Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Chin Med J (Engl). 2010 Feb 5;123(3):301-4.
The main risk factors for postoperative failure in tympanoplasties are large perforations that are difficult to repair, annular perforations, and a tympanic membrane (TM) with extensive granular myringitis that require middle ear exploration and mastoidectomy. The aim of this study was to investigate a novel technique of perichondrium/cartilage composite graft for repairing the large TM perforation in the patient of otitis media.
Retrospective chart reviews were conducted for 102 patients with large tympanic membrane perforations, who had undergone tympanoplasty from August 2005 to August 2008. Tympanoplasty or tympanomastoidectomy using a perichondrium/cartilage composite graft was analyzed. The tragal or conchal perichondrium/cartilage was used to replace the tympanic membrane in patients.
Patients aged from 13 to 67 years were followed up in average for 24 months (10 - 36 months). Seventy-four ears (72.61%) were used the tragal perichondrium/cartilage as graft material and 27 ears (27.39%) were used the conchal perichondrium/cartilage. Graft take was successful in all patients. Postoperative complications such as wound infection, hematoma, or sensorineural hearing loss were not identified. Nine patients (8.82%) had the partial ossicular replacement prosthesis, 14 patients (13.72%) using the autologous curved incus and 79 patients (77.45%) without prosthesis. Successful closure occurred in 92% of the ears. A total of 85.8% patients achieved a postoperative hearing improvement.
The graft underlay tympanoplasty using perichondrium/cartilage composite is effective for the majority of patients with large perforation. The hearing was improved even if the mastoidectomy was required in the patients with otitis media with extensive granulation.
鼓室成形术中术后失败的主要危险因素是难以修复的大穿孔、环状穿孔以及广泛颗粒状中耳炎导致的鼓膜，需要中耳探查和乳突切除术。本研究旨在探讨一种用于中耳炎患者修复大鼓膜穿孔的新型软骨膜/软骨复合移植物技术。
对 2005 年 8 月至 2008 年 8 月期间因大鼓膜穿孔接受鼓室成形术或鼓室乳突切除术的 102 例患者进行回顾性病历分析。分析使用软骨膜/软骨复合移植物的鼓室成形术或鼓室乳突切除术。将耳屏或耳甲软骨膜/软骨用于替代鼓膜。
102 例患者的平均随访时间为 24 个月（10-36 个月），年龄 13-67 岁。74 耳（72.61%）使用耳屏软骨膜/软骨作为移植物材料，27 耳（27.39%）使用耳甲软骨膜/软骨。所有患者的移植物均成功存活。术后无伤口感染、血肿或感音神经性听力损失等并发症。9 例（8.82%）患者使用部分听骨置换假体，14 例（13.72%）患者使用自体弯曲砧骨，79 例（77.45%）患者未使用假体。92%的鼓膜穿孔完全愈合。85.8%的患者术后听力改善。
软骨膜/软骨复合移植物覆盖式鼓室成形术对大多数大穿孔患者有效。对于广泛肉芽形成的中耳炎患者，即使需要乳突切除术，听力也会得到改善。
