耳显微镜下明胶海绵吸附自体血贴补修复外伤性鼓膜穿孔162例体会(1)
【摘要】 目的：探究耳显微镜下明胶海绵吸附自体血贴补修复外伤性鼓膜穿孔的效果。方法：选择2012年1月-2017年12月笔者所在医院收治的162例外伤性鼓膜穿孔患者为研究对象，所有患者均给予明胶海绵吸附自体血贴补修复治疗，观察患者鼓膜穿孔修复的手术效果及语言频率(0.5、1、2 kHz)平均气骨导差值是否提高。结果：162例患者中治愈48例，好转90例，无效24例，总好转率为85.2%。患者治疗后的平均气骨导差值显著高于治疗前，差异有统计学意义(P<0.05)。其中3例患者出现排斥反应，半年后采用取乳突部骨膜行鼓膜修补术后治愈。2例穿孔鼓膜术后部分愈合，患者不愿再手术，半年后失访。其余穿孔者全部愈合。结论：耳显微镜下明胶海绵吸附自体血贴补修复外伤性鼓膜穿孔效果显著，排斥反应少，值得临床推荐。
【关键词】 耳显微镜； 明胶海绵吸附； 自体血； 外伤性鼓膜穿孔；
doi：10.14033/j.cnki.cfmr.2018.25.060 文献标识码 B 文章编号 1674-6805(2018)25-0-03
【Abstract】 Objective：To explore the effect of gelatinized sponge on repairing traumatic tympanic membrane perforation by absorbing autogenous blood patch under ear microscope.Method：From January 2012 to December 2017，162 patients of traumatic tympanic membrane perforation in our hospital were selected as the research object，all the patients were given gelatin sponge adsorption of autologous blood repairing treatment，tympanic membrane perforation repair surgery effect and language frequency (0.5，1 and 2 kHz) average bones difference whether to raise was observed.Result：Among 162 patients，48 were cured，90 were improved，24 were invalid，and the total conversion rate was 85.2%.The mean pneumo-bone conduction difference of patients after treatment was significantly higher than that before treatment，the difference was statistically significant(P<0.05).3 cases had a rejection reaction，and half a year later，they were cured by taking the periosteum of the mastoid process and repairing the tympanic membrane.2 cases of perforated tympanic membrane partially healed after surgery，the patient was unwilling to operate again and lost the visit half a year later.All other perforations healed.Conclusion：Under the auricular microscope，gelfoam can effectively repair traumatic tympanic membrane perforation with less rejection，which is worthy of clinical recommendation.
【Key words】 Ear microscope； Gelatinous sponge adsorption； Autologous blood； Traumatic tympanic membrane perforation
First-author’s address：PLA 478 Hospital，Kunming 650200，China
耳外伤导致的鼓膜穿孔常伴有不同程度的听力下降、耳鸣、耳闷等不适感，给患者造成了不同程度的生理和精神损害[1-2]。鼓膜穿孔自行愈合的时间一般在半年以内，其中穿孔过大和穿孔边缘有卷曲者通常难以自愈，且长时间的愈合中，患者一旦出现感冒、耳部污染、进水等都会引发感染，对穿孔的恢复极为不利，所以外伤后及时处理显得尤为重要[3]。笔者所在医院自2012年起，采取患者自体血滴入明胶海绵作材料行鼓膜贴补修复穿孔的方式，取得良好的疗效，现将结果报道如下。
1 资料与方法
1.1 一般资料
选择2012年1月-2017年12月笔者所在医院收治的162例外伤性鼓膜穿孔患者为研究对象，其中女109例(109耳)，男53例(54耳)；年龄14～65岁，平均(35.7±8.6)岁；病程2 d～5个月，平均(33.5±17.6)d。纳入因挖耳器、火柴棍、毛線针等直接刺穿损伤和手掌、外物击伤、电光炮炸伤等损伤患者；排除严重心肝肾功能不全患者、孕期患者、哺乳期患者。所有患者经筛查穿孔周边均有足够的残缘做血管床以便于搭桥。听力检查显示所有患者均有不同程度的传导性耳聋，部分患者伴有轻重不一的耳鸣及神经性耳聋，部分患者穿孔缘鼓膜部分卷曲，患者外耳道，鼓室内均洁净无感染，术前气导损失：语频(0.5、1、2 kHz)10～40 dBHL，平均15 dBHL；骨导损失均<10 dBHL。, http://www.100md.com(尚玉堂 赵浩然)
【关键词】 耳显微镜； 明胶海绵吸附； 自体血； 外伤性鼓膜穿孔；
doi：10.14033/j.cnki.cfmr.2018.25.060 文献标识码 B 文章编号 1674-6805(2018)25-0-03
【Abstract】 Objective：To explore the effect of gelatinized sponge on repairing traumatic tympanic membrane perforation by absorbing autogenous blood patch under ear microscope.Method：From January 2012 to December 2017，162 patients of traumatic tympanic membrane perforation in our hospital were selected as the research object，all the patients were given gelatin sponge adsorption of autologous blood repairing treatment，tympanic membrane perforation repair surgery effect and language frequency (0.5，1 and 2 kHz) average bones difference whether to raise was observed.Result：Among 162 patients，48 were cured，90 were improved，24 were invalid，and the total conversion rate was 85.2%.The mean pneumo-bone conduction difference of patients after treatment was significantly higher than that before treatment，the difference was statistically significant(P<0.05).3 cases had a rejection reaction，and half a year later，they were cured by taking the periosteum of the mastoid process and repairing the tympanic membrane.2 cases of perforated tympanic membrane partially healed after surgery，the patient was unwilling to operate again and lost the visit half a year later.All other perforations healed.Conclusion：Under the auricular microscope，gelfoam can effectively repair traumatic tympanic membrane perforation with less rejection，which is worthy of clinical recommendation.
【Key words】 Ear microscope； Gelatinous sponge adsorption； Autologous blood； Traumatic tympanic membrane perforation
First-author’s address：PLA 478 Hospital，Kunming 650200，China
耳外伤导致的鼓膜穿孔常伴有不同程度的听力下降、耳鸣、耳闷等不适感，给患者造成了不同程度的生理和精神损害[1-2]。鼓膜穿孔自行愈合的时间一般在半年以内，其中穿孔过大和穿孔边缘有卷曲者通常难以自愈，且长时间的愈合中，患者一旦出现感冒、耳部污染、进水等都会引发感染，对穿孔的恢复极为不利，所以外伤后及时处理显得尤为重要[3]。笔者所在医院自2012年起，采取患者自体血滴入明胶海绵作材料行鼓膜贴补修复穿孔的方式，取得良好的疗效，现将结果报道如下。
1 资料与方法
1.1 一般资料
选择2012年1月-2017年12月笔者所在医院收治的162例外伤性鼓膜穿孔患者为研究对象，其中女109例(109耳)，男53例(54耳)；年龄14～65岁，平均(35.7±8.6)岁；病程2 d～5个月，平均(33.5±17.6)d。纳入因挖耳器、火柴棍、毛線针等直接刺穿损伤和手掌、外物击伤、电光炮炸伤等损伤患者；排除严重心肝肾功能不全患者、孕期患者、哺乳期患者。所有患者经筛查穿孔周边均有足够的残缘做血管床以便于搭桥。听力检查显示所有患者均有不同程度的传导性耳聋，部分患者伴有轻重不一的耳鸣及神经性耳聋，部分患者穿孔缘鼓膜部分卷曲，患者外耳道，鼓室内均洁净无感染，术前气导损失：语频(0.5、1、2 kHz)10～40 dBHL，平均15 dBHL；骨导损失均<10 dBHL。, http://www.100md.com(尚玉堂 赵浩然)