张强

[摘要] 目的 探讨耳内镜下生物羊膜行鼓膜修补术治疗外伤性鼓膜穿孔的临床疗效。 方法 选取我院2010年1月～2014年1月收治入院的100例鼓膜外伤性穿孔患者，根据穿治疗方法不同将患者分为两组，观察组50例采用耳内镜下生物羊膜行鼓膜修补术治疗，对照组50例采用保守治疗，观察两组临床疗效，并进行统计学分析。 结果 观察组共治愈42例（90%），其中小穿孔和中穿孔所有患者均全部治愈，总有效率为100.0%；对照组治愈28例（56.0%），其中小穿孔14例，中穿孔8例，好转16例（32.0%），无效6例（12.0%）。观察组治愈率明显高于对照组，差异有统计学意义（P<0.05）。观察组治愈的42例，愈合时间8～30d，平均（11.5±7.0）d；对照组治愈28例，愈合时间13～60d，平均（30.0±9.3）d。观察组鼓膜穿孔愈合时间明显短于对照组，差异有统计学意义（P<0.05）。两组穿孔直径较大者，愈合时间均较长，但观察组3例治愈，4例好转，对取得的治疗效果自我满意，对照组3例无效，3个月后行颞肌筋膜修补鼓膜。 结论 耳内镜下生物羊膜行鼓膜修补术治疗外伤性鼓膜穿孔安全、有效。

[关键词] 生物羊膜；外伤性鼓膜穿孔；耳内窥镜；生物胶

[中图分类号] R764.9 [文献标识码] B [文章编号] 2095-0616（2015）14-198-03

Clinical study on endoscopic myringoplasty with biological amniotic membrane for treatment of traumatic perforation of tympanic membrane

ZHANG Qiang

Department of Ear and Throat Neck Surgery， the Fifth People's Hospital of Dongguan City， Guangdong Province， Dongguan 523900， China

[Abstract] Objective To investigate the clinical curative effect of endoscopic myringoplasty with biological amniotic membrane for treatment of traumatic perforation of tympanic membrane. Methods 100 cases of patients with traumatic tympanic membrane perforation admitted in our hospital from January 2010 to January 2014 were selected， the patients were divided into 2 groups according to the different wear method of treatment， the observation group of 50 cases received endoscopic myringoplasty with biological amniotic membrane for treatment， the control group of 50 cases received conservative treatment， clinical curative effects of two groups were observed， and carries on statistics analysis. Results In the observation group， 42 cases were cured （90%）， in which small perforation and perforation in all patients were healed， the total effective rate was 100.0%； 28 cases in the control group were cured （56.0%）， in which small perforation in 14 cases， perforation in 8 cases， improved in 16 cases （32.0%）， invalid 6 cases （12.0%）. In the observation group， the cure rate was significantly higher than that in the control group， the difference was statistically significant （P<0.05）. 42 cases were cured in the observation group， healing time was 8-30d， the average was （11.5±7.0） d； the control group 28 cases were cured， the average healing time of 13-60d， （30.0±9.3） d average. The observation group tympanic membrane perforation healing time was shorter than that in the control group， the difference was statistically significant （P<0.05）. Two groups of perforation diameter was larger， the healing time was longer， but the observation group of 3 cases were cured， 4 cases improved， self satisfied to obtain the effect of the treatment， 3 cases in the control group invalid， 3 month after the temporal muscle fascia of tympanic membrane. Conclusion Endoscopic myringoplasty with biological amniotic membrane for treatment of traumatic tympanic membrane perforation safe， effective.endprint

[Key words] Biological amnion； Traumatic perforation of tympanic membrane； Ear endoscopy； Biological glue

鼓膜穿孔后造成患者耳鸣、听力下降，尤其是

穿孔后造成鼓膜对中耳的保护屏障作用削弱、消失，易发生继发中耳感染，造成许多并发症，所以早期发现，早期治疗[1]。本科自2010年1月～2014年1月门诊共诊治50例鼓膜穿孔患者，经用耳内镜下生物羊膜行鼓膜修补术治疗治疗效果良好，现报道如下。

1 资料与方法

1.1 一般资料

本研究资料来自于我院2010年1月～2014年1月收治入院的100例鼓膜外伤性穿孔患者，所有患者均为外伤性鼓膜穿孔，穿孔鼓膜无感染。其中，女82例（82%），男18例（18%），年龄13～49岁，平均（25.5±7.2）岁，病程l～28d，平均（5.2±4.3） d。左耳59例（59%），右耳33例（33%），手掌击伤41例（41%），拳击伤18例（18%），车祸13例（13%），撞伤9例（9.0%），爆震伤8例（8.0%），挖耳损伤6例（6.0%），中耳炎手术失败2例（2.0%），游泳2例（2.0%），鼓膜紧张部穿孔57例（57%）。穿孔有不规则穿孔、椭圆形、类圆形、棱形及纵形等，就诊时间为外伤后3h ～ 1个月，纯音测听，52%为传导性耳聋。……