Li H, Yang X, Lu L, Chen J, Dai Y H
Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline(Laboratory);Research Institute of Otolaryngology, Drum Tower Hospital,Nanjing, 210008, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Nov;32(22):1703-1706. doi: 10.13201/j.issn.1001-1781.2018.22.005.
To analyze the failure reasons of the typeⅠtympanoplasty and to summarize the successful experiences of the reoperation. A retrospective clinical study of 42 patients undergoing second type Ⅰtympanoplasty in the ENT department of Nanjing Drum Tower Hospital from 2007 to 2017 was performed. By reviewing the perioperative clinical data and by following up the patients for 3 months to summarize the failure reasons of the first tympanoplasty and successful experiences of the second tympanoplasty. All of the 42 patients received second tympanoplasty under general anesthesia using the post auricular approach, harvesting the temporalis fascia as the graft material, enlarging the external canal to optimize of the operation vision and using underlay tympanoplasty technique. During the operation calcification was found in 12 cases, tympanosclerosis in 6 cases, handle of malleus attached to promontorium tympani in 7 cases, and remnant tympanic membrane adhered to promontorium tympani in 10 cases. Three months after the second tympanoplasty all of the perforations were closed. The air-bone gap(ABG) between 0.5-4.0 kHz before and after the second tympanoplasty were(26.4±8.7) dB HL and(14.0±7.3) dB HL, respectively. The difference is statistically significant(=0.000). ABG less than 20 dB HL was found in 35 cases (83.3%) after the second tympanoplasty. Type Ⅰtympanoplasty is a delicate operation. Poor surgical outcomes of the first operation were due to inadequate exposure, mucosal lesion of the promontory, and inadequate gelatin sponge filling in the middle cavity. Post auricular approach, enlarged and straight external canal could optimize the operation vision, resolve the adhesion of the tympanum easily and acquire the adequate anterior overlap, which are benefit for success closure of the perforation and better hearing after surgery.
分析Ⅰ型鼓室成形术失败原因，总结再次手术的成功经验。对2007年至2017年在南京鼓楼医院耳鼻咽喉科接受二次Ⅰ型鼓室成形术的42例患者进行回顾性临床研究。通过回顾围手术期临床资料并对患者随访3个月，总结首次鼓室成形术的失败原因及二次鼓室成形术的成功经验。42例患者均在全身麻醉下采用耳后入路行二次鼓室成形术，取颞肌筋膜作为移植材料，扩大外耳道以优化手术视野，采用内植法鼓室成形术技术。术中发现钙化12例，鼓室硬化6例，锤骨柄粘连于鼓岬7例，残余鼓膜粘连于鼓岬10例。二次鼓室成形术后3个月所有穿孔均愈合。二次鼓室成形术前、后0.5 - 4.0 kHz气骨导差（ABG）分别为（26.4±8.7）dB HL和（14.0±7.3）dB HL，差异有统计学意义（=0.000）。二次鼓室成形术后ABG小于20 dB HL者35例（83.3%）。Ⅰ型鼓室成形术是一种精细手术。首次手术效果不佳的原因是暴露不充分、鼓岬黏膜病变以及中耳腔明胶海绵填充不足。耳后入路、扩大并伸直外耳道可优化手术视野，轻松解决鼓膜粘连问题并获得足够的前重叠，有利于穿孔成功封闭及术后听力改善。
