进行对比。方法通过耳内切口不附加切口取乳突骨膜、软骨,或通过耳后附加切口取颞肌筋膜,利用这些自体材料用于鼓室成形术。并将两种方法的相关因素进行对比。对比项目包括:手术耗时、各种材料的成功率、近期听力学效果、局麻手术率、患者对两种切口的满意率。结果不附加切口的手术方式所取用的自体组织材料可以达到和颞肌筋膜同样的听力效果、手术成功率(P=0.777和0.977);但由于不附加耳后切口,手术时间显著缩短(54.9±11.6对80.42±11.8 min,P=0.000),局麻手术率高(P=0.000),患者对手术切口的满意度高(P=0.000)。结论耳内切口可以方便地直接取乳突骨膜或是软骨用于鼓室成形术。这样可以快速、高效地完成手术,并达到更好的美容效果,节约医疗成本。
Objective To introduce the method of inserting mastoid periosteum or cartilage without any other incision under the incision in the ear and compare the operation and effect of periosteum, perichondrium, cartilage-cartilage composite film and temporal fascia repair tympanic membrane. Methods The mandibular periosteum, cartilage were removed without additional incision through the otolaryngology, or the temporal fascia was obtained by additional incision in the ear. These autologous materials were used for tympanoplasty. The correlation between the two methods was compared. Contrast items include: time-consuming surgery, the success rate of various materials, recent audiology, local anesthetic surgery rate, the patient satisfaction rate of two incisions. Results The incision-free surgical procedures used the same hearing effect and temporal success rate (P = 0.777 and 0.977) as those of the temporal fascia. However, the operation time was significantly shortened without the incision of the ear 54.9 ± 11.6 vs 80.42 ± 11.8 min, P = 0.000). The rate of local anesthesia was high (P = 0.000). The patients were satisfied with the surgical incision (P = 0.000). Conclusions The ear canal incision can be easily used directly to the mastoid periosteum or cartilage for tympanoplasty. This can be done quickly and efficiently, and achieve better cosmetic results, saving medical costs.